Infertility Testing - Male Factor

Investigations

Correct diagnosis is a crucial step in determining appropriate therapy, and a variety of procedures can be used, ranging from simple blood tests to more complicated analytical methods. Furthermore, as infertility often has several causes, many factors must be considered. Once the diagnosis is established, treatment can be tailored specifically to the individual needs of the couple.

There is a very long list of investigations for diagnosis of infertility, however there is no consensus on which test is essential before reaching the exact diagnosis. Use of investigative test depends on sensitivity, specificity, positive and negative predictive value, invasiveness and possibility of harmfulness and cost.

Male Factor

Conventional semen analysis: Remains a mainstay in investigating male fertility potential. Serial semen samples (at least two) done at the same Laboratory give a correct idea about the fertilizing ability of the sperms.

WHO criteria (1999) Lower limit of normal semen testing, semen produced by masturbation at temperature of 15 to 38 degrees centigrade are:

  • Count: > 20 million/ ml
  • Motility: > 50 % progressive motility
  • Morphology: > 30 % normal forms
    25 % of proven fertile men have sperm count below 20 million / ml

CASA: Motility by CASA of limited value and is not superior to conventional semen analysis (Krause 1995)

Sperm survival – The semen sample is washed & motile fraction isolated & seen for survival 24 hours & 48 hours later. Poor survival may indicate decreased fertilizing ability of sperms.

Sperm Function Test: Should not be a routine investigation as they are complex, expensive and do not always provide clinically useful information (Oehninger et al 2000)

  1. In-Vitro mucus penetration test

  2. Hamster egg penetration test

  3. Post coital test: Tells us if the sperms survive in the female genital tract after an vaginal intercourse. It may be abnormal due to severe oligoasthenospermia, or presence of cervical factor or antisperm antibodies in female or male partener





  4. Antisperm antibody assessment in semen and serum – gives idea about immunological factor

  5. HOS – gives idea about the membrane integrity of the sperm. Normally more than 60% of the sperms should show a positive test.



  6. Varicocele assessment: Either by clinical exam. Or by ultrasound with Doppler studies.

  7. Hormonal Assay – FSH, LH, Testosterone, estradiol, prolactin, T3, T4, TSH

  8. Karyotyping: To rule out chromosomal or genetic abnormalities

  9. DNA Framentation &

  10. Y Deletions

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Dr. Patil’s Fertility and Endoscopy Clinic

Center for Assisted Reproductive Technology, Endoscopic Surgery and Andrology

No 1, Uma Admirality, First Floor, Bannerghatta Road, Bangalore - 560029
Ph: 080 - 41201357, 41462419 Mobile: 9945221622
E-Mail: drpatilsclinic@gmail.com

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