Male Factor (Sperm Disorders)
Only male-related sperm disorders are found in 25% of the couples who applied to the doctor with the complaint of inability to have a child, while 30-35% of the couples have both female and male disorders. Semen analysis (Spermiogram) is one of the first tests to be performed in these couples. The structure (morphology) of sperm cells is as important as sperm count and motility. Since the sperm analysis of the same man at various times can yield different results (these values may sometimes be below the normal limits), 2-3 spermiogram results may be required at intervals of a few weeks to obtain a healthy result.
The normal values determined by the World Health Organization (WHO) for the spermiogram are as follows:
In spermiogram analysis performed at least twice:
Volume: 2 – 4 ml
Ph : > 7.2
Sperm count (concentration): > 15 million /ml
Movement (motility): ≥ 40%
Progressive motility: > 30%
Morphology (normal structure) Kruger: ≥ 4%
Viability: > 75%
Leucocytes: < 1,000,000/ml
Advanced Tests and Consultations in Male Infertility:
A urology specialist should consult to investigate the causes of male infertility. If there are disorders such as varicocele, undescended testis, etc. in men, they may need to be investigated and corrected.
Some blood tests are performed to investigate the cause of male infertility.
Follicular stimulating hormone ( FSH )
Luteinizing hormone ( LH )
Testosterone ( T )
Prolactin (PRL)
The following examinations are also performed for men whose genetic factors are considered in the further examination stages.
Karyotype
Y Chromosome Microdeletion Detection
DNA fragmentation (TUNEL) tests
Treatment of Male Factor Infertility:
In cases of infertility due to male factor, drug treatment is only available for cases having hormonal disorders. There are currently no drugs defined for disorders other than this limited group. Thus, drugs used for various sperm disorders (especially morphology) have no effect and cause time and economic loss.
In mild sperm abnormalities, the woman can be vaccinated with ovulation induction.
Vaccination treatment should be tried at most 4 to 5 times. In order to achieve success in vaccination, at least 2 to 3 million motile spermatozoa must be detected in the sperm analysis. Below these values, in vitro fertilization (IVF/ICSI/IMSI) is applied to the patient.
If the patient has been diagnosed with "Azospermia", in other words, if there is no spermatozoa in his semen, the method of obtaining spermatozoa by biopsy or aspiration from the epididymis or testicles is applied. Azoospermia may occur due to the inability of sperm production or obstruction in the testicles resulting in the sperm not mixing with the semen. While sperm can be found in approximately 80% of patients who underwent TESE or TESA because of obstruction, this rate drops to 40% in case of disorders with sperm production in the testicles.
