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Male factor infertility plays a role in about approximately half of all cases of infertility. To understand what might be causing a couple's infertility, the male partner should undergo a male fertility work-up with a semen analysis. Because a man's sperm count and semen consistency can vary from day to day — and some conditions can also have a temporary effect — a semen analysis to determine fertility should be performed on at least two samples, at least seven days apart over a period of two to three months.
For a semen analysis, the typical volume of semen collected is around one-half to one teaspoonful (2 to 6 milliliters) of fluid. Collecting less semen might indicate there are fewer total sperm, which could affect fertility. Collecting more semen could indicate there is too much fluid, which may dilute the concentration of sperm. Semen should be thick and then liquefy within 10 to 30 minutes.
A semen analysis typically measures three things:
- sperm count
- sperm morphology
- sperm motility
Sperm count is measured in millions of sperm per milliliter (mL) of semen. For optimal fertility, men should have a healthy sperm count, which is considered 15 million or more sperm per milliliter. (In the past, a healthy sperm count was considered 20 million sperm per milliliter.) Having fewer sperm and/or a lower sperm concentration could impair fertility.
A morphology analysis is performed to study the size, shape and appearance of sperm. Healthy sperm have oval heads and long tails, which allow them to be propelled forward effectively. The more abnormal sperm that are present, the less likely a man is fertile. Abnormal sperm may have defective heads or tails that are misshapen, crooked, tapered or kinked. Fertile men should have a normal shape and structure to at least 14 percent to 15 percent of their sperm.
Motility checks whether the sperm are moving well or not. The ability of sperm to propel itself and move forward is important in order to successfully fertilize an egg. Motility can be graded from A to D (fast progressive, slow progressive, nonprogressive and immotile). Sperms of grade C and D are considered poor. A fertile man should have at least 40 percent to 50 percent of his sperm exhibiting health motility.
Assisted Reproductive Technology May Help with Male Factor Infertility
Men who have a lower sperm count, poor morphology or poor motility may need the assistance of a fertility doctor to increase their odds of successfully achieving a pregnancy. Methods to increase the odds of conceiving include first-line treatments such as intrauterine insemination (IUI) and more advanced technologies such as in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI).