Sperm Disorders

In approximately half of couples who are unable to have children, the cause may be related to the male partner. In line with research conducted by the World Health Organization, sperm count and quality in men are steadily being adversely affected worldwide. Radiation, carcinogens and chemical substances that we are exposed to play a role in this, as do increasing life pressures and stress. Therefore, even though basic and simple tests are performed on the prospective mother, if no cause has been identified, prospective fathers should be evaluated before starting difficult and burdensome investigative tests. The problem should never be assumed to lie with either the man or the woman. Just as a baby belongs to both, failure to achieve pregnancy is a shared problem of the couple. The cause may be related to one or both partners.

Semen Test: The Semen Analysis Test, the most important and fundamental test in determining male infertility causes, should be performed first, as it is an inexpensive, easy and effective test. This test is usually easy. However, in men experiencing erectile problems, it can become difficult under stress. Although in our country this test is often performed by healthcare professionals from different branches who are not specialists in the subject, evaluation of the sperm cell by an embryologist is of great importance.

How is a semen test performed and what are the necessary conditions?

Samples for the test are provided in specially prepared private units with showers at IVF centers, where confidentiality and privacy are carefully protected. Providing a sample in a toilet or any other environment is not appropriate. Sexual abstinence (no intercourse) for 2–7 days before the test is preferred. Abstinence shorter than 2 days or longer than 7 days adversely affects the result. To collect semen by masturbation, the laboratory provides a sterile container. During masturbation, the use of any lubricant, soap, saliva or similar substances may need to be avoided. Providing a semen sample can be very stressful for men. Patients who have difficulty providing a sample should share this with their doctor in advance.

What Is Examined in the Test?

Basically:

• Sperm count
• Structure of sperm cells
• Motility of sperm is evaluated.

An important point to remember: a definitive diagnosis should not be made based on a single semen test. If the result is abnormal, the test should be repeated.

What Affects the Test Result?

In the last 2 months, the prospective father's:

• Infectious diseases he has had
• Hormonal disorders
• Spinal cord injuries
• Varicocele
• Smoking
• Cancer treatments (chemotherapy, radiotherapy)
• Mumps, testicular and hernia surgeries in childhood
• Certain occupations (working in work environments exposed to high temperature, radiation and chemicals)
• Excessive alcohol consumption
• Drug use
• Severe stress, fatigue, sleeplessness
• Some medications used may affect the number and quality of sperm.

For these reasons, if a problem is detected, the test should be repeated after 2–3 months. Of course, during this period the prospective father should regulate his lifestyle.

What Are the Causes of Problems Found in the Semen Test?

• Unknown cause 45–50%
• Varicocele 10–15%
• Infections 5–8%
• Genetic disorders 2–4%
• Sexual problems 2–3%

What Is Done to Determine the Problem Found in the Semen Test?

• Examination
• Hormone tests
• Ultrasonography examination
• Genetic examination
• Cystic fibrosis investigation
• Sperm FISH test
• Testicular biopsy

What Are the Treatment Options?

Treatment is planned according to the degree of the male problem. In severe problems, IVF with micro-injection (ICSI) is necessary. In mild cases, insemination treatment is performed first. If success cannot be achieved with insemination treatment, IVF treatment should be started. If there is no serious problem with sperm structure and motility and the sperm count is above 10 million, insemination is preferred. If the sperm count is below 10 million, or there are structural and motility problems in the sperm, the time and money that would be spent on insemination should instead be spent on IVF treatment, which provides higher pregnancy rates. In mild sperm disorders, positive results can be achieved by correcting lifestyle and through treatments given under physician supervision.