A topic that is rarely spoken about, male infertility accounts for up to 50% of all infertilities, and impacts approximately 7% of men. But what is male infertility, and how deep does it go into explaining possible fertility problems?
What is male infertility?
Almost a third of fertility problems are related to male factor. A man’s fertility will rely on the quantity and quality of his sperm and it is estimated that approximately one in 20 men in Australia will have a decreased sperm concentration. Male fertility can be affected by problems with sperm production or physical issues. Studies have revealed that approximately two thirds of men with fertility problems will have a sperm production issue which could range from low sperm production to no sperm being produced at all, to poor motility, functionally impaired antibody production or morphologically abnormal sperm being produced.
Due to the fact that that the examination of the male is relatively non-invasive, this is often the first test performed when investigating the cause of infertility.
At Fertility First, our highly experienced andrology scientists will assess male fertility through a semen analysis and sperm antibody testing to measure the key parameters of semen known to impact fertility. All tests in our NATA accredited laboratory follow the guidelines and assessments set out by the World Health Organisation (WHO).
What is DNA fragmentation?
Genetic integrity of sperm is essential for normal fertilisation and embryo development. High levels of DNA fragmentation in sperm have been linked to early pregnancy loss, miscarriage, poor embryo development and IVF outcomes, and abnormalities in the offspring including an increased vulnerability to childhood cancer. The most significant contributing factors to increased sperm DNA fragmentation include:
- Recreational drug use
- Long periods between ejaculation
- Advanced age
- Environmental pollutants (air pollution, exposure to chemicals, certain work environments/occupations such as spray painting)
Upon entering the female reproductive tract, the sperm will undergo a maturation process which will allow them to successfully fertilise the egg. Just like people who reach puberty at different times, so do sperm. If a sperm matures too early, it will not reach the egg and it will die before it has a chance to fertilise the egg.
Sperm that mature too late will not be capable of fertilisation, even if they come into contact with the egg. When the mature sperm reaches the egg, it will bind to the “protective shell” or the eggs’ zona pellucida and through a series of chemical reactions and physical force it will be able to penetrate and fertilise the egg. The protective granuloma cells surrounding the egg produce a protein called Hyaluronan and the mature, functional sperm cells will express receptors for this protein and bind to it during the fertilisation process.
The Hyaluronan Binding Assay (HBA test) will allow the andrology scientist to quantify the percentage of the sperm that can bind to this protein, revealing the percentage of a man’s sperm that is mature. This test can help determine which treatment to apply to a patient. Binding scores that are low are generally recommended for ICSI in conjunction with a viscous medium that allows the embryologist to choose a sperm with normal functionality known as SpermSlow.
What are sperm antibodies?
Antibodies are proteins that will attach to a specific substance or organism which the body recognises as “foreign”. When the body detects a foreign organisms, white blood cells will secrete antibodies into the blood stream which will then attach to the “foreigner”. Some antibodies will destroy the foreigner while others will act as beacons to direct the body’s other defence mechanisms to the scene. Sperm will not normally be recognised as part of the body and can therefore be considered as foreign, thus initiating this immune response.
In a man, the organs that produce and store the sperm (the testes and the epididymis) are protected environments and as a result the sperm are not usually detected or destroyed by the body’s defence mechanisms. However, after an infection, physical damage or an operation such as a vasectomy, the protective layer can become less effective, the body will detect the “foreign” sperm and antibodies will be produced.
Both women and men can generate antisperm antibodies (ASABs) and can cause fertility problems in one or more of the following ways:
- They can cause clumping of sperm in the semen.
- Cause interference with the passage of sperm through the cervical mucus.
- Directly prevent fertilisation from occurring once the sperm meets the egg.
Once a patient has had a clinically positive ASABs test, it is usually recommended that the best option is through ICSI to maximise their chances of fertilisation. Various studies have shown that patients with clinically significant levels of ASABs can still achieve a healthy pregnancy through ICSI to the point that success rates are unaffected by the presence or concentration of the antibodies.
How we can help?
Fertility First is the only fertility clinic in NSW and one of the few units in Australia that offers patients the option of the TUNEL assay which is used to assess the fertility potential of sperm. The TUNEL assay provides invaluable information about the quality of the DNA inside the sperm’s chromosomes and helps to provide clinical diagnosis and the management of male infertility.
We also offer the 8-hydroxydeoxyguanosine (8OHdG) assay which is used to calculate the percentage of sperm that have been damaged by free radicals and oxidative stress. If a man has an abnormally high DNA fragmentation, the result of the 8OHdG test will show us whether the fragmentation is due to oxidative stress from free radicals or due to another mechanism.
After your first semen analysis, we will be able to tell you the simplest, easiest approach to repair or compensate for any damaged sperm.
How do I make an appointment?
It is possible to make an appointment for a semen analysis, TUNEL assay and HBA using the same semen sample if there is a sufficient volume.
Due to the length of time required to perform the assays, appointments can only currently be made for Tuesdays, Thursdays at 6:30am and 7:30am. It is recommended that you ejaculate 2 days prior to the test and appointments must be made at least 2 days in advance due to the preparation required.
Tests cannot be performed if you have abstained for more than 7 days.
Appointments can be made by calling Fertility First on (02) 9586 3311
Please note that the reagents required to perform the assays are very expensive and must be prepared the day prior to your test. A cancellation fee of $590 will be applied if your appointment is cancelled with less than 24 hours notice to the laboratory. A full listing of Fertility First costs can be found at the treatment costs page.