Tampa Male Fertility Clinic: Treating Male Infertility
Fertility and Sperm Production
Fertility depends on the ability to produce and deposit enough healthy sperm into the female reproductive tract at ovulation. Sperm production begins with hormones. The pituitary gland in the brain releases follicle stimulating hormone (FSH), which stimulates sperm production in the testicles, and and lutenizing hormone (LH), which stimulates testosterone production.
Testosterone is the male hormone that is necessary for sperm production and development, male physical characteristics, and sex drive.
Male reproductive system
The hormones begin sperm production in the testicles. The sperm travel from the testicles to the epididymis, a fifteen foot long coiled tube attached to the back of each testis, where they mature. From there, the sperm travel through a tube called the vas deferens (vas) that leads from the epididymis to the seminal vesicles located behind the bladder.
These form an ejaculatory duct. These two ducts then go into the prostate gland. The seminal vesicles and the prostate gland produce the fluid that composes semen that contains the sperm, which is then carried through the urethra and out through the penis.
Infertility is defined as the inability to achieve pregnancy after at least a year of trying. As many as 15% of all couples trying to have a baby will be unsuccessful in a year. In 40% of the cases, infertility is due to a female factor, in 20% of cases there is a combination of female and male factors, and in 40% of cases, infertility is caused by male factors.
When you are evaluated for infertility, your doctor will take a medical history. In addition to a general medical history and questions about sexual contact and sexual history, your doctor will ask about some of the following:
- Whether you had mumps after puberty
- Testicle trauma or undescended testicles at birth
- Previous infection of the reproductive system or sexually transmitted disease
- Previous cancer, and what treatment was given
- If your mother took DES while pregnant
- Exposure to toxins, including tobacco, alcohol, or drug use
- Thyroid disease
You will also be given a physical exam to determine your general health. Your testicles, scrotum, and prostate may be examined for abnormalities. A testicle that is undescended may be the reason for your fertility problems. An enlarged vein (varicocele) on your scrotum can reduce sperm quantity and quality. Your prostate will be examined to see that it a normal size and shape and that there are no signs of infection.
Your doctor may ask for a semen sample to evaluate the quantity and quality of your sperm. A semen sample is usually obtained by masturbation. If you do not produce a specimen at the doctor’s office, you may prefer to bring it to the doctor’s office within an hour of collection. You will be supplied a special clean container, and you must keep the sample close to body temperature. You should avoid sexual intercourse for two or three days before collecting your sample to insure that the sample is accurate. The amount of sperm in the semen may be lowered if ejaculation has occurred less than a day or so before the sample is taken, and sperm may be less mobile if ejaculation has not occurred in seven or more days. Several samples may be requested over time to insure an accurate evaluation.
This semen analysis will determine the mobility of your sperm (sperm must move to swim through the woman’s reproductive system and fertilize her egg), your sperm count (at least 20 million sperm per milliliter), and sperm morphology (shape). Although all men have some abnormally shaped sperm, if you have a large percentage of abnormally shaped sperm, there number of normal sperm with fertilizing potential is decreased.
Your sperm may also be tested for viscosity (thickness). Semen is ejaculated as a liquid, becomes thick, and should become liquid again after 30 to 40 minutes. If the semen does not re-liquefy, the sperm may have trouble getting through the woman’s cervix into her reproductive tract where fertilization occurs. Semen volume will also be examined to insure enough is being produced. With amounts too low, the sperm may not reach the cervix. The volume of ejaculate usually varies between 1 and 5 milliliters (less than a teaspoon).
Your doctor may choose to perform additional tests. These tests may include some of the following:
Fructose test Fructose is a sugar that is normally found in the seminal vesicles (the pouches behind the bladder through which sperm travel). If there is no fructose in the semen, the vas may be obstructed, or the seminal vesicles may be absent.
Postcoital Test (PCT) The PCT is given around the time a woman ovulates to determine if sperm are able to live and move in the woman’s cervical mucous. This test is given 2 to 12 hours after intercourse and can help determine if there are problems with sperm quality or the cervical mucous, or suggest antisperm antibodies (see below).
Anitsperm Antibody test Sometimes a man’s or a woman’s immune system will try to destroy sperm, thinking that they are a foreign substance. Antibodies are produced that cause the sperm to clump or become immobile. This test to see if these antibodies are present may be done on the semen or cervical mucous, or by blood test on the man or woman.
White blood cells in semen If white blood cells, which resemble immature sperm cells under the microscope, are present, a possible infection of the urinary tract is indicated. Cultures may be taken for bacteria or sexually transmitted diseases if white blood cells are found in the semen.
Computer-Assisted Semen Analysis Computers can give detailed information about sperm mobility and morphology (shape).
Sperm Enhancement Studies These tests attempt to enhance sperm function by using chemicals or substances in the hopes that the enhanced sperm will perform better than untreated sperm.
Sperm Penetration Assay Also known as the hamster test, this is when a hamster’s eggs have their zona pellucida (outer covering) removed. The eggs are then exposed to the man’s sperm, which are able to penetrate the eggs although no embryos can develop. Fewer than 10-20% of the eggs penetrated suggests that the sperm are unable to penetrate a woman’s egg.
Acrosome Reaction Tests The acrosome is the part of the sperm that is able to penetrate the woman’s egg to fertilize it. This test determines if the sperm can acrosome react properly.
Zona Binding or Hemizona Assay The zona pellucida is the shell of the woman’s egg that must be penetrated by the sperm for fertilization to occur. Before the sperm penetrates the egg, it must first bind to the zona. This test helps determine if the sperm are capable of binding to and penetrating the egg.
Hypo-osmotic Swelling Test Each sperm is a cell that is surrounded by a membrane. In this test, the sperm are placed in a solution and checked for swelling of the sperm tail. Abnormalities may suggest sperm problems that reduce fertility.