In the diagnosis of male infertility, sperm analysis, or spermogram is of the utmost importance. In the course of the examination, the count, motility and morphology of the sperm is assessed. Hormone tests are also important in assessing male fertility, while the presence of sexually transmitted diseases must be ruled out.
Genetic research into the causes of infertility has developed rapidly in recent times, and it has been proven that gene and chromosome mutations can cause infertility in both women and men.
Main causes of male infertility
Deterioration of the sperm count and quality
The most common causes of male infertility are chronic genital inflammation, testicular varicose veins, hormonal disorders and a stressful lifestyle. The general health of the man is also affected by chronic diseases, the need to take strong drugs and damage occurring to the nervous system. In the case of men, factors such as toxic substances and radiation damage are also important. Of course, male fertility is also affected by his lifestyle: use of alcohol, tobacco and anabolic steroids, as well as trauma.
Less commonly, male infertility may occur due to developmental disorders, chromosomal disorders and gene mutations.
In most cases, the following assessments are needed
One of the first steps to assess fertility is aspermogram, or a study of the sperm quality. A sperm analysis provides information on whether the reason for a couple’s infertility may rest with the male. The semen sample obtained for the analysis is given in a dedicated private room, in which the man can be accompanied by his partner if desired. In order for the results of the semen analysis to be as accurate as possible, at least 2 days but not more than 7 days should have elapsed since the previous ejaculation.
You can register for a consultation with our andrologist-urologist without a referral letter.
International criteria developed by the World Health Organization (WHO) are used to assess the semen.
According to the requirements of the World Health Organization (WHO), a semen analysis is still considered to be within the normal limits if the semen volume is at least 1.5 ml, there are at least 15 million sperm per ml, 40% of the sperm are mobile and at least 4% are normal in appearance. If a man’s sperm count is below the WHO limits, the cause of the couple’s infertility may lie with the male, and in vitro fertilisation (IVF) may be needed in order to have a baby.
When analysing the semen, its volume, colour, number of sperm (i.e. concentration), mobility, appearance or morphology, presence of inflammatory cells, presence of autoimmune responses, etc., are evaluated. In the case of abnormalities, it is recommended to consult our andrologist-urologist. Spermogram should always be performed before an in vitro fertilisation procedure, even if the cause of the infertility rests with the female. However, spermogram does not need to be conducted if one was conducted during the previous year. Data on the semen quality is needed in order for the embryologist to make a better decision on which method to use to fertilise the eggs under laboratory conditions.
Before the in vitro fertilisation procedure, the man must have a blood test for various viral diseases (HIV, hepatitis B and C) and syphilis, in addition to a urine test for inflammatory agents (chlamydia, trichomoniasis and gonorrhoea). However, these analyses do not need to be performed if they were previously performed within the prior three months and everything is in order.
· If a normal examination of the semen shows an inflammation, the andrologist will perform additional tests to determine the inflammatory pathogens (chlamydia bacteria, gonococcus, ureaplasmas, mycoplasmas, etc.) in the genitals and to evaluate the parameters in relation to prostate secretion.
If necessary, your andrologist will determine the level of hormones in your blood.
In some cases, your doctor will assess the blood supply to your genitals via an ultrasound, using a so-called Doppler test to measure your blood flow.
If the number of sperm in the seminal fluid is extremely low, then a consultation with a geneticist is indicated.
In certain cases, when there are no sperm in the semen and genetic tests are in order, it is necessary to look for sperm in the testicular tissue via a testicular sperm extraction (TESE). To do this, pieces of tissue are surgically removed from the testicle under general anaesthesia or under a local anaesthetic and are examined for the presence of sperm under a microscope. If sperm are found in the tissue, they can be used for the in vitro fertilisation, and the tissue can also be cryopreserved in our laboratory for subsequent procedures.
Today, in addition to the basic sperm test, there are a number of additional tests that can help to explain the decline in sperm quality and, if possible, prescribe the necessary treatment:
Determine oxidative stress in semen. Higher oxidative stress may indicate inflammation and be the cause of infertility or a failed in vitro fertilisation procedure. The results of this test will help the doctor to determine the treatment needed and to choose the appropriate IVF method. It is recommended to take antioxidant supplements in cases of increased oxidative stress.
MAR IgG test – a test for antibodies against sperm. The MAR IgG test is an additional test that can be performed within the first spermogram.
The spermogram is free-of-charge for those who are insured with the Estonian Health Insurance Fund if a doctor’s referral is available, and the examination is paid for without a referral. You can find the prices of these procedures in our price list.