Infertility is one of the major medical challenges of modern times, affecting millions of people worldwide. Clinical estimates suggest that approximately 48 million couples and 186 million individuals globally struggle with infertility. Studies indicate that 40% of infertility cases are attributed to male factors, another 40% to female factors, and the remaining 20% to a combination of both or unexplained (idiopathic) infertility. Alongside this growing issue, advancements in medical science and technology now provide the tools and knowledge needed for timely diagnosis and treatment. It is therefore essential for every adult man to evaluate his reproductive health and understand his fertility potential, particularly if he is planning to start a family.
But how is male fertility properly assessed, and what should this evaluation include?
Key Steps in Male Fertility Assessment
The investigation of male fertility begins with a comprehensive semen analysis, conducted by specialized scientific personnel. This test determines whether sperm cells are being produced and evaluates their characteristics (both quantitative and qualitative). Specifically, basic parameters are assessed, including sperm count, motility and morphology. Advanced assessments may also include morphological abnormalities and immunological factors, such as the presence of anti-sperm antibodies.
However, a normal semen analysis does not always rule out underlying issues. Some men with normal semen analysis results and no concurrent female factors may still face difficulties conceiving.
Additional Tests Beyond Semen Analysis
Beyond a semen analysis, a microbiological examination and semen culture is crucial to identify possible pathogenic microorganisms. This test is important not only for the health of the male reproductive system (chronic infections can lead to conditions like prostatitis or epididymitis) but also for fertility and the health of the partner in case of transmission.
In addition to conventional microbiological testing, molecular testing (PCR) offers high sensitivity and specificity for detecting sexually transmitted pathogens, achieving nearly 100% accuracy. This includes identifying viruses like HPV (human papillomavirus), which can significantly affect male fertility, as well as other microorganisms present in low concentrations.
DNA Fragmentation and Genetic Integrity
If pregnancy attempts are unsuccessful after a certain period and the above tests have been completed, it is advisable to evaluate the genetic integrity of spermatozoa, focusing on DNA fragmentation. Research shows that when a high percentage of sperm cells have fragmented DNA, fertilization of the oocyte can result in poor embryo quality, reduced developmental potential, failed implantation, or an increased risk of miscarriage during the first trimester. Testing for DNA fragmentation is particularly valuable in cases of prolonged conception attempts or recurrent pregnancy losses, as it assesses factors beyond the scope of standard semen analysis.
Another related test involves measuring oxidation-reduction potential (sORP) in sperm using the MiOXSYS system. While the production of reactive oxygen species (ROS) is a natural biological process necessary for spermatogenesis, excessive ROS (due to lifestyle factors like smoking, alcohol consumption, diet, or pollution) can lead to oxidative stress. This stress damages sperm DNA, contributing to male infertility. The presence of pathogens in the reproductive system can further alter the spermatogenesis environment, exacerbating oxidative stress and DNA fragmentation.
Genetic Testing
In cases of unexplained infertility, azoospermia (absence of sperm), repeated miscarriages, or significantly low sperm count, genetic testing for both the man and the couple becomes essential. This includes karyotype testing to examine the number and structure of chromosomes. Chromosomal abnormalities can be a cause of male infertility and may also have implications for offspring health. Additionally, genetic sequencing of key genes, such as those linked to cystic fibrosis, or identifying microdeletions on the Y chromosome, can provide critical information about the underlying causes and help protect the health of future children.
Male fertility assessment, starting with semen analysis and microbiological testing/culture, is vital for the reproductive health of men and should be performed before a couple tries to conceive. Early diagnosis helps to avoid unnecessary delays and the emotional burden of unsuccessful attempts.
Because the sooner a problem is identified, the easier it is to address!