One of the many misconceptions about infertility is that it primarily affects women. Recent studies have revealed, however, that male infertility accounts for 40 to 50 percent of all infertility cases.
Just as women have reproductive issues that are unique to their gender, medical problems that are exclusive to men also need to be addressed. These male medical conditions, including infertility, are treated by specialists in the field of Andrology.
What is Andrology?
Andrology is a medical speciality that deals with diseases and conditions that are specific to men, particularly those of the male reproductive system.
Among the general public, there is some confusion regarding Urology and Andrology. To clearly distinguish between the two, Urology is the broader medical field, encompassing problems in the urinary tract in both men and women and the male reproductive system. Andrology is a subspecialty of Urology, specifically focusing on male reproductive issues, including male infertility, impotence, and sexual dysfunctions, just to name a few.
Simply put, both men and women can see a urologist for problems with their urinary tract. While urologists can also treat men with problems in their reproductive systems, andrologists are the ones who can provide specialised treatments for male reproductive issues.
As a 1989 study has strongly pointed out, an infertility treatment team is not complete without an andrologist since their expertise encompasses all aspects of male fertility, including physiology, endocrinology, biochemistry, genetics, immunology, histopathology, surgery, treatment of sexually transmitted diseases, and sexology. Thus, they can provide more accurate and specialised treatment for infertile male patients.
Types of Andrology Services
When it comes to the management of male infertility here are the types of sperm functional diagnostic services that andrologists may recommend to their patients:
1) Semen Analysis
Semen analysis is the standard test performed as a major test of male fertility potential. It provides useful information concerning sperm production, sperm motility and viability, patency of the male genital tract, secretions of the accessory organs, as well as ejaculation and emission. In this procedure, a semen sample is obtained and analysed both quantitatively and qualitatively. Quantitative analysis of the sample includes the determination of the sperm count or concentration. Qualitative analysis involves a thorough inspection of sperm based on their morphology, vitality, and motility.
Although the routine semen analysis reveals useful information for the initial evaluation of the infertile male, such parameters may not be sufficient alone to interpret the fertility status of an ejaculate, unless significantly abnormal. Additional tests may need to be used to indicate the functional activity of spermatozoa.
2) DNA Fragmentation Assay
The DNA Fragmentation Assay is a test that is used to measure the amount of DNA damage in sperm in a semen sample. A major causative factor for sperm DNA damage is oxidative stress due to excessive production of reactive oxygen species. Other factors can include defects in sperm chromatin packaging and DNA repair mechanisms as well as abnormalities in the regulation of programmed cell death, which are vital for regulating sperm production.
All men have some amount of sperm DNA damage, but sperm DNA fragmentation (SDF) is significantly higher in infertile men. While men with poor semen parameters are more likely to have high SDF, high SDF is also found in men with normal semen parameters who may be diagnosed with unexplained infertility. Elevated levels of sperm DNA fragmentation (SDF) may affect fertility by hindering fertilisation, early embryo development, implantation and pregnancy.
One method of this assay is the Sperm Chromatin Dispersion Test (SCD) test, which measures the percentage of sperm with fragmented DNA called the DNA Fragmentation Index (DFI). Men with a DFI of less than 15 percent have a higher fertility potential. Those men with a DFI greater than 30 percent have a low fertility potential and will require clinical treatment for improvement of sperm quality.
3) Sperm Oxidative Stress Assay
Reactive oxygen species (ROS) are by-products of oxygen metabolism released from sperm cells and leukocytes. In ideal quantities, ROS serve to optimise sperm function. ROS are neutralized by antioxidants and are kept in optimal levels.
A state of oxidative stress develops, and can result in lipid peroxidation, protein changes, DNA damage and sperm death. Studies have shown that oxidative stress is one of the major causes of male infertility, especially for those who have unexplained and idiopathic male infertility. Oxidative stress can not only affect sperm but potentially have consequences on a systematic level such as decreasing amount of testosterone or LH. Increased levels also directly damage sperm DNA, thus compromising the paternal genomic contribution to the embryo.
4) Sperm Hyaluronan Binding Assay
Sperm Hyaluronan Binding Assay (HBA) is a sperm function test that provides qualitative assessment of sperm quality, maturity and fertilisation potential by measuring the proportion of sperm bound to hyaluronan. HBA results may assist clinicians in identifying patients with a potentially poor prognosis for intrauterine insemination (IUI) and in-vitro fertilisation (IVF).
5) Sperm Survival Test
The Sperm Survival Test involves the washing of sperm and removing them from the seminal plasma. They are then cultured and incubated for 24 to 48 hours. This test measures more dynamic aspects of sperm function than the basic semen analysis. Two important physiologic properties of sperm necessary for insemination success are the number of highly motile sperm in a sample and the longevity of those sperm. This test aims to provide two main information: (i) Total number of sperm likely to be available during an IUI preparation; and (ii) How well these sperm survive over 48 hours.
6) Retrograde Semen Analysis
Retrograde Semen Analysis is performed if the male patient presents low semen volume and low sperm count in the first semen analysis, which is indicative of retrograde ejaculation occurs when semen enters the bladder instead of emerging through the penis during orgasm. This happens when the bladder neck muscle does not tighten properly. Patients with retrograde ejaculation usually have a history of prior surgery or medical problems that predispose them to this condition. Men who have a higher chance of retrograde ejaculation are those who have had transurethral surgery of the prostate, testicular cancer surgery, or childhood bladder surgery. Other predisposing factors for retrograde ejaculation include the side effect of certain medications used to treat high blood pressure, prostate enlargement and depression; nerve damage caused by a medical condition such as diabetes, multiple sclerosis, Parkinson’s disease or a spinal cord injury.
7) Trial Sperm Wash
Trial Sperm Wash involves the separation of sperm from seminal fluid. A trial wash is often used in order to determine if the technique is a viable approach to achieving a pregnancy with IUI or IVF.
8) Freezability
Freezability test involves the freezing of sperm at ‘ultra-cold’ temperatures using liquid nitrogen and post-thaw analysis of the viable sperm after the freezing process is completed. This is done so that one can tell how well the sperm has survived the freezing and thawing process to give the clinician and patients as accurate an indication of the quality of the frozen sperm as possible. If the post-thaw survival is acceptable, the frozen specimens may be stored for any male of reproductive age undergoing treatment which is likely to impair his fertility potential.
If you and your partner have been trying to conceive for more than a year but have not been successful, it may be time to seek the advice from our fertility specialists. Our Sincere IVF Center and Sincere Andrology Laboratory offer precise fertility tests for both male and female patients and treatments aimed at giving our them optimum results.
If you have related issues or want to know more about our Andrology services, we can help. WhatsApp us at 9-SINCERE (0-0880620) 24/7 or email us at enquiries@shg.com.sg to make an appointment.
