How important is male factor and how to overcome that?

During this event, Dr Laura García de Miguel, Medical Director at Clínica Tambre explored the importance of male fertility and shared strategies to overcome it.

At the very beginning of each cycle, all initial tests include semen analysis and freezing for future use. This is in case a fresh sample cannot be used or if specific filters are needed. The semen analysis will show the general appearance, pH, volume, consistency, concentration of spermatozoa, mortality, and morphology. You will receive a report the same day with all information.

Semen analysis can vary, abstinence of around 3 days and confirmation with a laboratory that you are not taking any drugs or medications and haven’t had a fever in the past 2 to 3 weeks is recommended.

Interpreting semen analysis results

• Azoospermia: Complete lack of sperm, often due to stress or obstructions.
• Asthenozoospermia: Less than 32% mobile sperm or less than 40% general mobile sperm.
• Oligozoospermia: Volume less than 1.5 milliliters.
• Necrozoospermia: Less than 58% viable sperm.
• Teratozoospermia: More than 4% abnormal sperm.

If results are abnormal, ideally, the test should be repeated. It’s crucial to confirm sample collection time, and sexual abstinence, and consider factors like ejaculation frequency, recent fever, drug intake, and occupation.

Karyotype analysis

Another test that is also recommended is a karyotype test before treatment, as chromosomal abnormalities can impact sperm and embryo development. Although not compulsory, it helps assess potential risks. The frequency of abnormality in karyotype is less than 1% in the human population.

Complimentary tests

Complimentary tests may include biochemical analysis of seminal plasma, assessing fructose from seminal vesicles, maltase from the epididymis, and citrate from the prostate.

If abnormalities in sperm are detected, undergoing biochemical testing becomes crucial. This process allows for communication between the patient, neurologist, and other specialists to pinpoint the issue, whether it’s in the seminal vesicle, the prostate, or elsewhere. Notably, not all clinics perform this test in-house; outsourcing is often required due to the need for automatic analysis by trained biologists and specialized units for result interpretation.

Another valuable complementary test is the CometFertility test, which assesses the percentage of fragmented sperm in an ejaculate. Fragmentation refers to breaks or interruptions in the DNA, with normal levels below 60%. Understanding this fragmentation is crucial, as it can impact fertilization success and increase the risk of miscarriages.

In cases of oligoasthenospermia or severe asthenozoospermia, hypospermia, leukospermia, and sperm agglutination confirming infections through sperm and urine culture is essential. Identifying the cause allows for targeted treatment, often involving antibiotics. Freezing sperm after washing is a rule to confirm protection and ensure sperm quality in challenging infection removal cases.

Chromosperm and FISH (Fluorescence In Situ Hybridization) tests provide insights into the genetic status of spermatozoa. Detecting chromosomal disorders is crucial, as it influences the number of abnormal embryos, potentially leading to failures or miscarriages.

Tailoring approaches for unique cases

While each case is unique, certain reproductive solutions can be explored. Intrauterine insemination (IUI) is recommended for specific scenarios, and in vitro fertilization (IVF) becomes a viable option with varying sperm recovery levels. Pre-implantation genetic testing for aneuploidies (PGT-A) offers a method to select chromosomally healthy embryos, particularly useful in cases of abnormal karyotypes or high fragmentation.

For cases of azoospermia and severe oligoastenoteratoozoospermia, understanding parameters such as volume, pH, and hormones is crucial. Testicular biopsy and sperm aspiration interventions TESA (Testicular Sperm Aspiration) may be recommended to improve chances.

Potential reproductive solutions

Y chromosome microdeletion (YCMDs), a genetic cause of male infertility, presents specific challenges. Sperm banking, ICSI, and even sperm donation are considered. Clínica Tambre has the oldest sperm bank in Madrid and is one of the oldest in Spain offering various sperm donors and the latest technologies, such as Fenomatch, which is an artificial intelligence program that helps to match physical resemblance between the father and the donor.

Conclusion

The male factor in infertility doesn’t need to be a taboo topic. In Spain, a significant percentage (20.6%)  of assisted reproductive cycles address male-related challenges. Each case requires unique consideration and a comprehensive approach, emphasizing the importance of trusting clinics with advanced technologies and a multi-disciplinary team for effective counseling and treatment.