Infertility is a shade more common in women than with men. About 40-50% of couples with difficulty conceiving will have some sperm issues, ranging from mild to severe problems. Sometimes this is the only reason for a couple’s infertility, and sometimes male infertility problems and female infertility issues occur together in both partners.

Part of the reason that women have more infertility issues is that getting older often has more effect on female fertility than on male fertility, as a woman makes few, if any, new eggs in her lifetime, with a peak number of eggs at birth. The number and quality of eggs left (ovarian reserve or egg supply) declines in women in their 30’s and 40’s, and rarely in their 20’s. Men have less consistent effects of aging, as they make new sperm all the time, so some men in their 50’s or 60’s may have little or no sperm problems.

In couples trying to conceive without success we find a sperm issue about 40-50% of the time, ranging from mild to severe sperm problems. Semen analysis is an important part of infertility testing. Sometimes the sperm issue is the only problem we find when we test both partners, but often there are male and female factors together. Even if the man’s sperm is ‘normal’ it helps a lot if the male partner is supportive.

Not right away. If only one sperm count was zero (azoospermia), he should repeat the test 1-2 months later – make sure it’s at a fertility clinic where if there are ‘no sperm’ they can centrifuge or ‘spin down’ the semen so that even a few sperm will be seen. If no sperm are seen again, he will need hormonal testing, and genetic tests – karyotype and Y chromosome microdeletions (YCMD), and we will refer him to a Urologist for a physical examination. Most men have sperm that can be surgically retrieved, but certain YCMD mean that a testicular biopsy should not be done.

We can’t force him to do a test he doesn’t want to but it’s a bad idea to ‘skip’ testing for him. In couples who aren’t getting pregnant after trying for a year or longer, almost half the time there is a sperm issue (40-50% of couples). It could be the only problem or occur along with problems on the woman’s side. A Semen Analysis is a good test to do early on. A Semen Analysis can be collected at home if you live less than an hour away. It is possible to start with your tests and do the Semen Analysis later if your husband is unwilling to be tested early on we can discuss the test with your husband at the first visit or at the second meeting, when we go through fertility testing results and make a treatment plan.

There are procedures available to men who do not have sperm in their semen. These procedures involve taking tissue samples directly from the testes in various ways, depending on the situation. If sperm are found in those tissue samples, then microinjection (ICSI) can inseminate the eggs.

A Semen Analysis through PSFC is a good place to start for him. In couples who aren’t getting pregnant after trying for a year or longer, almost half the time there is a sperm issue (40-50% of couples). It could be the only problem or occur along with problems on your side. He should also quit tobacco use, cut down alcohol if he has moderate to heavy drinking habits, avoid using drugs, and aim for a normal weight.

After trying the various procedures available for azoospermic men, sperm is still not found, and then sperm donation should be considered the next available option.

We review his medical and lifestyle history, including alcohol, tobacco and prescription medication use, and recommend a Semen Analysis for fertility testing. When both partners attend fertility visits (preferred but not mandatory), the man may look bored, or nervous, or even embarrassed by the whole fertility thing. Some can find the humor in the situation which helps. Men with significant sperm issues benefit from a scheduling a physical exam with a Urologist later; men with normal or near-normal sperm tests don’t need to get a physical exam. We do not advise but Semen can be collected at home if you live less than an hour away.

Azoospermia (no sperm or no living sperm) could be due to obstruction (blockage) or a sperm production issue. It should be confirmed by more than one semen analysis: a fertility clinic will ‘spin down’ a sample with no sperm so that we can find very low numbers of sperm. Many men still have some sperm production, so sperm can be surgically retrieved for IVF with ICSI (In Vitro Fertilization with Intracytoplasmic Sperm Injection), or donor sperm can be used for fertility treatment such as Intrauterine Inseminations (IUI). At PSFC, we handle Azoospermia cases very effectively.

Unfortunately, there is no treatment for severe male infertility that is 100% guaranteed to work using your own sperm. However, surgically-retrieved epididymal or testicular sperm, combined with IVF with ICSI, the chance of success can increase significantly.

Donor sperm is the closest thing for couples where the male partner has azoospermia as it is sperm from healthy men without known fertility issues. A genetic test identifies some men ahead of time who won’t get sperm at retrieval. Having Donor sperm as a backup is a good idea.

Azoospermia should be diagnosed by an Andrology lab at a Fertility clinic or a Urology clinic. More than one semen analysis is needed to confirm the diagnosis. If we see a semen sample with no sperm we use a centrifuge to ‘spin down’ the specimen so that we can find very low numbers of sperm. See a Fertility MD (Reproductive Endocrinology and Infertility or REI) for a complete Semen Analysis test.

Oligozoospermia means low sperm count. Any abnormal Semen Analysis needs a second test 1-2 months later for confirmation, ideally through a fertility clinic. Hormonal testing may identify treatable problems, and tablets may improve sperm; hormone shots are needed very rarely. Mild to medium low sperm count is often treated with Intrauterine Inseminations (IUI), where washed sperm is placed inside the woman’s uterus. Severe sperm problems need IVF with ICSI (In Vitro Fertilization with Intracytoplasmic Sperm Injection) or the use of donor sperm.

The World Health Organization defines oligozoospermia as less than 20 million sperm per ml (milliliter). More recent studies show that in men with proven fertility, the lower limit of normal is around 15 million sperm per ml. Semen Analysis should be done through a Fertility clinic (PSFC) or a Urology lab and an abnormal result needs a second test 1-2 months later for confirmation.

We may do hormonal tests, looking for low testosterone, high estrogen, thyroid or prolactin issues or abnormal LH or FSH hormone levels. Some men get better sperm with treatment of hormone problems. Some men need genetic tests, and/or a consultation with a Urologist. Mostly we treat mild to medium sperm problems with Intrauterine Inseminations (IUI) where washed sperm is placed inside the woman’s uterus; severe sperm problems need IVF with ICSI (In Vitro Fertilization with Intracytoplasmic Sperm Injection) or use of donor sperm. No sperm (azoospermia) or very severe sperm problems may need a surgical sperm retrieval procedure.

Absolutely. In all couples not getting pregnant after a year or more trying, the male partner should get a Semen Analysis; 40-50% of these men have a sperm issue, ranging from mild to severe sperm problems. About half the time the sperm issue is the only problem, and the other half have male and female factors together, like blocked tubes or low egg supply. If your sperm test is normal, you don’t need much else in the way of testing. Men with abnormal sperm counts may need hormonal or genetic blood work.

I recommend getting a Semen Analysis ‘done right’ here at PSFC.  We have trained Andrologists, using the correct equipment and microscopes, and quality control standards to give you the most accurate results. A complete Semen Analysis looks at Sperm Count (the concentration of sperm per milliliter of semen), Motility (the percentage of moving sperm), Morphology (the % of normal-shaped sperm), and a screening test for Sperm Antibodies.

Get a Semen Analysis at a fertility clinic (PSFC)  instead of taking a general medical testing lab. Home sperm tests are not very useful, and you can’t tell by looking at your semen.

They should have no major effects on sperm count. I’m assuming you’re talking about ‘regular’ prescription corticosteroids like triamcinolone (Kenalog) – these have little to no effect on sperm, unlike anabolic steroids like testosterone or Dianabol, which can cause major reductions in sperm count. Some studies indicate that heavy use of Non-Steroidal Anti-Inflammatory Drugs or NSAIDs, including aspirin, may affect sperm motility and sperm morphology (the % of normal-shaped sperm) as well.

An abnormal semen analysis, such as a low sperm count, always needs a second test 1-2 months later for confirmation. Based on how low the count is, and/or sperm quality tests like motility and morphology (the % of normal-shaped sperm) are, we may do hormonal or genetic blood work. In some guys taking tablets or rarely shots can increase count. Men who are overweight may get better sperm numbers and quality by losing weight, and men should cut down heavy alcohol use and quit using tobacco, avoid illegal drugs and anabolic steroids, and review any prescription drugs with their MD.

• Stop smoking as smoke contains substances that have a harmful effect on spermatozoids.
• Reduce consumption of alcohol to the minimum. Alcohol decreases ability of the body to produce testosterone that is essential in the formation of sperm.
• Avoid hot bath, sauna and tight underwear. For the optimum functioning of testicles body temperature should be lower than 37°C. Do not expose your manly parts to the elevated temperature of the external environment for more than 30 minutes per week.
• Test for the possible infections with sexually transmitted diseases.
• Learn to relax and improve your sleep quality. Stress affects reproductive system and fertilization ability, impacting quality of sperm and number of spermatozoids. A balanced work and life routine is very significant, also a good 8 hours sleep at night.
• Exercise regularly in fresh air with a moderate activity at least 2 times a week, it will help to maintain your body in a good physical form and reduce the negative impact of stress. Sedentary lifestyle and excess weight significantly reduce the quality of sperm.
• Decrease the consumption of caffeine containing drinks. Caffeine stimulates adrenal glands and causes the same effect as stress.
• Drink sufficient amount of liquid at least 1.5 – 2.0 litres a day. Sperm requires the body to have enough liquid as 80% of sperm consists of water.
• Have sex regularly at least twice a week. Quality of sperm reduces if it is stored in the body for a prolonged period. Also, too intense sex harms sperm.  48 hours are needed for it to restore. Do not use any kind of lubricants.
• Include fatty fish in your diet. Fatty fish contains fatty acids necessary for the formation of qualitative sperm. It is recommended to consume mackerel, sardines, salmon etc.
• Include vegetables and fruits in your diet. They contain vitamins, antioxidants and minerals that increase the number of spermatozoids.
• Eat products rich in zinc and folic acid. You can find zinc in meat, fish, eggs but folic acid in leafy vegetables, legumes and wholegrain bread. If the body lacks folic acid, number of spermatozoids can reduce by 90%.
• Quality of sperm improves if you consume sufficient number of fruits and vegetables, grain fibres, polyunsaturated fatty acids, for example, omega-3 (fish, shell-fishes and seafood), poultry, products containing antioxidants (vitamins E, C and D, β-carotene, selenium, β-cryptoxanthin, lycopene) and folates, low fat dairy and skimmed milk.
• Quality of sperm declines if you consume too much caffeine containing products and alcohol, sweets and sweetened drinks, saturated fatty acids (beef, goat, sheep, pork, as well as milk and butter), trans fats (margarine, fatty spreads, cookies, pies, cakes, pastries, fried products), protein (processed red meat), soya products and potatoes, cheese and whole milk products.

• Refrain from sexual activity for not less than two and not more than seven days
• Refrain from alcohol, and preferably also smoking
• Refrain from saunas or hot baths
• Sperm sample should not be provided until two weeks after an antibiotic treatment or cold
• Sperm sample is given in a designated room – with magazines and video provided

• Providing of material (sperm) in PSFC takes place in a discreet manner, observing strict confidentiality rules.
• Room where you can provide sperm sample is located separately in a discreet corner in the Ground Floor. You can use magazines and videos provided
• You obtain sperm with the help of masturbation
• Please do not use lube, cream or other ointments when you obtain sperm
• DO NOT obtain the material in the condom, also DO NOT pour the sample from the condom into the container
• It is important to gather all sperm in the container

• Spermogram
• Sperm oxidative stress test
• MAR test
• HBA test
• DNA Fragmentation test

There are several different standards for morphology reporting. There is an older standard called WHO morphology, where 30% normal forms is a ‘perfect score’. The most common method of reporting nowadays is called Kruger or ‘strict’, where the ideal range is 15% or greater normal morphology.

To answer your original question: yes, low morphology means your husband may be ‘subfertile’ and it may be harder to conceive naturally. Dr Kruger’s group compared morphology with other numbers like count and motility, and all were helpful at identifying men with subfertility, with a value of under 5% for strict morphology being the suggested cutoff. More abnormal shaped sperm means he may have more sperm with genetic abnormalities.

Even if the abnormal morphology test was done at a fertility clinic using the Kruger or strict morphology, one repeat semen analysis 1-2 months after the first is still a good idea.

None of the sperm tests are 100% predictive, though – you may still get pregnant ‘easily’ as it only takes one good sperm to fertilize an egg.

We recommend seeing a Fertility specialist or Urologist at PSFC for further testing and advice, if you aren’t already seeing one.

Men with low morphology (% of normal-shaped sperm) may have more genetically abnormal sperm. More genetically abnormal sperm increases the chance of miscarriage or chromosomally abnormal pregnancy but does not cause common birth defects.