MALE FERTILITY: Assessing the Male Factor and Treating Male Infertility

It was not all that long ago that men were not felt to have a “biologic clock”. Again, it was not that long ago that the only assessment of male fertility that was thought to be important was the sperm count and that if there was a good number of sperm then everything on the male side was fine. This is certainly not the case anymore.

It is well known that age affects male factor fertility as do lots of other things such as environmental exposures (smoking, exposure to toxic chemicals, and obesity). In addition, some jobs are known to increase the risk of sperm and testicular dysfunction in men (such as farmers, chemical handlers, those exposed to low level radiation over time, etc.). In addition, even the area of the country in which one lives might affect fertility in men (rural inhabitants/workers as well as those who live in densely populated urban areas). Many of these factors of age and environmental exposure do not affect the traditional parameters of count of motility that are typically assessed on the semen analysis. So, the semen analysis is now inadequate as being a good measure of male fertility potential.

These environmental exposures, age, occupation, etc., affect sperm largely on a qualitative level. It is well known that these factors can alter DNA constitution as well as chromatin integrity. We can now measure these with several different tests on a single semen sample. So, the era of male factor assessment has now turned to not only looking at quantitative aspects (count and motility) but also qualitative aspects which are relatively speaking more influential as independent predictors of fertility potential.

The measures that are most commonly looked at and clinically valuable in helping patients determine treatment options as well as success of those options include DNA fragmentation, high DNA stainability, and high resolution morphologic assessment of the sperm. All of these tests in addition to count and motility can be done on a single semen sample and currently are the optimal assessment for assessing male fertility potential. However, these tests are not obtained at just any laboratory or hospital but yet are easy to obtain through physician’s offices and reproductive specialist centers. Even if the sperm count is within the normal range on basic analysis, significant abnormalities can be present in these other tests, obviously influencing fertility. So, again it is no longer adequate to assess simply count and motility. One must look at these other parameters as well. It is too easy not to do in the course of assessing male fertility. I believe that men seeking fertility treatment with their partners or even men who are in high risk situations with


occupation and environmental exposure should be screened with these simple tests on a single semen sample. I encourage you to bring these things up with your physician or seek further information by contacting us.
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