Coping with male-factor infertility can be stressful for a couple as social conditioning makes most men reluctant to accept the condition, and those who do manage to come to terms with it, find it difficult to discuss the issue openly.

Being armed with the right information on male infertility empowers you and your partner to understand the condition from a medical rather than social point of view, and protects you from suffering at the hands of quacks.

Below you will find basic yet pertinent information regarding the primary cause of male infertility worldwide: problems with sperm production and sperm quality.

Understanding sperm production

Unlike a woman who is born with about two million eggs in her ovaries, a man produces sperm every day throughout his lifetime.

The male reproductive system includes the testes, vas deferens (muscular tubes that transport sperm to the ejaculatory ducts), prostate gland, seminal glands, urethra, and penis. Over 12 billion sperm cells are produced every month in a structure called the seminiferous tubule located in each of a man’s testes. The storage and maturation of sperm takes place in the epididymis, a coiled tube-like structure that lies next to the seminiferous tubule.

Before sperm are ejaculated through the urethra, they are mixed with seminal fluid from the seminal glands and another protective fluid from the prostate gland to constitute what we know as ‘semen’. These additions are nature’s way of nourishing your sperm cells and providing them a ‘transport vehicle’ to move effortlessly through the female reproductive tract.

While each ejaculation contains about 250 million sperm cells, only a couple of hundred survive, and vehemently compete to reach a fertile egg. If all goes well, one of these sperm succeeds in fertilizing the egg. Having adequate number of healthy and fast-moving sperm is critical when you are trying to conceive a baby.

What is sperm count and how does it affect a man’s fertility?

Sperm count refers to the number of sperm cells per millilitre of a semen sample. As per WHO guidelines (2010), sperm count of 15 million sperm cells per mlof semen is considered normal.

Fertility doctors consider a concentration of 40 million to 300 million cells per ejaculate as normal. Sperm count below 20 million/ml may cause infertility issues if there are problems with sperm movement, shape or size (more information below). A count below 10 million/ml is considered too low and makes natural conception extremely difficult.

Indeed you need only one good sperm for pregnancy to occur, however as only a handful of the millions of sperm you produce will make it to the fallopian tubes of your partner, a healthy sperm count is necessary to increase the likelihood of pregnancy.

What is sperm motility and how does it impact a man’s fertility?

Sperm motility or movement is the ability of your sperm cells to swim through your partner’s reproductive tract to reach the fertile egg. Poor sperm motility means that sperm are either too slow in their movement or are not moving in a straight line. Sperm motility is expressed in % and indicates the percentage of your sperm that are motile. A man may be producing adequate number of sperm, but if they are not fast swimmers, they may all perish on their way to the egg cell.

According to WHO parameters (2010), normal progressive sperm motility is 32% – which means at least 32% of sperm in a sample of 200 sperm cells should be good swimmers.

What is sperm morphology and how does it affect a man’s fertility?

Sperm morphology measures the size and shape of your sperm cells. A sperm cell that moves fast but has an abnormal shape would fail to successfully penetrate the female egg. This aspect of sperm quality, however, is more relevant when a couple is considering in vitro fertilization or IVF.

The WHO reference value for normal sperm morphology (2010) is 4% – which means these many sperm cells in a semen sample should be of normal shape and size.

Semen Analysis

In treating male infertility, semen analysis is the first and the most important test. Semen analysis provides your fertility specialist pertinent information regarding your sperm count, motility and morphology along with sperm volume, fructose and pH levels. Semen analysis is almost always a part of the preliminary fertility testing for couples who are having trouble conceiving naturally despite regular unprotected sexual activity.

It is important for you to know that there is usually no straight-forward answer to sperm-related infertility. For example, a man may have a healthy sperm count but poor sperm movement may be making pregnancy difficult to achieve. In another case, a couple may successfully conceive without assistance in spite of poor sperm count if the sperm are highly motile.

Equipped with the results of your semen analysis, your fertility specialist would be able to guide you to best possible recourse.

Further reading: Male infertility: Misconceptions, causes and solutions