Procedures

What is the most important test for evaluating male fertility?

The semen analysis or seminogram constitutes the cornerstone of the study of male fertility. The main male fertility test is the seminogram, which analyzes the quality of semen. This test provides crucial information on several parameters that determine the fecundative capacity of sperm.

To perform this test, a semen sample is obtained through masturbation after a period of sexual abstinence of 2-5 days. Semen analysis is performed, by consensus, following World Health Organization protocols and reference values. The sample must be analyzed within the first hour after obtaining it to ensure accurate results.

The seminogram evaluates multiple parameters including:

• Volume of the ejaculate (normal: 1.5-5 ml)
• Concentration of sperm (normal: more than 15 million/ml)
• Mobility sperm (normal: more than 40% with progressive mobility)
• Morphology of sperm (normal: more than 4% with adequate shape)
• pH, viscosity and other physical characteristics of semen

If the results of the first seminogram show alterations, a second analysis is recommended to confirm the findings, as several factors may temporarily affect seminal quality.

What other tests complement the fertility study in men?

Although the seminogram is the main test, there are several complementary studies that allow a more complete evaluation of male fertility. These additional tests are especially useful when the seminogram shows changes or when there are specific suspicions about the cause of infertility.

Hormonal analysis

Hormonal analysis makes it possible to determine if there are any alterations in male sex hormones. Through a simple blood test, the levels of hormones essential for sperm production are evaluated, such as:

• Follicle Stimulating Hormone (FSH)
• Luteinizing Hormone (LH)
• Testosterone
• Prolactin
• Estradiol

Alterations in these values may indicate problems in the functioning of the hypothalamic-pituitary-testicular axis, responsible for sperm production.

Genetic study

Genetic studies are essential in cases of severe infertility. Various chromosomal studies can be performed on the patient, such as karyotyping, Microdeletions of the Y chromosome, or the Cystic Fibrosis study. These tests make it possible to identify chromosomal alterations that could explain infertility and that could also be transmitted to the offspring.

Sperm DNA fragmentation test

This test assesses the integrity of the genetic material in sperm cells. A high percentage of DNA fragmentation can negatively affect fertility, even when the parameters of the seminogram are normal. This analysis is especially useful in cases of recurrent miscarriages or repeated failures in assisted reproduction techniques.

Imaging tests

Imaging tests, such as scrotal ultrasound or MRI, can provide information about the structure and function of the male reproductive system. These techniques can identify anomalies such as varicocele, cysts, obstructions or tumors that could be affecting fertility.

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Results

How are the results of male fertility tests interpreted?

Proper interpretation of fertility test results requires the specialized knowledge of reproductive medicine professionals. The values obtained must be compared with the reference parameters established by international organizations such as the World Health Organization.

In the case of the seminogram, it is important to remember that the reference values represent statistical limits and do not absolutely determine fertilization capacity. The predictive value of seminal parameters used individually is low in the diagnosis of infertility since it does not completely discriminate between fertile and infertile men, and low numbers do not exclude the success of assisted fertilization. That is, some men with parameters below normal can conceive naturally, while others with apparently normal values may have difficulties.

The main changes that a seminogram can detect are:

• Oligozoospermia: reduced sperm concentration
• Asthenozoospermia: decreased sperm motility
• Teratozoospermia: high proportion of sperm with abnormal morphology
• Azoospermia: total absence of sperm in the ejaculate

Often, these disorders occur in combination, known as oligoasthenoteratozoospermia (OAT).

It is essential that the specialist evaluate the results of all tests together, also considering the patient's medical history and the risk factors present.

What possible diagnoses can be obtained after the study?

After completing the male fertility study, the specialist may arrive at various diagnoses that explain the difficulty in conceiving. The causes of male infertility are varied and can be classified according to their origin:

Pretesticular (hormonal) causes

These affect the production of hormones necessary for spermatogenesis, such as hypogonadotropic hypogonadism, hyperprolactinemia or thyroid disorders.

Testicular causes

They directly affect the testicles and their ability to produce sperm, such as:

• Varicocele (dilation of the testicular veins)
• Cryptorchidism (undescended testicles)
• Orchitis (testicular inflammation)
• Testicular injuries
• Genetic alterations

Post-testicular causes

They involve problems in transporting sperm:

• Duct obstruction
• Congenital absence of vas deferens
• Ejaculatory dysfunction

Idiopathic infertility

In 40% of cases of infertility, after carrying out a complete study, it is not possible to know the reason why they do not have children. This is called idiopathic fertility. It is suspected that many of these cases have a genetic origin that has not yet been identified.

Knowing the specific diagnosis is crucial to determining the best therapeutic approach and the chances of success with each treatment.

Causes

What are the main factors affecting male fertility?

Male fertility can be affected by multiple factors, some modifiable and others not. Identifying these causes is critical to establishing an appropriate treatment plan.

Age

Although men produce sperm throughout their adult lives, sperm quality gradually declines with age. Numerous studies have shown that there is a decline in sperm quality directly related to male age. Between the ages of 40 and 70, a gradual process of decline in testosterone production begins, which ultimately affects sperm quality. This deterioration is reflected in lower volume, mobility and normal morphology, as well as greater damage to sperm DNA.

Lifestyle

A number of habits can negatively impact male fertility:

• Smoking: Reduces sperm concentration and mobility
• Alcohol: Excessive consumption affects sperm production
• Obesity: Alters hormonal balance and increases scrotal temperature
• Sedentary lifestyle: Lowers testosterone levels
• Stress: May alter hormone production

Diseases and medical conditions

Underlying diseases such as high blood pressure, high cholesterol, diabetes, overweight and some tumors can cause low sperm levels, low sperm motility, increased sperm morphological changes or sexual dysfunction. In addition, specific reproductive system conditions such as varicocele, cryptorchidism, or genitourinary infections are common causes of male infertility.

Genetic Factors

When there are alterations in the male's DNA sequence, we are faced with anomalies that cause infertility of genetic origin. There are several genetic causes of male infertility, such as microdeletions on the Y chromosome or chromosomal anomalies. These changes can affect sperm production or function and in some cases can be transmitted to offspring.

Environmental and Occupational Factors

Exposure to environmental toxins, radiation or high temperatures in the workplace can deteriorate semen quality. Occupations that involve long periods of sitting, exposure to chemicals, or high temperatures pose a greater risk.

How do medications affect men's fertility?

A number of medications can have a significant impact on male fertility, either as a side effect or as a primary action. Certain medications can have a negative effect on the quantity and quality of sperm that can be found in a semen sample. It is essential to inform the specialist about all the drugs being taken, including supplements and non-prescription drugs.

Medications that may affect male fertility include:

• Chemotherapy and radiation therapy: They can damage spermatozoa-producing cells, in some cases permanently
• Antihypertensive drugs: Especially calcium channel blockers and beta-blockers
• Anti-androgens: Used for prostate cancer or benign hyperplasia
• Antidepressants and anxiolytics: May affect libido and cause erectile dysfunction
• Anabolic steroids: They suppress natural testosterone production
• Some antibiotics: Like tetracyclines and macrolides

In many cases, the effect on fertility is temporary and reversible upon discontinuation of medication. However, it is important to never interrupt treatment without first consulting with the prescribing physician.

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Solutions

What treatments are there to improve male fertility?

Treatments for male infertility vary depending on the cause identified and can range from lifestyle changes to advanced assisted reproduction techniques.

Lifestyle Modification

Male fertility is an essential component in the conception process. Lifestyle has a significant impact on sperm quality. Adopting healthy habits can significantly improve semen quality within 3-6 months:

• Maintain a healthy weight
• Follow a diet rich in antioxidants
• Do moderate exercise
• Avoid the use of tobacco, alcohol and drugs
• Reduce stress
• Avoid exposure to high temperatures in the genital area

Pharmacological treatment

In cases of hormonal problems, medications may be prescribed to normalize hormone levels and improve sperm production. Pharmacological treatment will be applied in those cases with an infectious origin (antibiotic treatment) or endocrine (hormonal treatment). There are also vitamin and antioxidant supplements that can help improve semen quality in some cases.

Surgical treatment

Some causes of male infertility require surgical intervention:

• Varicocelectomy to treat varicocele
• Correction of duct obstructions
• Surgical sperm extraction in cases of azoospermia

Surgical treatment will be aimed at situations that require the reversion of a vasectomy (recanalization of the vas deferens). These interventions can improve seminal quality or allow sperm to be obtained for assisted reproduction techniques.

Assisted Reproductive Techniques

The assisted reproduction techniques that can be used in male infertility, if the condition has not resolved with medical or surgical treatment, are artificial insemination (AI) and in vitro fertilization (IVF). The choice of technique will depend on the severity of the male factor:

• Artificial insemination: Indicated in mild-moderate cases
• Conventional in vitro fertilization: For moderate cases
• Intracytoplasmic sperm injection (ICSI): For severe cases

In extreme situations where it is not possible to obtain viable sperm, the use of donor sperm may be considered.

How can a man naturally improve his fertility?

There are several natural strategies that can help improve male fertility. These measures are especially useful as a complement to medical treatments or in cases of mild disorders.

Food and nutrition

Following a Mediterranean diet pattern can help men improve their seminal quality. Therefore, a diet rich in vegetables and fruits, fish, legumes, whole grains and nuts could be beneficial in improving seminal parameters. Certain nutrients are particularly important for male reproductive health:

• Antioxidants (vitamins C and E): Protect sperm from oxidative damage
• Zinc: Essential for testosterone production
• Omega-3 fatty acids: They improve sperm motility
• Selenium: Contributes to normal sperm formation
• Coenzyme Q10: Promotes cellular energy production

Stress Management

Emotional stress can affect sperm production and can also make sexual intercourse difficult. Acute stress can cause a decrease in sperm motility, while chronic stress causes a decrease in sperm count. Techniques such as meditation, yoga or regular physical activity can help control stress levels.

Testicular temperature care

The testicles function optimally at a temperature slightly lower than the body temperature. To maintain a suitable temperature:

• Avoid prolonged baths or showers that are very hot
• Do not use the laptop directly on your lap
• Wearing underwear that is not very tight
• Avoid frequent saunas and hot tubs
• Reduce long periods of sitting

Optimal sexual frequency

The optimal sexual frequency for fertility is between 2 and 5 days, since in this time interval the sperm with the best quality. Having sexual intercourse every 2-3 days during the female fertile period optimizes the chances of conception.

These natural measures can produce significant improvements in seminal quality, but it's important to remember that sperm cells take approximately 3 months to form, so the results will not be immediate.

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Expectations

How long does it take to complete a male fertility study?

The time needed to complete a male fertility study varies depending on the complexity of the case and the initial findings. In general, the basic process can be completed in 1-2 months, but more comprehensive studies may extend longer.

The study usually follows a logical sequence:

1. First consultation and physical examination: 1 day
2. Basic seminogram: Results available in 1-7 days
3. Hormonal analysis: Results available in 1-2 weeks
4. Genetic testing: Results may take 2-4 weeks
5. Additional specific tests: As required

It is important to consider that if the first seminogram shows alterations, it is generally recommended to repeat it after 2-3 months to confirm the findings, which may extend the total time of the study.

Avida Fertility specialists optimize this process to provide a clear diagnosis in the shortest possible time, allowing the most appropriate treatment to be initiated quickly in each case.

What are the chances of success after an infertility diagnosis?

The chances of success after a diagnosis of male infertility vary considerably depending on the specific cause, the severity of the alterations found, the age of the couple and the treatments applied.

Up to 1 in 5 couples who are diagnosed with infertility eventually become pregnant without treatment. Most couples with infertility become pregnant after treatment. These data offer a hopeful perspective, although it's important to maintain realistic expectations.

Factors that positively influence the prognosis:

• Identifying a treatable cause
• Age of women under 35
• Absence of associated feminine factor
• Short-term infertility

Advances in assisted reproduction techniques have significantly improved success rates, even in severe cases of male infertility. Treatments for these pathologies have been effective in most cases, allowing a significant number of couples to conceive spontaneously. With the right combination of medical treatments, lifestyle changes and assisted reproduction techniques, many couples can fulfill their desire to become parents.

At Avida Fertility, our multidisciplinary team works closely with each couple to develop a personalized plan that maximizes the chances of success, adapted to their specific needs and particular circumstances.

Prevention

Can male infertility be prevented?

Although not all cases of male infertility are preventable, many risk factors can be modified to preserve long-term fertility. On the path to parenthood, it is crucial to adopt preventive measures that ensure and protect the ability to conceive.

Healthy lifestyle habits

Maintaining a healthy lifestyle from a young age can prevent many fertility problems:

• Balanced diet rich in antioxidants
• Regular physical activity without going too much
• Maintaining a healthy weight
• Avoid the use of tobacco, alcohol and drugs
• Adequate stress management

Protection against infections

Sexually transmitted infections can cause permanent damage to the male reproductive system. Using a condom and having regular checkups is essential to prevent these complications.

Avoid environmental toxins

If you are exposed to sources of heat, radiation, pollutants, poisons or other toxins in your profession, keep in mind that these can affect seminal quality, and take all necessary preventive measures. Using appropriate protective equipment in hazardous work environments is essential.

Fertility Preservation

In specific situations, such as before cancer treatments, it is advisable to consider cryopreservation of sperm to ensure the future possibility of having biological children.

Regular medical checkups

Regular urological examinations can detect conditions such as varicocele or hydrocele early, which if treated early have less impact on fertility.

What steps are recommended during fertility treatments?

During fertility treatments, it is essential to follow certain recommendations to optimize results and increase the chances of success.

Adherence to treatment

Rigorously following prescribed medical guidelines is essential. This includes taking medication at the indicated times, attending all scheduled appointments, and performing recommended follow-up tests.

Lifestyle Optimization

Male fertility can be influenced by a variety of factors, including healthy habits, lifestyle factors, and medical treatments. During treatment, it is even more important to:

• Completely avoid alcohol and tobacco
• Follow a balanced diet rich in antioxidants
• Maintain adequate levels of physical activity
• Effectively manage stress
• Ensure adequate rest

Testicular temperature control

Moderate exercise, avoiding high-impact activities and wearing appropriate clothing and equipment is important for male fertility. Adequate sleep helps regulate hormone levels and improve sperm quality. In addition, avoiding sources of excessive heat in the genital area is crucial during treatment.

Communication with the medical team

Informing the specialist about any change in medication, occurrence of side effects or changes in the general state of health allows the treatment to be optimally adjusted.

Psychological support

Fertility treatments can be emotionally challenging. Having professional psychological support or participating in support groups can be a great help in managing associated anxiety and stress.

At Avida Fertility, we accompany our patients throughout the process, offering a comprehensive approach that considers both the medical and emotional aspects of fertility treatment.

References

1. World Health Organization. (2024). WHO laboratory manual for the examination and processing of human semen. OMS. Trusted Source.
2. American Society for Reproductive Medicine. (2024). Diagnosis and treatment of infertility in men: AUA/ASRM guideline. Fertility and Sterility, 116 (2), 256-271. Trusted Source.
3. Agarwal, A., Majzoub, A., & Esteves, S.C. (2023). Clinical utility of sperm DNA fragmentation testing: practice recommendations based on clinical scenarios. Translational Andrology and Urology, 9 (1), 409-423. Trusted Source.

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