When a couple experiences infertility, approximately 40% of the time, it is a sperm problem. Many couples are surprised by that number, as many couples assume that just because there is ejaculate, there is functional sperm in it. Unfortunately, that is not always the case. There must be an adequate quantity of sperm and sperm that are moving produce much higher pregnancy rates than non-moving sperm. We can get around the non-moving sperm problem with ICSI, which works quite well.
Men who have had vasectomies can get even more complicated. Sperm live an environment that is protected from the human immune system. Once a man has had a vasectomy, that protective environment is breached and sperm are “seen” by the human immune system and the immune system forms antibodies against the sperm. Even if the man has his vasectomy reversed, or has the sperm aspirated from the testicle by a urologist, the sperm are often of low quality. A new test is out that can be performed at home and give the couple and idea of whether or not the man has enough sperm to achieve pregnancy by natural methods. Here is a link to the article.
One of the drawbacks of this test is that it does not measure quality. This has to be done by a full semen analysis, which can be done at our clinic. A full semen analysis measures not only quantity, but also quality. Quality is measured by both appearance and function. It is not enough to just have a good sperm count. Function can be more important than number. We have had a number of patients with almost normal sperm counts, but there wasn’t a moving sperm in the sample. These types of results can influence whether a couple is a good candidate for intra-uterine insemination (IUI) vs. in vitro fertilization (IVF.)
At Red Rock Fertility, we are evaluating another sperm quality test that tests the ability of sperm to bind to a protein that is normally present on human eggs. I think this is going to prove to be an excellent test to let patients know if IUI will work for them on not. I will discuss this test in a future post.