premature ejaculationCategoriesFertility Problems

Male Factor Infertility

The first and simplest fertility test involves a specimen of the male ejaculate. An average ejaculate contains one-half to one full teaspoon of semen. The average ejaculate volume after 3 days of abstinence is 3 to 5 cc. Sperm make up only about 3 percent of the average ejaculate. The other 97 percent consists of fluids made in the prostate gland and the seminal vesicles.

Sperm Count (millions per cc)Pregnancy Rate (percent)
5 – 1027.8
10 – 2052.9
20 – 4057.1
40 – 6060.0
60 – 10062.5
Over 10070.0

100 million sperm per cc is very high; 15 million is very low. The lower the counts, the higher the risk of infertility. There is no general agreement on the lower limit; some specialists believe that even a very low sperm count does not rule out the chance of fertilization, providing the sperm are well-formed and have good swimming skills.

In an average ejaculate, there will always be defective sperm. About 20 percent will lack proper structure or motility. They can have three tails but no head, a head but no tail, and so on. They can lack all sense of direction, clump together, swim feebly, or not swim at all. To reach the oviducts, sperm must move forward, and at fairly high speed.

Sperm Washing: When sperm are deposited at the top of the vagina, they have great distances to travel before they reach the oviducts. This allows time for “capacitation”, the enzymes in the head become activated to help sperm enter the tube and penetrate the wall of the egg. Sperm washing is a high-tech procedure which allows capacitation for poor quality sperm. It can be used in combination with in vitro fertilization.

Hormone drugs can stimulate under-active testicles, and raise the sperm count. If the problem is found to be that the man produces antibodies to his own sperm, steroids can suppress this immune reaction. When planning for intercourse at specific ovulation dates, keep in mind that it takes 72 days altogether for sperm to mature in the testicles and epididymes, before they are ready to be ejaculated.

A recent study found that men who were not under stress to “perform” produced higher sperm counts than those who were. Many women can sympathize with this. It is much the same “performance pressure” as feeling “obliged” to always have an orgasm. Keep a partner from feeling such pressure at specific ovulation dates. One way could be by more frequent intercourse. Studies on college athletes showed that abstinence appears to have little effect on sperm quality.

premature ejaculationCategoriesFertility Problems

Looking Inside

A laparoscopy is a surgical procedure to examine the internal structures. A coloured solution is introduced into the uterus via the vagina and cervix. The laparoscope is inserted though a small cut in the abdomen wall. When the tubes are open, the coloured fluid can be seen to flow through them, and out into the pelvic cavity. If some fluid pools in little pockets, there may be scarring. The egg can get trapped in the pocket, and die. The pelvic cavity, ovaries, and uterus are also examined to see if endometriosis, inflammation, or some birth defect could be causing the problem. Where appropriate, surgical procedures to relieve a minor problem will be done at the same time.

A laparoscopy is a surgical procedure to examine the internal structures. A coloured solution is introduced into the uterus via the vagina and cervix. The laparoscope is inserted though a small cut in the abdomen wall. When the tubes are open, the coloured fluid can be seen to flow through them, and out into the pelvic cavity. If some fluid pools in little pockets, there may be scarring. The egg can get trapped in the pocket, and die. The pelvic cavity, ovaries, and uterus are also examined to see if endometriosis, inflammation, or some birth defect could be causing the problem. Where appropriate, surgical procedures to relieve a minor problem will be done at the same time.

A hysteroscopy is a procedure performed through the vagina. A fluid or carbon dioxide gas is introduced into the uterus via the vagina and cervix to expand the area and allow a better view. The mucus-secreting glands of the cervix are examined to see if they are working properly. The cervical canal and uterus lining are checked for structures which might add to the problem: polyps, fibroids, or bands of scar tissue. Some minor surgical procedures can be done at the same time, if appropriate.

A hysterosalpingogram (HSG) is an internal X-ray of the uterus and tubes. A radio-opaque dye is injected into the uterus through the vagina and cervix, and the X-ray is taken. HSG is a painful procedure. Cramps and spasm can give a false-positive result; there appears to be a blockage where, in fact, none exists. The iodine solution in the dye can cause an allergic reaction. HSG has become less popular in recent years.

premature ejaculationCategoriesFertility Problems

Other Fertility Tests

There are many different tests to find the cause of fertility problems. They include:

  • Evaluation of cervical mucus. This involves an examination of mucus production, which may be scanty and blocking the sperm.
  • Postcoital tests. These occur after intercourse to evaluate the progress of sperm inside the vagina.
  • Basal body temperature charting. This test checks the timing of ovulation dates.
  • Hamster test. Sperm are evaluated to find out whether or not they can penetrate hamster eggs.
  • Hormone assay tests. These check the sex hormone levels of the partners.

One major problem with these tests is that they all take time. If the woman is no longer young, it may be suggested that she bypass all tests and goes straight for in vitro fertilization. However, most tests are covered by much medical insurance, and in vitro fertilization often is not.

It is only natural to want to know the cause of infertility. If either partner has tubal obstruction, or corrective surgery works, the problem is cured. If the problem is with the egg or sperm, hormone therapy is highly effective. The couple can then have as many children as they wish. With in vitro fertilization, an entire new program must be undertaken each time for each new baby. No single program can guarantee success.

Research from in vitro programs shows that time is a critical factor in choice. In’ one program, 35 women over age 40 had their eggs fertilized outside the uterus. When the fertilized eggs were returned to the uterus, only 5 women achieved pregnancy and none carried the fetus to term. Yet when these same women received eggs donated by women under age 35, 20 got pregnant and 15 delivered babies.