OCCULTIC INFERTILITY 2: WHAT TO DO WHEN YOUR SPERM ANALYSIS’ RESULT IS BAD.

Semen analysis remains the mainstream for further decision-making investigations in infertile male. Indeed, semen analysis, when correctly executed following WHO guideline gives clinically important information not only on the fertility potential of a man, but also on the general health status of the male reproductive tract. It should also clear that semen analysis not necessarily to the fertility potential of a man, and in particular of the specific couple one is investigating. Furthermore, interpretation of semen analysis report should be done considering all parameters together and in the context of all other clinical information of the patient.

Semen analysis is not etiological and pathophysiological diagnosis of male infertility, as it merely indicates the fertility potential and health status of the testis and seminal tract. Accordingly, no treatment should be done based on semen analysis alone only. When you have poor semen result, the next thing you need to do is hormonal assay. Hormones play a very important role in the male fertility process. GnRH (gonadotropin-releasing hormone) is a hormone that stimulates the pituitary gland, which is the brain’s hormonal control center. The pituitary gland in turn releases FSH (follicle-stimulating hormone), which stimulates the testicles to make sperm. The pituitary also secretes LH (luteinizing hormone), which causes the testicles to produce testosterone, which is needed in high levels to promote adequate sperm production. A deficiency in any of these hormones can cause significant problems with sperm production and quality. In addition, some fertility-related issues (such as normal erection and ejaculatory function) also rely on adequate hormone levels and balance.

Medical care providers who are not very familiar with male infertility problems often prescribe hormonal medications just to try out a treatment, without any identified hormonal problem that they are trying to correct (this is called "emperic" treatment). Studies have shown that this type of hormonal treatment is not particularly effective. A better way of evaluating and managing hormonal problems in men is to always try to get baseline hormone levels drawn before any hormonal medications have been started. If your FSH & LH are normal, it means if you are given right treatment, you will respond and your sperm quality will improve. Please note that a good treatment should run for at least 90 days, if the quality is too poor. If FSH & LH results are high, depend on the result values, there may be indication for testicular failure. Any treatment at this stage may be a journey to no destination. If you are oligospermia, rather than wasting your time and fortune on any treatment when you have a very high value of FSH & LH, it better you use the few sperm cells present in your body for ART treatment option to achieve conception. There is hope for you, if you know the right thing to do. Some men with low sperm count has been treated with testosterone injection/drug derivatives, without any check on your testosterone level. It should be noted that if you take testosterone injection/drug derivatives, and your testosterone is relatively normal, your low sperm count will end up in azoospermia (Zero sperm count). This is the reason why you have increase in your sperm count and when you continue the treatment, you find out that your result is becoming bad.

There are some drugs you could take to improve/boost your sperm count and quality. If your sperm quality is poor, please stay away from alcohol and stop smoking. This habit affects the ability of the sperm cells to fertilize egg due to sperm DNA damage cause by reactive oxygen species (ROS). If you have moderate oligospermia (low sperm count), there is treatment option in assisted reproductive technology that will enhance achieving conception with your wife. Those that have severe oligospermia (Few sperm cells) to azoospermia (No sperm cells), there is hope in assisted reproductive technology to achieve pregnancy with your wife.

TO BE CONTINUED.

REFERENCES:

https://www.maleinfertilityguide.com/hormone-testing-and-interpretation.

Alberto Ferlin, (2017), Sperm DNA fragmentation testing as a diagnostic and prognostic parameter of couple infertility. Transl androl Urol.

WOJUADE KEHINDE (Semenology & IUI 2017, Advance andrology (2019) EART India, Basic Fertility Course (IIRRH, India,2019) IS THE CEO/Fertility Scientist OF ABIMS UNIQUE MEDICAL LABS SERVICE/ ANDROLOGY. 37 AKINREMI STREET ANIFOWOSE IKEJA. Whatapp/call: +2348023026235. +2348077047724. www.abimsuniqe.com [email protected].

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