Find clue to curing sperm infertility cells men

M yles Elton was 21 when his doctor told him he might never have children.

He and Erin were teenage sweethearts and had married the year before. Then, after an offhand comment from his mother about a medical complication Myles suffered as a baby, which can often lead to infertility, he booked in for a series of tests. The results were life-changing. In our minds, that was something that would just happen.

So Erin went off the pill. After five months, Erin was pregnant with Lucy, who will turn five in March. It took seven months to conceive Norah, who was born when they were both Myles and Erin are now 27, and hoping for a third child. The family live in Wollongong, an hour south of Sydney.

When I speak to them, the girls have just had bathtime and are sitting, damp-haired and pyjama-clad, on the bed with their dad.

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Lucy is a bundle of giggly, nervous energy, and with good reason: it is the day before she is due to start school and she is excited. One thing is sure: they will be among the youngest parents at the school gates. Myles says that when people found out he and Erin were expecting Lucy, they were shocked. I love being a young dad.

In many ways, Myles has been lucky.

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He found out he might be infertile in plenty of time. Professor Allan Pacey has worked in the field of male infertility for two decades. As with women, fertility issues increase as men age. This news is difficult to comprehend for a generation of men who have grown up seeing images of famous older men becoming fathers.

Pablo Picasso had his last daughter at the age of 67, the same age Steve Martin had his first, and Rod Stewart, who had his first child at 18, welcomed his eighth at the age of But these are exceptions to the rule. In reality, Jayasena says, once men are over 35, their age and the lifestyle changes that come with it become major factors in whether their partner will be able to get pregnant.

Research now suggests that men above the age of 35 are about half as fertile as men under the age of The decline in fertility is not as clearcut among men as among women, with experts debating the relative influence of contributing factors, including reduced sperm count and motility, and lifestyle changes such as decreased sexual frequency and increased bodyweight. Advanced paternal age also leads to an increased risk of miscarriage.

In , researchers led by Dr Stephanie Belloc from the Eylau Centre for Assisted Reproduction in Paris studied 12, couples undergoing fertility treatment. They found that the chances of miscarriage almost doubled, from Yet unlike women, whose biological clocks are endlessly discussed and dissected, and who are now in some cases being offered egg-freezing as a corporate perk, young men tend not to think about their fertility unless something goes wrong.

The year-old from Essex had suffered from pain in the scrotum for five years, and two years ago was diagnosed with varicocele, an abnormal enlargement of the veins which affects blood flow to the testicles. Then he was faced with the prospect of surgery, which carried a slight risk of affecting his fertility. The position and size of the urethral meatus should be noted because severe hypospadias can impair sperm deposition near the cervix. Those smaller than 20 cm 3 are suggestive of decreased sperm production and may occur in hypogonadal men as well.

Varicoceles are found most commonly on the left side, but up to 20 percent may be bilateral. Diagnosis should be made in a warm room by palpation of the spermatic cord with the patient in the standing position. An isolated right-sided varicocele or a lesion on either side that does not disappear when the patient assumes the supine position should prompt imaging of the retroperitoneum to evaluate for inferior vena caval or renal vein obstruction. Digital rectal examination is performed to examine the prostate gland, seminal vesicles, and possible cysts that can cause ejaculatory duct obstruction.

Table 3 presents clinical clues to and possible diagnoses of male infertility. Infrequent intercourse, lubricant use. Decreased virilization or abnormal hair distribution, gynecomastia. Low semen volume. Obstruction vs.

Causes of Male Subfertility

The semen analysis is the foundation of the laboratory evaluation. At least two samples, preferably taken at least two or three weeks apart, should be analyzed after two to three days of sexual abstinence. The sample should be collected by masturbation in a clean container and analyzed within one hour of collection. The sample can be collected at home if it is kept at body temperature and brought to the laboratory in sufficient time.

Normal semen parameters, as defined by the World Health Organization, are summarized in Table 4. Leukocytospermia, which is defined as more than 1 million white blood cells per mL of semen, requires specific testing. It is not possible to definitively identify these cells by microscopic appearance alone.

Doxycycline Vibramycin , in a dosage of mg twice a day for two weeks, is an effective regimen. A repeat semen analysis should be performed at the completion of therapy. The semen analysis does not test fertility, but rather fertility potential. The chance of initiating a pregnancy correlates with the total number of moving sperm. The morphology is a measurement of the percentage of the normal-shaped sperm.

The Kruger or strict morphology score has been correlated with decreased success with fertilization in vitro. The significance of this finding in estimating the chance for natural conception is less clear. As with any other single semen parameter, it cannot be used in an absolute way to predict fertility. A semen analysis does not assess sperm function. Specialized testing is available to evaluate this factor, and the test of choice varies among treatment centers.

Most tests attempt to examine some component of sperm-oocyte interaction or fertilization. Interpretation of these test results can be difficult, and the question of whether the results influence clinical management is controversial.

These tests generally are performed only in specialized fertility laboratories. Male subfertility caused by correctable endocrinopathies is rare. As such, hormone testing for all subfertile men is not necessary.

When sperm concentration is less than 10 million per mL, measurement of the serum testosterone and follicle-stimulating hormone FSH levels is indicated. If the total testosterone level is normal, no further endocrine testing is needed. If the total testosterone level is low, the serum luteinizing hormone and prolactin levels can be checked to evaluate for a pituitary cause.

When testosterone is merely borderline or only slightly low, supplementation should be avoided unless the man is significantly symptomatic i. Testosterone supplementation will actually lower the sperm concentration in such men because it can cause pituitary suppression of gonadotropins. In the setting of subfertility, the FSH level may be elevated, suggesting end-organ testicular failure. A low level may indicate an underlying FSH deficiency, such as occurs with hypogonadotropic hypogonadism Table 3.

More specialized testing may be required based on the outcome of this initial evaluation Figure 1. Most specialized testing requires referral to a center with clinical and laboratory expertise in the field of reproductive medicine. For example, men with low ejaculate volume less than 1 mL should have a post-ejaculatory urine sample analysis to rule out retrograde ejaculation.

Azoospermic men can undergo testicular biopsy to evaluate the level of sperm production and differentiate between testicular failure and obstruction i. In patients with azoospermia, low semen volume less than 1 mL , and a normal FSH level, transrectal ultrasonography is indicated to evaluate for possible ejaculatory duct obstruction 31 Figure 2. Multicenter trials are underway, but previous data suggest that the fertilization rate in vitro decreases if there are less than 15 percent normal-shaped sperm, as defined by the World Health Organization manual. Adapted with permission from World Health Organization.

Reference values of semen variables. In: WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction. Cambridge: Cambridge University Press, —1. Genetic testing and counseling are indicated in specific instances.