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For the man with an abnormal semen analysis, additional tests which may be recommended include specialized sperm tests, blood tests; and testis biopsy.
The role of antisperm antibodies in causing male infertility is controversial, since no one is sure how common or how serious this problem is. However, some men (or their wives) will possess antibodies against the sperm, which immobilize or kill them and prevent them from swimming up towards the egg. The presence of these antibodies can be tested in the blood of both partners, in the cervical mucus, and in the seminal fluid. However, there is little correlation between circulating antibodies (in the blood) and sperm-bound antibodies (in the semen), There are many methods of performing this test, which can be quite difficult to standardize, as a result of which there is a lot of variability between the reports of different laboratories. The older methods of testing used agglutination methods on slides and in test tubes. Perhaps, the best method available today is one which uses immunobeads, which allow determination of the location of the antibodies on the sperm surface. If they are present on the sperm head they can interfere with the sperm's ability to penetrate the egg; if they are present on the tail they can retard sperm motility. Of course, if the test is negative, this is reassuring; the problem really arises when the test is positive! What this signifies and what to do about it are highly vexatious issues in medicine today, and doctors are even more confused about this aspect than patients.
In the semen culture test, the semen sample is tested for the presence of bacteria, and , if present, their sensitivity to antibiotics is determined. Interpreting this test can also be problematic! It is normal to find some bacteria in normal semen samples - and the question which must be answered is : are these bacteria disease- causing or not?
Tests which assess the sperm's ability "to perform" include the following sperm function tests.
The postcoital test is the easiest test of sperm function, since it is performed in vivo. It is done when the wife is in the " fertile" period, during which time the cervical mucus is profuse and clear. The gynecologist examines a small sample of the cervical mucus, under the microscope, a few hours after intercourse. (This can be embarrassing and awkward for the patient, but it is not painful at all). Finding 5-10 motile sperm per high power microscopic field means that the test is normal. A normal test implies normal sperm function and can be very reassuring.
An abnormal test needs to be repeated and, if the problem is persistent, one needs to determine if the defect lies in the sperm or in the mucus, by cross-testing with the husband's sperm, donor sperm, wife's mucus and donor mucus.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
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