Male Infertility

Severe male infertility

(Very low sperm numbers, azoospermia)

The most severe forms of male infertility are non-obstructive azoospermia and severe oligospermia (or cryptozoospermia), where men have very rare sperm in the ejaculate. It is important to remember that standard semen analyses do not evaluate the entire semen specimen. What? How can that be true? Let me review the details of how a semen analysis is done.

Semen analysis

A standard semen analysis evaluates the ejaculated fluid for the number, motility, and morphology (shape) of sperm as well as some other characteristics. If no sperm are initially seen, then the sample is centrifuged (spun at high speed) to concentrate the cells, including sperm, that may be present in the specimen.

The centrifuged specimen typically has a volume of 200 to 400 microliters. The specimen typically has 5 to 20 microliters of that sample taken and examined under an operating microscope for analysis. The report that you receive is therefore on a very small part, possibly as little as 1% of the total concentrated sample. So, it is not a complete evaluation of the semen specimen. More complete evaluation of a semen specimen is only done by a limited number of laboratories, and is typically called an Extended Sperm Preparation (ESP) or Extended Prep, and requires much more work on the part of the laboratory (as the second part of this analysis can take hours.) Early reports describing this “ESP” are provided here ( https://pubmed.ncbi.nlm.nih.gov/9222005/ ) A relevant brief video is https://youtu.be/0WaTfxB6IeA?list=TLPQMjEwOTIwMjP1bcMbSy7Ktw

Additional management of both cryptozoospermia as well as non-obstructive azoospermia are provided below.

Consult with Dr. Schlegel

Take the first step towards better health and schedule a consultation with Dr. Schlegel today to discuss your specific concerns and explore personalized medical solutions.