生育地圖How Does Male Infertility Affect IVF Treatment? What is ICSI?
Male factors (sperm issues) account for approximately 40–50% of infertility causes in couples. Common diagnostics include semen analysis (WHO 2021 6th edition reference lower limits: progressive motility PR ≥30%, normal morphology ≥4%). When sperm problems are identified, ICSI (Intracytoplasmic Sperm Injection) is a common laboratory option in IVF treatment. The following is a neutral educational summary, not medical advice.
WHO "Laboratory Manual for the Examination and Processing of Human Semen" 6th edition (2021) ↗
How to Prepare for a Semen Analysis? How Many Days of Abstinence?
Semen analysis is a core test for male evaluation. Collection methods affect result accuracy. Common preparation points are as follows:
- Abstinence period: Avoid ejaculation for approximately 2–7 days before collection. Too short or too long an interval may affect parameters.
- Pre-collection status: Avoid alcohol consumption and note recent fever (fever may temporarily affect sperm performance).
- Collection method: Usually obtained by masturbation in a clinic collection room. Collect the entire sample completely (the first portion has higher sperm concentration, avoid missing it).
- When collecting at home: Must be kept near body temperature, protected from sunlight, and delivered to the laboratory within approximately 30–60 minutes.
- Single results can fluctuate: If results are abnormal, a repeat test is usually scheduled after an interval (about 2–4 weeks or more) to confirm, not based on a single test.
This section is a neutral educational summary, not medical advice. Actual collection protocols depend on the institution.
What Do 'Oligozoospermia, Asthenozoospermia, Teratozoospermia, Azoospermia' Mean in a Semen Report?
Semen reports often use specific terms to describe abnormal aspects. Comparison is as follows:
| Term | English | Meaning |
|---|---|---|
| Oligozoospermia | Oligozoospermia | Low sperm concentration or total count |
| Asthenozoospermia | Asthenozoospermia | Low progressive motility |
| Teratozoospermia | Teratozoospermia | Low percentage of normal morphology |
| Oligoasthenoteratozoospermia | OAT | Combination of the above three |
| Azoospermia | Azoospermia | No sperm found in ejaculate (obstructive or non-obstructive) |
| Cryptozoospermia | Cryptozoospermia | Very few sperm found only after centrifugation and concentration |
Interpretation is based on World Health Organization (WHO) reference values. A single abnormal result requires repeat testing. Overall significance is assessed by a physician based on individual condition. This section is a neutral information summary, not medical advice.
What Are the Differences Between PESA, TESE, and Micro-TESE for Azoospermia or Difficult Sperm Retrieval?
When usable sperm cannot be obtained from ejaculate, surgical sperm retrieval may be necessary, followed by ICSI for fertilization. Common procedures are compared below:
| Procedure | Site/Method of Sperm Retrieval | Common Indications |
|---|---|---|
| PESA | Percutaneous epididymal sperm aspiration | Obstructive azoospermia (sperm present in epididymis) |
| MESA | Microsurgical epididymal sperm aspiration | Obstructive azoospermia, retrieved under microscope |
| TESE | Testicular sperm extraction (biopsy) | Obstructive or non-obstructive conditions |
| micro-TESE | Microdissection testicular sperm extraction (searching for seminiferous tubules under microscope) | Non-obstructive azoospermia, more helpful in finding rare sperm |
Retrieved sperm are usually used with ICSI for fertilization. The ability to obtain sperm and the choice of procedure must be evaluated by a physician. This section is a neutral information summary, not medical advice.
What Is the General Workup Process for Male Infertility?
Male evaluation typically proceeds from simple to complex, gradually clarifying the cause. Common steps are as follows:
- History and physical examination: Inquire about past illnesses, surgeries (e.g., hernia, undescended testis), medications, and lifestyle; perform testicular physical exam.
- Semen analysis: Core initial test; repeat if abnormal.
- Hormonal testing: If necessary, measure FSH, LH, testosterone, prolactin, etc.
- Imaging: Scrotal ultrasound to evaluate varicocele and structural issues.
- Genetic testing: In cases of severe oligozoospermia or azoospermia, may include karyotype, Y chromosome microdeletion, etc.
- Multidisciplinary integration: As needed, urology (male reproduction) and reproductive medicine collaborate to plan next steps.
Actual tests vary by individual condition and institution, as assessed by a physician. This section is a neutral information summary, not medical advice.
WHO 2021 (6th Edition) Reference Lower Limits for Semen Analysis
When receiving a semen analysis report, it is often necessary to compare with the reference lower limits published by the World Health Organization (WHO). The table below lists the lower limits from WHO 2021 (6th edition) and notes differences from WHO 2010 (5th edition) to avoid using outdated values.
| Parameter | WHO 2021 (6th ed.) Lower Limit | Difference from 5th ed. |
|---|---|---|
| Volume | ≥1.4 mL | 5th ed.: ≥1.5 mL |
| Sperm concentration | ≥16 million/mL | 5th ed.: ≥15 million/mL |
| Total sperm number | ≥39 million/ejaculate | Unchanged |
| Total motility (PR+NP) | ≥42% | 5th ed.: ≥40% |
| Progressive motility (PR) | ≥30% | 5th ed.: ≥32% |
| Vitality | ≥54% | 5th ed.: ≥58% |
| Normal morphology | ≥4% | Unchanged |
| pH | ≥7.2 | Unchanged |
These values are the 5th percentile lower limits derived from a large population of fertile men; they are statistical references, not absolute boundaries between normal and abnormal. A single value below the limit does not indicate infertility; repeat testing after an interval is usually needed. Overall significance is interpreted by a physician based on individual condition.
Reference values are based on WHO 6th edition (2021). Laboratory standards may vary slightly. This section is a neutral information summary, not medical advice.
FAQ
How is male infertility diagnosed?
Common diagnostic tools include semen analysis (evaluating sperm concentration, motility, morphology), hormonal testing, and, if necessary, testicular sperm retrieval assessment. Diagnosis must be made by a urologist or reproductive medicine specialist based on individual condition. This page is neutral educational information, not medical advice.
What is ICSI (Intracytoplasmic Sperm Injection)?
ICSI (Intracytoplasmic Sperm Injection) is a fertilization method in IVF where a single sperm is directly injected into an egg by an embryologist. It is indicated for cases of low sperm concentration, poor motility, or abnormal morphology. Whether to use it is assessed by a physician.
What indicators are looked at in a semen analysis report?
World Health Organization (WHO) 2021 (6th edition) reference lower limits include: volume ≥1.4 mL, total sperm count ≥39 million/ejaculate, sperm concentration ≥16 million/mL, total motility ≥42%, progressive motility (PR) ≥30%, normal morphology ≥4%. Laboratory standards may vary slightly. It is recommended to have a physician explain the significance of individual reports.
What are common causes of male factor infertility?
Common factors include varicocele, hormonal imbalances (e.g., low testosterone), vas deferens obstruction, chromosomal abnormalities (e.g., Y chromosome microdeletion, Klinefelter syndrome), and history of certain chemotherapy or surgeries. The exact cause requires diagnosis by a physician.
What tests are needed before a male enters an IVF cycle?
Typically, semen analysis, infectious disease screening (HIV, syphilis, hepatitis B/C), and, if necessary, hormonal evaluation and genetic counseling are required. In specific cases (e.g., azoospermia), testicular or epididymal sperm retrieval assessment (TESE/PESA/MESA) may be needed. Specific items depend on institutional protocols.
Can azoospermic patients undergo IVF?
Azoospermia is classified as obstructive or non-obstructive. In obstructive cases (e.g., vas deferens obstruction), sperm can be retrieved via epididymal or testicular aspiration (PESA/TESE) for use with ICSI. Non-obstructive cases are more complex; the ability to obtain sperm must be assessed by a physician. This page is neutral information, not medical advice.
What is the relationship between varicocele surgery and IVF treatment?
Varicocele surgery may improve semen parameters, but outcomes vary by individual and require several months of observation. Whether surgery is performed and its impact on IVF planning should be jointly evaluated by a urologist and reproductive medicine specialist. This page is neutral information.
Does using ICSI increase the cost of IVF?
ICSI usually incurs additional laboratory fees, which vary by institution. Testicular sperm retrieval surgeries (TESE/PESA) are also separate charges. It is recommended to request a complete cost breakdown including possible procedures during consultation. This page is neutral information; costs are subject to institutional written explanations.
Further References (Official Data Sources)
· This page is a neutral compilation of information, for reference only, not medical advice, and does not constitute any treatment commitment. Actual regulations and treatments should be based on announcements from competent authorities and explanations from qualified physicians.
