Male fertility - it takes two to tango

Any longer than that and the motility may be low because the sperm will have started to die off. Even in a normally fertile sample, the majority of sperm will be misshapen, many will swim round in circles and up to 20% will be non-swimmers. The sperm cycle (the time from production of immature spermatids to the release of fully-formed mature sperm capable of finding and fertilising an egg) takes about 70 days, so sperm tests should not be repeated too close together as this does not leave time for the sperm to recover.

If a first sample is abnormal, it should be repeated after 3–4 weeks, ideally with the sample being produced at the clinic, rather than brought in from home. For men who find it impossible to produce a sample by masturbation, then special silastic condoms are available so their partner can help.

Andrology Assessment

If routine analysis suggests a significant sperm problem then the man should have an 'andrology assessment'. This will include a general health check (stress, hypertension and diabetes are all bad for sperm) and physical examination of the genitalia looking for problems such as:

• Varicocele (varicose veins on the scrotum)
• Undescended testes
• Levels of FSH (follicle stimulating hormone), LH (luteinising hormone) and testosterone – a blood test will give these results.

The sperm samples are further tested to assess 24-hour survival, the proportion of sperm that have rapid forward progressive motility ('gold medal swimmers'!) after preparation and for the presence of anti-sperm antibodies (the MAR test).

Treatments that work

IUI (intrauterine insemination)
For mild 'male factor' problems, the first treatment that the couple can try is IUI (intrauterine insemination). This can be performed in a natural cycle or with ovarian stimulation. The woman's cycle will be monitored with ultrasound scans and/or urinary LH-testing sticks and just prior to ovulation her partner will produce a sperm sample.