Although the most determining factor, or at least one of the most important when achieving a pregnancy, is the woman’s age, it is equally important to study the man.
To rule out possible problems when it comes to getting pregnant related to male fertility, the first thing to do is take a good anamnesis and an exhaustive medical history of the man that collects all the antecedents, both family and personal. Above all:
The first thing will be to know the medical history of the male to rule out problems that cause infertility.
The most important complementary test for men is the seminogram, which is used to assess the number and motility of the sperm and the morphology.
Faced with a pathological result, it is best to repeat the sample after a few weeks, at least 15 days later. This test will guide the couple towards what type of treatment should be carry out if an Assisted Reproduction Technique is necessary. In cases of doubt, REMT (total sperm count) will be perform after sample training. If the REMT is greater than 5 million, the sample is suitable for inseminations. Below this value, conventional IVF will be indicates, and if it is less than 1 million, it will be IVF by microinjection.
In cases of male factor, in couples who are going to undergo an In Vitro Fertilization technique, it is also necessary to request a karyotype in peripheral blood in cases of repeated abortions or suspected genetic alterations. This test studies the 22 pairs of homologous chromosomes and the sex chromosomes X and Y. Other genetic tests for the male are determinations of microdelections of the Y chromosome, studies of the cystic fibrosis gene, both in blood.
Other genetic studies are carry out on sperm; it is FISHe (fluorescent in situ hybridization of sperm), which determines the chromosomal endowment of sperm. Others are the study of meiosis and the study of sperm DNA fragmentation. The ultimate goal of all these genetic tests is to select genetically normal sperm when performing an assisted reproduction technique and thus avoid or at least minimize the possibility of genetic alterations and abortions in these couples.
In cases of azoospermia (no presence of sperm in the ejaculate), the most important thing is determining whether it is azoospermia due to obstruction of the seminal tract or it is azoospermia due to no sperm production. In cases of azoospermia due to obstruction, a testicular biopsy can be perform, consisting of taking a small piece of pulp from the testicle and looking under the microscope whether or not there are sperm in the tissue. If we find sperm that are not motile, it will be necessary to perform an IVF cycle to fertilize oocytes by introducing the sperm into the egg or ICSI. If we do not obtain sperm in the sample, the couple will have to change the male gamete and go to a semen bank.
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