For a couple to be able to conceive, the man would have to be able to:
1. Have an erection hard enough for vaginal penetration
2. Ejaculate while his penis is inside the vagina
3. Have sperm in his semen.
If a man is able to perform steps 1 and 2, we will do a semen analysis to check if he indeed has sperm in his semen and if he has sperm, we would need to ascertain the parameters of the sperm, namely the count or density of sperms, motility of the sperm (ability to swim) and morphology of the sperm (normal sperms).
Any of the above parameters can be deranged and affect a man’s fertility.
Men who have seen me for fertility issues range from having erectile dysfunction, ejaculatory dysfunction to deranged sperm parameters or even combination of any of these 3 problems.
As mentioned above, semen analysis will detect any problems with the quantity of sperm (in terms of numbers) as well as the quality of sperm (in terms of motility and morphology).
One of the most common cause of poor semen parameters would be varicoceles (dilated veins that drain the testicles). In couples that present to us with subfertility, with men having deranged semen parameters, 30% of these men would have varicoceles. Treatment of varicoceles have been shown to improve semen parameters. Having said that, this still would not guarantee successful conception.
