Male fertility tests: fructose, anti-sperm antibody and post-coital tests
MALE FERTILITY TESTS: FRUCTOSE, ANTI-SPERM ANTIBODY AND POST-COITAL TESTS
If there are no sperm in the semen analysis it may mean that none are being produced by the testes, or that they are being produced but the tubes are blocked and they cannot get through to be ejaculated. Where no sperm are present, a test for fructose is done. Fructose is a sugar normally found in semen. The absence of fructose in the semen can mean that the seminal vesicles are blocked, stopping both sperm and fructose from getting through. It may be possible to surgically correct such a blockage. Alternatively, the absence of fructose could mean that the man does not have any seminal vesicles. If fructose is present but the man does not have any sperm in the sample, further investigations need to be done. These can reveal whether there is a blockage nearer to the testes or whether the testes are not in fact producing sperm.
Anti-sperm Antibody Test
This test attempts to determine whether the man is producing substances which are causing the sperm to clump together, lose motility or prevent fertilisation. These antibodies would make the man's immune system 'see' his own sperm as foreign bodies and try to destroy them.
The most common test for antibodies is the MAR (mixed antiglobulin reaction) test which is now often done as part of the normal semen analysis. If antibodies are present, the sperm will be clumped together instead of moving freely.
Sperm antibodies can be produced in response to an infection. Antibodies can also be produced in about 70 per cent of men after a vasectomy. During the procedure some sperm may leak out and, because previously they had been contained within the reproductive system, the body views them as a foreign substance and produces antibodies to them.
Treatments for anti-sperm antibodies may include steroids which carry their own side-effects, such as weight gain, stomach bleeding and depression. IVF may be a possibility if the sperm can still penetrate the egg, otherwise ICSI will be suggested.
It is also possible for the woman to be producing antibodies to her partner's sperm and this can be checked by a blood test.
The post-coital test has been used since the 1860s to assess the cervical mucus and the sperm's ability to swim through it. You go to the clinic around the time of ovulation after having intercourse about four to ten hours before. A cervical mucus sample is taken and examined under a microscope. The clinic is looking to see whether there are any sperm in the mucus, whether they are dead, or whether they are just shaking rather than moving forward. If a man has active, healthy sperm when he gives a sperm sample, and yet in the post-coital test the sperm are dead, then something is obviously happening once the sperm are inside the vagina. The test needs to be performed precisely at the right time of the cycle and it is possible to get a number of false results. This means that it has to be repeated, if it looks as if the woman is killing off her partner's sperm.
There are not many clinics who still do this test and it is interesting that a study published in the British Medical Journal in 1998 came to the conclusion that 'Routine use of the post-coital test in infertility investigations leads to more tests and treatments but has no significant effect on the pregnancy rate'. The researchers took couples who were attending an infertility clinic and then split them randomly into two groups. One group had all the usual fertility investigations plus the post-coital test and the other group just the fertility investigations without the post-coital. At the end of the study there was no difference in the number of pregnancies between the two groups, and yet the group having the post-coital test was given more fertility treatments on the basis of their post-coital results.
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