Male factor infertility: Semen analysis and sperm DNA fragmentation explained
An exclusive interview with Dr. Keith Jarvi, Head of Urology at Mount Sinai Hospital in Toronto, Canada
On EP44 of My Fertility Podcast we welcome Dr. Keith Jarvi, a Lunenfeld-Tanenbaum Senior Clinician Scientist, Head of Urology at Mount Sinai Hospital, and Director of the Murray Koffler Urologic Wellness Centre, the largest male infertility clinic in Canada.
Learn about diagnostic testing offered for male factor infertility: semen analysis and other testing at Markham Fertility Centre.
Let’s start with the basics: semen analysis. What makes it such a crucial test in male fertility evaluation?
Dr. Jarvi: Thanks for having me! The semen analysis is the foundational test for male infertility. Any couple that has been trying to conceive for a year without success should consider this test. There are two major components we evaluate:
- Sperm Count: If a man has a low sperm count, that’s an immediate red flag.
- Sperm Motility: This is actually more important than count. If sperm motility is very low, the chance of natural conception is extremely low.
All of these factors play a role, but severe issues in any one of them can indicate a problem.
That makes a lot of sense! One term that frequently confuses patients is sperm morphology. Can you explain what morphology is and why it’s such a debated topic?
Dr. Jarvi: Absolutely. Morphology refers to the shape and structure of sperm. A “normal” sperm should have an oval head and a long, straight tail. However, morphology is tricky because even slightly abnormal sperm can still lead to successful conception.
The problem is in the interpretation—what one technician deems abnormal, another may consider normal. Generally speaking, if a lab finds very low morphology and the count and motility are also low, that’s a concern. If count and motility are good, we may not worry too much about morphology alone.
That’s helpful! And how is morphology assessed in a semen analysis?
Dr. Jarvi: There are different grading systems, but most labs now use the Kruger strict morphology criteria. According to this method, sperm must be nearly perfect to be considered normal. If 4% or more of the sperm meet these strict criteria, it’s considered within the normal range.
Some labs use a less strict morphology assessment, where a higher percentage (e.g., 30%) may be reported as normal. It’s important for patients to understand which method was used when interpreting their results.
What if a patient gets a report showing 0% normal forms? Does that mean they cannot conceive?
Dr. Jarvi: Not necessarily. We need to look deeper into the details. If sperm have multiple severe defects, like missing heads or two tails, that’s problematic. However, if most sperm have only mild irregularities, conception is still possible.
Also, sperm selection in the reproductive process is highly efficient. The best sperm are typically the ones that fertilize the egg, reducing the risk of abnormalities in the child.
That’s reassuring! Let’s talk about sperm viability testing. What is it, and why is it important?
Dr. Jarvi: Great question. Viability testing determines how many sperm are alive versus dead. This is especially crucial for men with low motility because some sperm may simply be alive but not moving, while others are truly dead.
Labs perform this test using a special dye—live sperm remain unstained while dead sperm absorb the dye. If a man has low motility but high viability, fertility specialists can still work with the live sperm.
That leads us to sperm DNA fragmentation. What is it, and why does it matter?
Dr. Jarvi: Sperm DNA fragmentation measures the integrity of sperm DNA. Even if a semen analysis looks normal, high DNA fragmentation can increase the risk of pregnancy loss and lower the success rates of IUI and IVF.
Fragmentation is caused by oxidative stress, which damages sperm DNA. This can result from aging, smoking, obesity, heat exposure, or medical conditions like varicoceles.
Who should undergo DNA fragmentation testing?
Dr. Jarvi: There’s some debate on this. However, we generally recommend it for:
- Couples with recurrent pregnancy loss
- Couples with unexplained infertility
- Men with low sperm motility or abnormal morphology
- Before IVF, especially in older couples
What does a high DNA fragmentation result mean for a couple?
Dr. Jarvi: If fragmentation is above 30%, it’s associated with lower fertility rates and higher miscarriage risk. If it’s exceptionally high (50-60%), fertility outcomes are often poor.
However, we can improve sperm DNA quality by:
- Lifestyle changes (weight loss, quitting smoking, reducing stress)
- Antioxidant supplements
- Scrotal cooling
- Treating varicoceles (if present)
Speaking of scrotal cooling, what exactly is that?
Dr. Jarvi: Scrotal cooling lowers testicular temperature, which improves sperm quality. This can be done using specialized cooling devices or even a simple ice pack wrapped in a cloth.
For best results, men should apply cooling therapy for at least one hour daily for three months.
Is sperm retrieval from the testicles better than using ejaculated sperm for IVF?
Dr. Jarvi: This is controversial. Sperm taken directly from the testicles has less DNA damage than ejaculated sperm. However, it’s also less mature, so outcomes vary. We usually only recommend this approach if previous IVF cycles have failed.
What about anti-sperm antibodies? Should patients be worried?
Dr. Jarvi: Anti-sperm antibodies are immune system proteins that mistakenly attack sperm. This can occur after vasectomy, infection, or trauma.
If antibodies are present, they can bind sperm together and prevent fertilization. The best treatment is usually IVF with ICSI (intracytoplasmic sperm injection).
Final question—why isn’t DNA fragmentation testing covered by OHIP?
Dr. Jarvi: Simply put, OHIP is slow to cover newer tests. The test costs around $200-350 and must be paid out of pocket. If more patients advocate for coverage, this could change in the future.
Thank you so much, Dr. Jarvi! This was an incredibly informative discussion, and I’m sure our listeners will appreciate your expertise.
Dr. Jarvi: My pleasure! Thanks for having me.
If you found this interview helpful, stay tuned for Part 2, where we dive deeper into how to improve sperm health for fertility!