Obstructive

■ Congenital—congenital absence of vas deferens (associated with cystic fibrosis)

■ Acquired—vasectomy or infection (e.g., epididymitis)

Poor motility (asthenospermia)

• Motility probably more important than sperm count

• Causes include prolonged abstinence, excessive heat (e.g., vari-cocoeles, hot baths), excessive alcohol, smoking, recreational drugs, toxin exposure (e.g., solvents, pesticides, lead, mercury, gold), urogenital infection, anti-sperm antibodies (e.g., after vasectomy or testicular trauma), partial ductal obstruction, and idiopathic

Increased abnormal morphology (teratozoospermia)

• Rarely occurs in isolation; causes include impaired sperma-togenesis and testicular failure

In the absence of any abnormal parameters, if indicated, further adjunctive sperm function tests may be performed. These include—

• Computer-assisted semen analysis—to decrease subjective variables

• Seminal fructose testing—to detect seminal vesicle agenesis or obstruction

• Anti-sperm antibodies

• Semen leukocyte analysis—to detect an inflammatory etiology

• Sperm-cervical mucus interaction

• Sperm penetration assay—to assess the ability of sperm to penetrate a hamster egg

• Hypo-osmotic swelling test—to assess sperm motility

• Safe and non-invasive initial test for male factor sub-fertility

• If abnormal it suggests the likelihood of decreased fertility

• Prone to variations

• Not a direct measure of fertility

• Semen count and motility correlate best with fertility

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