Dad's Guide to Pregnancy For Dummies. Sharon Perkins

of normally shaped sperm is considered to be anything above 30 percent.

       Trajectory: Graded on a 4-point scale, this test determines how many of your sperm are moving forward. A normal score is 2+.

       White blood cells: Too many white blood cells can indicate an infection in your groin. A passing grade is no more than 0 to 5 per power field.

       Hyperviscosity: Your semen sample should liquefy within 30 minutes after ejaculation. If it takes longer, it reduces the chances for sperm to swim before being expelled from the vagina.

       pH: Like an AA battery, your semen needs to be alkaline to avoid making the vagina too acidic and, ultimately, killing the sperm.

      A semen analysis also evaluates the following:

       Head quality: The head of the sperm contains all the genetic material, so if the head is misshapen, it won’t be capable of fertilizing an egg.

       Midsection malaise: Believe it or not, this part of your sperm contains fructose, which gives your sperm energy to swim. If the levels are low, it can account for slow swimmers.

       Tail troubles: Much like a fish, a good tail is required for the sperm to swim forward. If too many of your sperm have no tail, multiple tails, or tails that are coiled or kinked, they won’t reach their destination.

      

A low sperm count may have you feeling, well, downright low. Feeling embarrassed is completely natural but also completely unnecessary. Infertility has no correlation to a man’s masculinity, nor does it have anything to do with the size of his penis. Having a low sperm count is no different from having asthma — it’s a medical condition that requires treatment.

      

Because sperm counts are created months out, you need to have a follow-up semen analysis to see whether the issue is corrected by lifestyle changes. Although you won’t be in a rush to do it all again anytime soon, whether your results are good or bad, schedule a follow-up analysis four to six weeks after the first one to get a better, more complete picture.

      Identifying and treating the causes

      The most common cause of a low sperm count is a varicocele, an abnormality in the vein in your scrotum that drains the testicles. Varicoceles can cause decreased fertility in the following ways:

       Increasing temperature in the testes

       Decreasing blood flow around the testicles

       Slowing sperm production and motility

      Varicoceles are treatable in the following ways:

       Surgery: An outpatient procedure during which an incision is made just above the groin and the swollen vein is “tied off.” Recovery takes seven to ten days and requires minimal activity and no heavy lifting. Risks are minimal and include infection, nerve injury, and the collection of fluid around the testicles.

       Radiographic embolization: Also an outpatient procedure, this requires the insertion of a catheter through the femoral vein in the groin. Dye is injected to show where the problem is located and, when isolated, it’s blocked so blood flow to that vein stops.

Other less common male-fertility issues include the following:

       Hormone imbalances: Medications to adjust hormone levels may improve sperm quantity.

       Chromosomal abnormalities: One such problem is sperm that lack part of the Y chromosome, which is the male chromosome. In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), where the best-looking sperm are injected directly into your partner’s egg in the lab, can help overcome abnormal sperm issues. (See the following section for more info.)

       History of cancer: Having treatment for cancer, including lymphoma and testicular cancer, can kill or damage sperm. Many men freeze sperm before undergoing cancer treatment for this reason.

       Various diseases: Diabetes, sickle cell disease, and kidney and liver diseases can cause problems. Treatment depends on your individual issues.

      Even if your ejaculate has no sperm at all, a procedure called a sperm aspiration in conjunction with an IVF cycle may be able to remove sperm directly from the testicles.

      Examining new developments in infertility treatments

      Researchers are always looking for the next big thing in treating infertility. Many of the most recent research has centered around eggs, namely freezing them and producing them.

      Putting eggs on ice

      Freezing sperm is old hat in the infertility world. Embryos can also be quite successfully frozen and thawed years later. Eggs, however, have had less success in the freezing department because they contain more water than embryos or sperm. Enter vitrification, a kind of “flash freezing” technique many fertility clinics now use to preserve eggs for later use.

      Although egg freezing doesn’t have a lot of application for most couples, it can be a valuable technique if your partner has to undergo treatments that could seriously damage her ovaries or if a disease such as endometriosis is destroying her ovaries.

If you’re not quite ready for parenthood but your partner is feeling the effects of the ever-advancing biological clock, egg freezing can buy you the time you need to travel the world, advance your careers, or climb Mt. Everest before settling down to parenthood.

      

Even though some fertility clinics claim high success rates freezing eggs, the proof is in the pudding, so to speak. You won’t necessarily know whether it worked until you actually try to use frozen eggs, perhaps years later, when it’s too late to go back for more. In most cases, fertilizing the eggs and freezing them as embryos has a better chance of success down the road.

      Circumventing early menopause

      Research that’s still in preliminary stages may find a way to make ovaries produce eggs in women who are in premature ovarian failure (POF), a condition where menopause that occurs early (before age 40) results in a shutdown of egg production.

      Researchers have removed the ovaries in women experiencing POF, cut the ovary into sections, and then treated them with drugs to block a protein that prevents egg follicles from growing normally. The ovary fragments are transplanted back near their original site, where the egg follicles then begin to grow. This technique could eventually help women whose reproductive days are cut abnormally short.

      Deciding how far to go to get pregnant

      Deciding what steps you’re willing to take to get pregnant is easier after you have a better understanding of the infertility issues you and your partner face. Most infertility treatments can be quite expensive, so check with your insurance company to see what it covers.

      

Making decisions on infertility treatments based on finances seems heartless, but if your insurance doesn’t cover a treatment or medicines, you could be looking at bills in the thousands of dollars.

      The most common procedures to aid in pregnancy are the following:

       Intrauterine insemination (IUI): A lab tech takes your sperm sample, pulls out the best of the best, and adds it to a saline solution, which is then inserted past your partner’s cervix. This gives the sperm a far shorter distance to travel and a greater chance for success.

       In