I routinely draw a set of hormones consisting of FSH (follicle stimulating hormone), LH (luteinizing hormone), testosterone and estradiol. The pituitary is a gland in the brain that regulates the creation of testosterone and sperm. The hormone FSH, which is also found in the woman, stimulates the testis to make sperm. When there is low or no sperm production, it may be due to an FSH deficiency. If this is the case, there is FSH supplementation available. More commonly, FSH elevation is due to a testicular dysfunction. Testosterone is the hormone made in the testes that supports the production of sperm. The testosterone levels are much higher in the testes than in the blood. LH, released from the pituitary, stimulates Leydig cells to produce testosterone within the testes. Testosterone is typically between 250 and 1200 ng/dl when measured in the blood. When the testosterone is low, some doctors will prescribe testosterone thinking that it will raise the sperm count. While this makes sense intuitively, it leads to a decline and sometimes an absence of sperm production. This is due to a suppression of the normal production of the testosterone in the testes. Testosterone is converted to dihydrotestosterone (DHT), which is a stronger hormone than testosterone. The drug Propecia, used for hair growth, blocks this reaction. Propecia has not been shown to effect sperm production in clinical trials.

Estradiol, or E2, is a hormone which is typically more important in women than men. It is formed when testosterone is converted to it by an enzyme called aromatase. When the estradiol is high, albeit rarely, it may cause breast tenderness and growth. There are medicines called aromatase inhibitors that block the conversion of testosterone to estradiol. They raise the testosterone while lowering the estradiol.



The SCSA is the Sperm Chromatin Structure Assay. It is a test to determine whether the sperm DNA integrity is good. It was initially believed that if the DFI (DNA Fragmentation Index) was 30% or more, that even if the couple was able to achieve a pregnancy through in-vitro fertilization, it would not lead to a live birth. Since that time, pregnancies resulting in live births have occurred using IVF/ICSI with DFI’s that exceeded 30%. The test is somewhat controversial and should be used as a guide. These patients all get ICSI and many embryologists, the scientists in the IVF Labs, believe that by taking the best looking sperm, they can achieve pregnancies that result in live births. Further, there are centers in Europe that are using very high powered microscopes to look at sperm and, by doing so, can achieve pregnancy and live births in patients with high DNA damage. This procedure is call IMSI.

DNA damage is thought to occur within the reproductive tract outside of the testis. It is for this reason that the urologist will do a TESE to harvest sperm prior to the location where the damage is speculated to occur. In addition to the DFI, the test also reports HDS (high DNA stainability). It is a measure of immature sperm seen in the specimen. Immature forms may be seen for several reasons. In brief, the DFI is given much more weight than the HDS.