First of all, I am not a good writer, sorry. My question is about my brother-in-law. For a long time now, my sister and brother-in-law are trying to have a baby with no result. According to doctors, he has a motility problem (due to extra sperm which could not travel to the egg fast). So kindly help with some advice to deal with this problem. Thank you.

Sperm motility refers to the ability of sperm to move forward by swimming inside the vagina, through the cervix, and into the fallopian tubes, where it could fertilize an egg. If more than 50 percent of a man's sperm lack movement, this may significantly reduce the chance a pregnancy will occur. The most common sperm motility problems are:

• not enough sperm swimming in semen
• sperm that swim but neither rapidly nor in a straight line
• sperm that swim in a way that does not allow them to penetrate the outer layer of an egg
• too few sperm to fully penetrate an egg, even after several hours of swimming

Several factors reduce sperm motility. Exposure to heat (possibly through the presence of a varicocele) while sperm mature in the epididymis can damage sperm, hindering their mobility. Long periods of sexual inactivity can also adversely prevent motility. Studies have shown that poor motility is seen in the first ejaculate after a prolonged period of sexual inactivity, whereas sperm motility improves in the following ejaculate.

Reproductive health care providers can perform several procedures to improve sperm motility:

Sperm washing spins ejaculate in a centrifuge to separate sperm from prostaglandins in the semen.

In vitro fertilization (IVF) combines sperm in a dish with several eggs taken from a woman's body. After several days, between 2 and 8 fertilized eggs are implanted in the woman's uterus to mature. Success rates for IVF are around 23 percent. Multiple fertilizations are likely to occur, resulting in more than one live birth since several eggs can mature.

Intracytoplasmic sperm injections (ICSI) are direct injections of a single sperm into an egg cell. The egg is then implanted into the uterus. This procedure results in live births about 30 percent of the time.

These procedures have both low success rates and high costs (between $6,000.00 and $12,000.00 USD per procedure), which often are not reimbursable by insurance. Discussing coverage with your insurance provider will help to clarify this issue.

Several products on the market claim to increase sperm motility. Some purport to provide proteins or enzymes needed for sperm to become "healthy." While some products are currently being tested, no products have approval from the U.S. Food and Drug Administration (FDA) as of yet.

Your sister and brother-in-law need to be honest with themselves and with each other regarding what they want, before they talk with their reproductive health care provider. The provider then will be able to give them the most accurate information to answer questions while perhaps creating a new plan for having a baby, which may even include adoption.

Alice

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