What could be the potential causes for non-motile sperms?

Q: I am a 41 years old married male whose semen analysis was done, which showed no sperm motility and a sperm count ranging between two million/ml to 20 million/ml. My wife and I have been unsuccessfully trying to have a child for the past five years. I underwent scrotal scan and testicular hormone tests, which showed healthy testicular functionality with no abnormalities. I was diagnosed with a mild varicocoele, which has operated three years back. Although the sperm tests revealed no improvement after the operation, then we were asked to go for IVF-ICSI. We consulted different doctors, but none of them were able to pinpoint the potential cause for the non-motile sperms. A recent DNA fragmentation test showed 26% fragmentation, while Y-chromosome deletion test came out normal. Recently, the doctor suggested that I may have necrospermia and recommended steroid treatment for 90 days. I was given Decadron, Proviron and Vitamin E for 90 days. At the end of steroid treatment, the sperm tests showed no difference whatsoever. I went to consult a fertility centre in Dubai, where I was given Proxeed Plus and an antioxidant for six months, of which three have now passed. According to the vitality test conducted by the centre, sperm and twitching could be noticed in a medium similar to Proxeed in composition. My 51 years old brother has the same issue and do not have children, so there may be a genetic factor involved. He and his wife tried IVF but not ICSI, since it was not yet widely used at the time. What could be the potential causes for sperm non-motility, if all other physical factors are normal? What reasons could prevent fertilisation using ICSI if the sperm is alive but non-motile? What other procedures would you recommend I should go for?

A:According to you description, you have primary infertility likely due to non-motile sperms, which may have genetic factors involved in it as your brother had the same problem. Non-motility associated with viable sperms may be due to ultra structural defects, which may need electron microscopic evaluation of sperms. As you have mentioned that you have undergone extensive tests and various treatments including a cycle of ICSI. Although Y-chromosomal test was OK but it may be worthwhile doing other genetic tests like Karyotyping. Do you get frequent upper respiratory tract infection? If yes then it may be wise to rule out Immotile Cilia Syndrome. You may also want to do Anti-Sperm Antibody test in semen to exclude frequent sperm agglutination, which is abnormal. The other cause of non-motility may be idiopathic where no cause is found. Since your last cycle of ICSI was almost 3 years ago, you may wish to consider another cycle of ICSI considering the fact that nowadays better pregnancy rates are possible after ICSI.