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Male Infertility Evaluation

The first step in the  male infertility evaluation involves a thorough medical history

Approximately 50% of all cases of infertility are actually due to abnormalities in sperm production or function. Unlike women, who are born with all of the eggs that they will ever have, men produce sperm from the time of puberty until late in life.  It typically takes between 90 and 108 days from the time that a sperm is produced in the testicles until it is eventually ejaculated.  Therefore, in addition to medical conditions that can adversely affect sperm production or function in general, any event that occurs during this period of sperm maturation can also have an immediate impact on a man’s fertility.

The first step in male infertility evaluation involves a thorough medical history – i.e. an office consultation during which your physician will ask you extensively about your basic medical condition, as well as about specific factors that could affect your fertility.  It is important to know whether you have fathered any pregnancies, whether they resulted in an ultimate delivery of a live child or not.  In addition, we will discuss any medical illnesses that you may have, either illnesses that you had in childhood such as mumps, or chronic illnesses that you may have such as hypertension.  We will also explore any operations that you have had, focusing specifically on any surgical procedures involving the scrotum such as a varicocele repair, treatment of a spermatocele or hydrocele, or even a hernia repair.  It is also important to note if you have undergone a previous vasectomy, with or without a vasectomy reversal.

We will next discuss in detail any medications that you are currently taking, as certain medications can affect both sexual performance and sperm development and function.

In addition, we will discuss lifestyle factors such as cigarette smoking, alcohol use, and the use of prescription and non-prescription medications.  It should be noted that cigarette smoking has been proven to have a significant adverse effect on sperm.  Similarly, alcohol consumption, especially in excess, can adversely affect testosterone production and ultimate sperm function.  Finally, certain illicit drugs such as marijuana can also have an adverse effect on sexual performance and sperm production.

Your family history is also important, as certain genetic conditions have been associated with a significant decrease in fertility potential.  An example is cystic fibrosis; the same condition that affects cells in the respiratory system can have a significant adverse effect on sperm production and function.

The next step in the evaluation typically involves a semen analysis.

For an optimal semen analysis, we recommend at least 48 hours of abstinence.  A sperm specimen can be collected either at home or at Ovation Fertility.  In the event that the specimen is collected at home, it needs to be maintained at close to body temperature and brought to our office within an hour of the time that it was collected.  Specimens should be obtained by masturbation, preferably avoiding any gels or other chemicals that might interfere with the ultimate semen evaluation.  Your partner can assist in the collection of the specimen, however, please follow the guidelines described above.

Once the specimen arrives in the laboratory, it will be evaluated for multiple factors including volume, concentration (the number of sperm per volume of semen), motility (the percentage of sperm that are alive and swimming), and normal morphology.  Morphology refers to the size and shape of the sperm themselves, as normal sperm are thought to be more likely to have normal chromosomes, whereas abnormally shaped sperm are thought to be more likely to be chromosomally abnormal and, therefore, non-functional.

In the event that the semen analysis shows a low sperm count, then your physician may recommend hormonal testing.

Specifically, we will obtain a blood specimen for the evaluation of your FSH, LH and testosterone levels.  In the event that you suffer from erectile dysfunction, we may also check a prolactin level, as over-production of this hormone has been associated with the development of impotence.  If it turns out that your hormone levels are abnormal, we may recommend treatment with one of several different medications that can easily correct these problems.  If, on the other hand, your hormone levels are normal, treatment with medication will most likely not be effective.  We would therefore recommend treatment with either intrauterine insemination (IUI) or in vitro fertilization (IVF).

If your semen analysis is significantly abnormal, we may ask you to repeat the test in order to ensure that the abnormal findings are consistent.  If that is the case, we will probably refer you to a urologist (a physician trained in the diagnosis and treatment of disorders affecting the male reproductive tract) who will perform a physical examination.  This is important to rule out the presence of a testicular mass or other scrotal lesion that could adversely affect sperm production.

The most commonly recommended treatments for abnormalities in either sperm production or function include IUI or IVF.  Severe cases of male factor may require in vitro fertilization with intracytoplasmic sperm injection (ICSI), a procedure in which a single sperm obtained from a sperm specimen can be injected directly into an egg that has been obtained from your partner.  This procedure is both safe and effective, and has been used since the mid-1990s for men with severe male factor infertility.

On rare occasions, there may be a total absence of sperm production – a condition called “azoospermia”.

Some types of azoospermia are caused by a blockage in the male genital tract, whereas other types are caused by problems within the testicles themselves.  In addition to the evaluation discussed above, men with this condition will also need to have some genetic testing to rule out abnormalities in either the Y chromosome or one of several other genes that can control sperm production.  Even in cases where we have no sperm in the ejaculate to work with, a variety of more invasive treatments including microsurgical epididymal sperm aspiration (MESA) or testicular epididymal sperm extraction (TESE) may still be successfully performed.

These procedures involve obtaining sperm through an incision in the scrotum and/or aspirating fluid directly from either the tubules that come off the testicles or the testicles themselves.  Sperm obtained through such procedures can then be utilized in combination with ICSI to produce healthy children.  Even if no sperm can be obtained through these procedures, men still have an opportunity to produce children using donor sperm.

In summary, a thorough evaluation of the male is an integral part of the overall fertility evaluation.  Diagnostic testing is easy, and there are many effective treatments available – even in the most severe cases.