20 Apr Workup for Male Infertility
Many infertile couples have more than one factor of infertility. While one-third of infertility is related to a female factor, another one-third is attributed to a male factor. The other 33% is related to both female and male factors or is considered “unexplained infertility.” Diagnosing male infertility problems involves conduction examinations and tests.
At the first meeting with the fertility specialist, the doctor will conduct a general physical examination and take a detailed medical history. This involves examining the genitals and overall condition and asking questions about injuries, surgeries, chronic health problems, sexual practices, and inherited conditions.
During the initial visit, you will be asked to give a semen sample by ejaculating into a special container in the office after masturbation. The semen is sent to the laboratory to measure the number of sperm present, check for abnormalities of shape (morphology), and determine motility (movement) issues. Sperm counts can fluctuate from one specimen to the next, so the specialist will conduct several semen analysis tests over a specified timeframe. This is the best way to ensure accurate results.
The factors reported in the semen analysis include:
- Total volume – Normal is 2.5 milliliters. A low volume indicates that seminal vesicles are not producing enough fluid or ducts are blocked.
- Sperm count – Normal range is > 40 million per milliliter. Counts below 20 million are considered poor, and counts of 20 million with normal shape and movement are considered normal.
- Motility and velocity – The number of active cells is evaluated along with the quality of sperm movement.
- Morphology – At least one-third of the cells should be of normal shape.
- Liquefaction – Normal semen coagulates into a pearly gel substance which liquefies within 20-30 minutes. Failure to form a gel and then turn to liquid indicates problems with the seminal vesicles.
Additional tests are used to identify the cause of the infertility if the semen analysis and initial examination is normal. These tests include:
- Scrotal ultrasound – Uses high-frequency sound waves to produce visual images inside the scrotum (testes). This is used to check for a varicocele and other problems of the testicles and support structures.
- Hormone testing – Hormones are produced by the hypothalamus, pituitary gland, and testicles. Abnormalities of blood hormone levels can contribute to infertility.
- Post-ejaculation urinalysis – Sperm in the urine indicates that sperm has traveled backward into the bladder instead of out the penis during ejaculation. This condition is known as retrograde ejaculation.
- Genetic tests – If sperm concentration is low, it could be related to a genetic cause. A blood test is used to detect subtle changes in the Y chromosome, inherited syndromes, and congenital problems.
- Testicular biopsy – Involves removing samples from the testicle using a needle. This test checks for sperm production. Lack of sperm indicates a blockage or problem with sperm transport.
- Specialized sperm function tests – These tests are used to check how well the sperm survive following ejaculation and if or not the sperm can penetrate an egg. Specialized tests are rarely performed unless the initial analysis indicates a need for them.
- Transrectal ultrasound – To check the prostate gland, a small wand is inserted into the rectum. Using sound-wave imaging, the doctor checks for blockages of the tubes that transport semen (seminal vesicles and ejaculatory ducts).
- Sperm mapping – This technology can “map” the location of sperm inside the testis. Using a special technique, this involves a minimally invasive procedure under local anesthesia to check for no sperm in the ejaculate (azoospermia).
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