Male Infertility:
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Infertility is defined as the inability to conceive after one year of unprotected sex. It can be a stressful, emotionally draining process for couples. One out of six couples experience infertility; a male factor is fully or partially responsible 30 to 50% of the time. Thankfully, due to advances in infertility care, the majority of infertile men can be treated. |
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INITIAL EVALUATION
Both partners should be evaluated preferably at the same time. Women often seek infertility evaluation before their partner and usually choose their obstetrician /gynecologist. A male needs his own doctor to receive appropriate counseling, advice and therapy. For men, this usually means a urologist with an interest in male reproduction. In the male, sperm contains the genetic material that must ultimately mix with the oocyte (egg) to initiate pregnancy. Sperm are produced in the testis. Each step in the process of sperm production and transport is important for functional sperm that can fertilize the egg. Any alteration in the process may result in male infertility. Since there are many potential causes of male infertility, male assessment must go beyond a semen analysis. Of course, the most important part of the evaluation is a careful history and physical examination by a physician. This section attempts to summarize the different types of evaluation that are involved with diagnosing the cause of infertility.
PHYSICAL EXAMINATION
LABORATORY TESTING
Both partners should be evaluated preferably at the same time. Women often seek infertility evaluation before their partner and usually choose their obstetrician /gynecologist. A male needs his own doctor to receive appropriate counseling, advice and therapy. For men, this usually means a urologist with an interest in male reproduction. In the male, sperm contains the genetic material that must ultimately mix with the oocyte (egg) to initiate pregnancy. Sperm are produced in the testis. Each step in the process of sperm production and transport is important for functional sperm that can fertilize the egg. Any alteration in the process may result in male infertility. Since there are many potential causes of male infertility, male assessment must go beyond a semen analysis. Of course, the most important part of the evaluation is a careful history and physical examination by a physician. This section attempts to summarize the different types of evaluation that are involved with diagnosing the cause of infertility.
- The age of the patient, the age of his partner, whether or not either one have prior proven fertility.
- Possible events in the patient's life that might have attributed to his fertility including but not limited to mumps orchitis, history of prior testicular trauma or malignancy.
- Environmental effects including use of alcohol and tobacco, use of anabolic steroids for bodybuilding or other purposes, frequent use of a hot tub, and type of underwear worn.
- Routine medications.
- History of any surgery to the genitourinary tract including orchiopexy, herniorrhaphy, or any transurethral surgery.
- Coital history including the length of time the couple has been trying unsuccessfully to conceive, the timing of intercourse, and the use of any lubricant or other material during intercourse that could be potentially spermicidal.
- History of a recent febrile illness that may have affected semen analysis parameters.
- Family history for a possible genetic cause
PHYSICAL EXAMINATION
- Assessment of sexual maturity, i.e. adult male growth hair pattern
- Evaluation of penis for any signs of hypospadias or epispadias or cordee
- Examination of testicles for consistency and size. An irregular epididymis may indicate infection or obstruction
- Palpatation of the vas deferens.
- Examination of the scrotum for possible varicocele with the patient in a standing and supine position, employing the Valsalva maneuver.
- Examination of the prostate to rule-out prostatitis. Transrectal ultrasound to rule-out ejaculatory duct cyst.
- Physical examination to rule out any chronic or unsuspected systemic diseases that may impair testicular function.
LABORATORY TESTING
- Semen analysis. Two semen analyses spaced at least three months apart. These should be collected for analysis after 3-5 days of abstinence from ejaculation. The lab should examine the sample within one hour of collection. The semen is analyzed for volume, sperm density, sperm motility, sperm morphology and forward progression. The sample is also analyzed for an increased number of found cells that could represent either white blood cells or immature sperm cells. Several semen analyses should be performed to assess if a particular problem is consistently present. If semen testing appears to fall into the average range, and a couple is still not achieving a pregnancy, more sophisticated testing may be necessary to better evaluate sperm function.
- Basic hormonal evaluation including FSH (follicle stimulating hormone), LH (luteinizing hormone), testosterone, and prolactin.
- Treatment will be determined based on the decided cause of the infertility.