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Evaluation of Male Infertility
Author: Dr. Anna Kaplan
When couples are evaluated for infertility, the cause is considered to be a “male factor” in about a quarter of the cases. Men need to be evaluated in the course of an infertility workup.
An infertility evaluation can be done by your regular doctor – a family practitioner or internist – or a specialist, such as a urologist or a reproductive medicine specialist.
The first thing a doctor will do is take a thorough history. If you are being evaluated for infertility, you may want to talk to your doctor without your partner present. There may be things you do not want to talk about in front of her.
The doctor will be looking for a number of things in your medical history. These include:
- Any abnormality in growth and development, especially genital development at puberty
- A history of childhood infectious diseases, especially mumps, since mumps can involve the testicles
- Any history of trauma to the testicles
- Any previous sexually transmitted diseases, discharge from the urethra, or burning with urination
- Any serious medical illness, past or present
- Surgery involving the urinary tract or genitals
- Recent high fever
- All current medication, since some can decrease fertility, and others can interfere with erections and/or ejaculation
- Any exposure to toxins, for example, at work
- Substance use or abuse, including cigarettes and alcohol
The doctor will also ask you about your sexual practices, to make sure that you are not doing anything that can prevent conception. He or she will want to know if you have any problems with intercourse including erectile dysfunction or premature ejaculation. He or she will want to know if you have ever fathered a child in the past with another partner.
The doctor will do a physical examination. In addition to making sure you are generally healthy and appear to have normal amounts of male hormone, the doctor will be checking your testicles and attached vas deferens for any obvious abnormalities, checking for other scrotal masses like hernias, and checking your prostate and urethra for any evidence of infection.
A semen analysis is very important; usually two are done. Semen is examined to measure sperm concentration (numbers of sperm), the appearance of the sperm, and the way the sperm moves.
Other laboratory testing will depend on your history and physical examination, as well as semen analysis. Cultures can be taken if infection is suspected. An analysis of urine may be done. Blood count, hormone levels, and liver and kidney function tests may be done. There are ways to physically evaluate parts of the reproductive system with ultrasound and other tests if necessary.
The semen test is often the most important part of the evaluation, so you need to make sure you have your test done at a good laboratory. Ask your doctor if he or she has been satisfied with the results of the lab they use.
When all of the information is collected, the doctor should be able to tell you if you have a specific problem that is causing you and your partner not to conceive. There are treatments for many of the different problems.
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