How Men Are Evaluated for Infertility
Arizona Urology Specialists male sexual and reproductive health specialists recommend a complete evaluation for male patients, including a semen analysis, to identify the cause of a couples’ infertility. The evaluation is a critical component of solving the cause of infertility and needs to be performed and managed by experienced physicians and a competent reproductive laboratory. Additionally, male hormone levels may influence sperm counts and should be evaluated by a male fertility specialist.
Every man who is having problems conceiving with his partner requires an evaluation, which includes:
- A complete history and physical examination
- Reproductive history of both male and female partners
- Screening semen analysis
- Blood work
- Exam to identify varicoceles, which are similar to varicose veins in the leg and are also a known cause of male infertility
- Possible advanced testing with ultrasound
The initial appointment usually takes about one hour. Further evaluation, often with hormonal or genetic testing, is then initiated as indicated. If there are any abnormalities found on preliminary screening, your physician will discuss one of the many options that may be available to you and your partner.
The semen analysis is the cornerstone of a male infertility evaluation. While it only takes one sperm to fertilize an egg, millions of sperm are necessary for proper sperm functioning. Semen samples can vary extensively from one time to another. To accurately assess the quality of semen, at least two samples separated by several weeks are required. A properly performed semen analysis requires special equipment and technical expertise. Most laboratories do not own this equipment or may not employ appropriately trained technologists. Our laboratory technologist has years of experience in semen analysis and sperm processing techniques. Our lab is certified with CLIA as a high-performance laboratory facility.
LOW SPERM COUNTS
Many subfertile men have low sperm counts. Sometimes this is only transient or an artifact due to improper semen analysis. When low counts (called oligospermia) are truly present, they are often associated with dilated veins in the scrotum, called varicoceles. Varicoceles are present in about 30% of all men undergoing infertility evaluations. Varicoceles appear to impair sperm production and function by increasing the temperature of the testicles. The vast majority of well-performed studies have demonstrated significant improvement in the semen quality and pregnancy rates after varicocele repair. Varicocele repair is performed as an outpatient procedure. While there are many methods of varicocele repair, Dr. Daitch utilizes the microsurgical technique. This technique has a better success rate and a lower complication rate than the standard techniques for varicocele repair. In addition, it is performed through a one to two-inch incision and there is no need to cut across muscle. This allows for much quicker recovery and less post-procedural discomfort.
Low sperm counts can also be caused by subtle hormonal abnormalities or environmental exposures such as medications, tobacco, pesticides, or solvents. Identification of these abnormalities/exposures and proper treatment can help to improve sperm counts. Finally, very low sperm counts may be due to underlying subtle genetic abnormalities. An accurate diagnosis is made with genetic testing from cells obtained with a swab of the inner cheek. These men often require advanced techniques such as in vitro fertilization (IVF or test tube baby) to father children. However, with proper testing and administration, the success rates and risks of passing any genetic abnormalities to their offspring can be determined.
LOW SPERM MOTILITY
Decreased sperm motility (asthenospermia), or the ability of sperm to move spontaneously, is common. As is the case with low sperm counts, low motility is often a transient phenomenon, or due to an improperly performed semen analysis. However, among men with true low motility, many will have dilated veins in the scrotum called varicoceles. Please refer to the Low Sperm Count section for more information about varicoceles. Low motility can also be due to various environmental exposures such as tobacco, pesticides, and solvents. Sometimes, anti-sperm antibodies cause low motility. Antibodies normally fight infection in the body, however, in some men these antibodies attach their own sperm. If this is suspected, special testing for antibodies is performed. When sperm counts are normal, the antibodies can be washed off the sperm, and the sperm used to inseminate their partners.
Finally, white blood cells in the semen can impair motility. Like antibodies, white blood cells usually fight infection. When they are in the semen, however, they often damage sperm. Treatment can be as simple as a course of antibiotics.
NO SPERM COUNT
The most common cause of semen containing no sperm is a vasectomy. Vasectomies can be reversed with very high success rates. About 10% of all infertile men have no sperm in the semen. Many of these men have normally functioning testicles, but the ducts which transport the sperm from the testicle are blocked. Using microsurgical techniques these ducts can be unblocked and couples can then have children naturally.
Occasionally, men are born with healthy testicles, but without the ducts that transport sperm from the testicles. This is diagnosed on physical examination. For such men, hormonal and genetic testing is usually performed to rule out any underlying abnormalities. Then, sperm can be obtained from the testicles with a minimally invasive procedure performed in the office. The sperm are then used together with in vitro fertilization techniques (test-tube baby) to obtain a pregnancy.
Men with no sperm in their semen who do not have a blockage require hormonal testing. Occasionally, hormone replacement will return sperm to the semen. Other men simply do not make enough sperm to reach the semen. Genetic testing can reveal any underlying causes. Even though these men have no sperm in their semen, with careful microscopic testicular dissection, small islands of sperm can often be found. These sperm are then used together with in vitro fertilization techniques to obtain a pregnancy.