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Infertility Workup For Men

Some studies suggest that the sperm count in American men has been declining over the last several decades. Possible reasons include an increase in sexually transmitted diseases, use of alcohol, smoking, and drugs, exposure to toxins and hazards in the environment, and mounting levels of stress. A urologist is the specialist who diagnoses and treats disorders of the male reproductive system. Diagnosing male infertility begins with a medical history and a physical exam.

The Medical History

History
Implications
Mumps Infection
as an Adult
 Contracting mumps after puberty can reduce fertility or cause sterility. There is a vaccine available to prevent mumps.
Cystic Fibrosis
 Cystic Fibrosis causes male sterility.
Undescended Testicles
 Testicles are suppose to descend from the abdomen into the scrotum in a newborn. If the testicles fail to descend in a timely manner, sterility can result.
Pain, Swelling or Injury
to Testicles
 Damage to the testicles can result in decreased fertility or sterility.
History of Sexually Transmitted Diseases (STD's)
 STD's can cause infections and scarring that can lead to infertility.
Impotence
 Whether medically or psychologically caused, impotence is a barrier to conception. Impotence is often treatable, speak to your health care specialist.
Surgeries, Medication Use, Exposure to Radiation or Chemotherapy
 A full medical history is needed to find other causes for reduced fertility.
Temperature Extremes
 Excess heat can reduce sperm production and quality. This includes hot tubs, saunas, and other very warm environments. Tight fitting underwear causing the testicles to be held too close to the body may create an environment that is too warm for normal sperm production.

The Physical Exam
A complete physical exam is done to assess overall health and well being. The prostate gland is checked for abnormalities. Genitals are examined for any obvious signs of trouble. The testicles are examined for possible varicoceles (mass of varicose veins in the scrotum). Varicoceles are a leading cause of infertility.

The Medical Workup
A full workup to evaluate the man may take place over several visits. The following table describes the most common tests that are performed.

Name of Test
Purpose
Considerations
Semen Analysis
 The semen volume, viscosity, and pH are noted. Sperm count, motility, and shape are all evaluated. If semen analysis shows abnormalities, a repeat sample will be taken to confirm results.
Semen Cultures
 The semen is screened for organisms, infections and sexually transmitted diseases. Any of these infections could cause problems with the sperm, and also problems to the reproductive tract. Many such infections are treatable.
The Fructose Test

Fructose is a natural sugar that is produced in the seminal vesicles. The semen is analyzed for fructose. It's absence may indicate blockages in the seminal vesicles.

 Blockages can be surgically corrected.
The PeneTrak Test
 This test measures the sperms ability to swim through mucus in a test tube. The distance covered in 90 minutes is used to diagnose sperm motility problems. Occasionally the test tube mucus results don't mimic what happens when the sperm meet the woman's cervical mucus in the vagina.
Sperm Agglutination Test
 Agglutination means clumping together. If sperm clump together they wont make it to their destination: the egg. Clumping can be caused by an infection, which if diagnosed may be treatable.
Sperm Antibody Test
 Antibodies are proteins that are made in our bodies. Antibodies are responsible for destroying germs or other invading organism. Occasionally our bodies make antibodies to a natural substance, such as to sperm. Sperm antibodies can be made in the man's or the woman's body and can destroy sperm or cause agglutination (clumping). If antibodies are presumed to be the problem, the semen can be collected and then rinsed in a laboratory. The cleansed sperm can be used to artificially inseminate the woman.
Hormone Tests

FSH and LH are hormones, messengers from the brain, that are responsible for directing sperm production.

A blood test is done to detect levels of FSH, LH and testosterone.

Low hormone levels can indicate a problem with the brain's control of sperm production. Hormone replacement therapy can correct the problem.

High hormone levels usually mean the message to produce sperm has been sent, but the testicles are unable to manufacture the sperm.
Vasogram
 Dye is injected into the reproductive tract and an X-ray is used to locate problems or blockages in the sperm transport system. Microsurgery can repair most blockages.
Testicular Biopsy
 A small sample of tissue is removed from one testicle. A microscope can confirm sperm production by viewing sperm in various stages of development. Damage and scarring to the tubing may be noted.

If no sperm are found, the man is probably sterile.

Surgical procedure. General anesthesia is used.
Chromosome Analysis
 If a testicular biopsy does not find any trace of sperm, then a chromosome test is done to find out if there is a genetic reason for sterility.

Chromosome flaws only account for about 2 % of all sterility cases.

Infertility caused by a chromosome error is not curable.

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