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7.1 Infertility Tests: Evaluation Process For Men




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This article is from the Infertility FAQ, by Rebecca Smith Waddell bec@fertilityplus.org with numerous contributions by others.

7.1 Infertility Tests: Evaluation Process For Men

Discussion of medical and surgical history. This includes a history of
systemic diseases, such as viral infections (particularly postpubertal
mumps and venereal disease), fevers, and diabetes mellitus, previous
surgery, especially in the genitourinary area, duration of
infertility, previous pregnancies, and sexual history. Many men had a
hernia repair as babies and this occasionally causes a blockage of the
vas due to scar tissue or to just bad surgical practices.

Physical exam: This includes an examination of testicle position in
the scrotum (if the testicles haven't descended properly, the sperm
will not be cool enough), an examination of the scrotum for
varicoceles (varicose veins of the testicles), and an examination of
the prostate and prostatic fluid for signs of infection. Also, fat and
hair distribution is examined, for signs of hormone imbalance.

Urinalysis: Looks for signs of a urinary tract infection, presence of
sperm in the urine (which, in conjunction with a low sperm count, may
indicate retrograde ejaculation), and signs of systemic disorders such
as kidney problems or diabetes mellitus.

Semen analysis: This is done at least three times, since sperm count
varies, and a 2-3 day abstinence is required before each
analysis. Normal values follow:

ejaculatory volume: 1.5-5.0 cc
sperm density: > 20 million/ml
motility: > 60%
forward progression: > 2, on a scale of 1-4
morphology: > 60% normal forms
(should have oval head and long tail)
1) no significant microscopic sperm clumping,
2) no significant white or red blood cells,
3) no increased thickening of the seminal fluid
(hyperviscosity).

For more information check
http://matweb.hcuge.ch/matweb/endo/PGC_network/Semen_analysis_rrumbullaku.htm.

Endocrine tests: Blood tests to check levels of testosterone, FSH
(follicle stimulating hormone), LH (luteinizing hormone), prolactin,
estradiol, and the thyroid hormones T-4 and T-3. Usually FSH levels
are measured first for men with low sperm counts, and others are
measured as indicated. Some patterns of hormone abnormalities are more
amenable to treatment than others. An elevated FSH is an indicator of
testicular failure or the beginnings of testicular failure. If this is
the case, there is little that can make a large difference in the
count. Low normal or low levels of testosterone often indicate
testicular atrophy (usually due to varicoceles). There is also little
that can be done to change the sperm count if the levels of
testosterone are low. Thyroid is an often overlooked or forgotten
cause of sperm problems and is easy to check and easy to remedy. A
link to general thyroid disease info is http://thyroid.miningco.com/.

Postcoital: Checks cervical mucus for presence of sperm after
coitus. If a sperm count is low, generally it is just as easy to move
on to intra-uterine insemination (IUI)rather than waste a cycle or
more trying to do a postcoital. The sperm of men with low counts are
more delicate and have more trouble surviving in mucus than do normal
men's sperm.

Sperm Penetration Assay (SPA), or Hamster test (HEPA): This tests the
ability of the sperm to penetrate a specially prepared hamster
egg. This test is controversial and there is no clear evidence that
the results are worthwhile. (FWIW, a little hamster has to die to
donate the egg.)

Testicular biopsy: Takes a small piece of testicular tissue, and
checks sperm-producing tubules and cells between the tubules. Possible
patterns include: Normal (the tubules and the sperm in them are
normal, so the problem is likely a blockage elsewhere), maturation
arrest patterns, hypospermatogenesis (elements are there, but sperm
isn't), and germinal cell aplasia (there just isn't any sperm there,
and the only options for parenthood are donor insemination or
adoption). This test is usually done as a last resort. It is often
done in conjunction with an IVF cycle where donor sperm are ready as a
backup in case there are no sperm in the biopsy.

Ultrasound of seminal vesicles to show their size, development, and
whether they are emptying and storing sperm properly.

Vasogram: An x-ray using a dye to outline the ducts and look for
obstructions.



 

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