MALE FERTILITY WORKUP

Can’t ignore it any more. Your buddies are posting pictures of their new babies, meanwhile you and your partner stare down each month a negative pregnancy tests. Infertility affects both men and women equally, hence why both of you should get tested for possible infertility problems. Be proud of yourself for taking control of your reproductive health! This is a big, bold step towards seeking the answers to those “why am I not getting pregnant” questions you are having.

Once your appointment is scheduled, what should you expect during a fertility workup? Not surprisingly fertility workups differ for both men and women. Let us walk you through all of the different components.

What should I expect when I visit my doctor?

You should probably anticipate answering a lot of questions. In order for your doctor to get the full story of why you may be having trouble conceiving, it begins with a bit of a Q&A session. Here are some of the topics that may be covered:

• History of  STD’s (sexually transmitted diseases)

• Current sexual patterns

• Medications

• Mumps after puberty

• Hernia repairs

• Athletic injuries to the groin

• History of undescended testicles

• Possible STDs

• Urinary tract infections

• Prostatitis

• Impotence or ejaculatory problems

• Smoking, drinking or drug use

• Surgical History

• Work Environment

The Physical Exam

Typically this is a basic work-up for men that commonly performed by your physician. During this exam your doctor will discuss your medical history, current medical status and potential fertility problems. You can likely expect:

Hair distribution/ patterns – in the genital area, which should be diamond shaped, extending upward toward the navel

A general examination – of the penis looking for abnormalities. An examination of the scrotum-with careful attention to the size and firmness of the testes

Prostate examination – to evaluate for enlargement or irregularity in the shape of your prostate, which can indicate abnormalities or cancer.

Hormone testing – FSH Levels: (The normal range is 4 to 10 mIU/mL),

Androgen Levels – Testosterone: (The normal range is 300 to 1,111 ng/dL), and Prolactin: (The normal level is less than 20ng/mL)

If these tests do not explain your difficulty conceiving, it is very likely additional tests may be ordered or you will be referred to an urologist and potentially to a Reproductive Endocrinologist (RE).

The Semen Analysis

Lean in for a moment. This is the single most important test of male infertility. Period. So let’s get down to brass tacks and discuss what are they looking for and they factors that are reported.

In a semen analysis, they are looking for the following: 

• Sperm count

• Ability of sperm to swim, this is referred to as motility

• Velocity or forward progression of the sperm

• Size and shape of the sperm this is referred to as morphology

• Total semen volume

• The liquefaction of the semen (the ability to go from normal gel-like state at ejaculation to a liquid state)

Interpreting a semen analysis

A semen analysis is usually done at a laboratory or a physician’s office. The man masturbates and collects the ejaculate into a cup. The semen should then be examined within a few hours, to achieve the most accurate results. The following is evaluated:

What is a normal volume?

2 to 5 milliliters is a normal volume. A very low volume indicates that the seminal vesicles may not be making enough fluid or that these ducts may be blocked. It may also indicate a problem with the prostate gland.

What is a normal sperm count?

40 million to 300 million is the normal range for the number of sperm per milliliter. Counts below 10 million are considered poor; counts of 20 million or more may be fine if motility and morphology are normal.

Why is motility and velocity important?

2 aspects of motility will be evaluated:

• The number of active cells as a percentage of the total number of cells (rated from 0-100%, at least 50% should be active)

• The quality of the movement of the sperm (rated from 0-4. A score of 2 or more is satisfactory.)

Morphology

At least 30% of cells should be of normal shape according to the WHO (world health organization)

Kruger (strict) morphology test: Examines the shape and size of the sperm head. Normal results are when 14% or more of the sperm have normal shaped heads. Men with less than 4% of normal shaped sperm may have a significant infertility problem.

Liquefaction

Normal semen which is liquid at ejaculation immediately coagulates into a pearly gel that liquefies within 20 minutes. Failure to coagulate and then liquefy may indicate a problem with the seminal vesicles, as would increased thickness or the presence of white blood cells.

Seminal Fructose

If no sperm are present, the semen will be tested for seminal fructose, normally produced by the seminal vesicles. If no fructose is present, congenital absence of the vas deferens or seminal vesicles or obstruction of the ejaculatory duct

Wait, there other types of sperm testing?

Yes, depending on what your doctor discovers in the first round of testing he or she may include the following additional tests:

Sperm Antibodies

If the sperm agglutinate (do not move well) the physician may order tests that can localize and quantify specific antibodies in the blood and on the sperm’s surface. Antibody attachment can affect the following:  If they stick to the head of the sperm, the sperm may not be able to penetrate  If they cover the tail of the sperm, the sperm may not be able to swim fast enough or in the right direction.

Sperm Penetration

This sperm penetration assay (SPA) is commonly referred to as the hamster egg test. It is designed to evaluate the sperm’s ability to break through the outer membrane of an egg and fuse with the egg cytoplasm.

Hemizona Assay Test

Evaluates the sperm’s ability to fuse with a previously frozen but no longer viable human egg. (This test is rarely performed now due to the increased technology of ART procedures)

Cervical Mucus Penetration Test (Pentrak)

A lab test that uses cow mucus to simulate the sperm’s ability to move through the woman’s cervical mucus.

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