Infertility work up for male
The evaluation begins with a medical history, physical examination, and a semen test. Other tests may be needed.
A man’s past health and medical history are important in the process of evaluation. The doctor will ask about childhood growth and development; sexual development during puberty; sexual history; illnesses and infections like mumps; surgeries (like hernia repair); injury to the genital regions; medications; exposure to certain environmental agents (alcohol, radiation, steroids, chemotherapy, and toxic chemicals); and any previous fertility testing.
Physical examination: A physical examination usually includes measurement of height and weight, assessment of body fat and muscle distribution, inspection of the skin and hair pattern, and visual examination of the genitals and breasts
Special attention is given to features of testosterone deficiency, which may include loss of facial and body hair and decrease in the size of the testis.
Other conditions that might affect fertility include:
Varicocele, absent vas deferens or thickening of the epididymis
Lab testing: A semen analysis (sperm count) is a central part of the evaluation of male infertility. This analysis provides information about the amount of semen and the number, motility, and shape of sperm.
A man should avoid ejaculation (sex and masturbation) for about three days before providing the semen sample. Ideally, a sample should be collected in the lab in the collection room after masturbation; if this is not possible, the man may collect a sample at home in a sterile laboratory container. The sample should be delivered to the lab within one hour of collection.
If the initial semen analysis is abnormal, the clinician will often request an additional sample; this is best done few weeks later.
Blood tests provide information about hormones that play a role in male fertility. If sperm concentration is low or the clinician suspects a hormonal problem, the clinician may order blood tests to measure total testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin
If genetic or chromosomal abnormalities are suspected, specialized blood tests may be needed to check for absent or abnormal regions of the male chromosomes (Y chromosome). Some men inherit genes associated with cystic fibrosis that can result in male infertility due to a low or absent sperm count. However, these men do not have the other usual signs of cystic fibrosis, such as lung or gastrointestinal disease.
Although infertility treatments may be able to overcome genetic or chromosomal abnormalities, there is a possibility of transferring the abnormality to a child. In this case, genetic counselling is often recommended to inform a couple about the possibility of parent-to-child transmission and the possible impact of the abnormality.
If retrograde ejaculation (movement of semen into the bladder) is suspected, a post-ejaculation urine sample is needed.
A testicular biopsy (collection of a small tissue sample) may be recommended in men with no sperm on the semen analysis. The biopsy can be done by surgically opening the testis or by fine-needle aspiration (inserting a small needle into the testis and withdrawing a sample of tissue). An open biopsy is usually done in an operating room with general anaesthesia, while a fine-needle aspiration may be done with local anaesthesia in an office setting. The biopsy allows the physician to examine the microscopic structure of the testes and determine if sperm are present. The presence of sperm production in the testes when there are none in the ejaculate suggests blockage in the reproductive tract