Male factor infertility is one of the most common causes of infertility
so it is extremely important to evaluate the male early when searching
for a cause of the couple’s inability to conceive. Generally, the
work-up of the male begins with a semen analysis. Depending on the results
of a semen analysis, we may recommend bloodwork or an examination by a
urologist. Sometimes an actual "cause" for the male infertility
can be identified, but more commonly no explanation is found. Although
the lack of diagnosis can be frustrating, success rates with treatment is high.
Patient History
It is extremely important to review the medical history of the male partner
of an infertile couple. Some men may have a history of sexual dysfunction
or abnormal ejaculation. Some are taking medications or hormones that
interfere.
Semen Analysis
The initial diagnostic study of male infertility is the semen analysis.
The analysis is generally performed on a specimen that has been produced
by means of masturbation into a sterile specimen container. For those
men who are unable or unwilling to masturbate, special semen collection
devices, which are used like condoms, can also be used to collect sperm
for analysis. Ideally the male should abstain from ejaculation for 2-5
days prior to the analysis. The specimen should be evaluated within one
hour from production.
A sperm test analysis will provide information on:
Basic measurements of the volume (in milliliters).
The percentage of the sperm which are moving (motility) and the quality
of the movement.
The quality of the movement of the sperm, described as the “progression”.
The shape of the sperm (morphology).
Labs may also report other parameters such as the pH, viscosity, agglutination,
color of the semen, or the viability (percentage of sperm which are alive
and dead).
Hormonal and Genetic Bloodwork
If the concentration (“count”) of the sperm is low in the semen
analysis, hormonal bloodwork will be ordered to determine if a central
(brain) or testicular explanation can be found. If the concentration is
extremely low (<5 Million/ml), genetic testing may be recommended (karyotype,
Y chromosome microdeletion testing.)
Urology
Some male infertility patients will be referred to an urologist for evaluation.
Via exam and sometimes, ultrasound, the urologist will ensure that all
pelvic structures are normal and that no blockages, masses or dilated
blood vessels (varicocele) are present. A large varicocele may decrease
sperm number and/or quality and can be a surgically correctable problem.
Unfortunately, in the majority of cases of abnormal sperm parameters,
a "cause" is never identified.
While we work with a number of experienced urologists to serve our male
patient population, we are partnered with Posterity for our male patients,
including all of our Progyny patients. Posterity offers at-home and virtual
care options, as well as in-person consultations and procedures.
To learn more about this partnership, please click
here.
Additional Diagnostics
There are many other diagnostic tests offered to evaluate infertility in
males. Some may be useful in very specific situations, such as a DNA integrity testing.
