Male Infertility Testing
Male factor infertility is one of the most common causes of infertility. We think that it is extremely important to evaluate the male early in the investigation of the infertile couple. A number of male infertility tests are available, but generally the work-up of the male can be as simple as a semen analysis and, depending on the circumstances, other lab tests. Sometimes examination by urologists is useful but not always necessary. 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, the success with treatment is usually very good.
Male Factor Testing: Patient History
Sometimes history alone is suggestive of a potential male factor infertility, and is significant in the diagnosis of infertility in men. Some men may have a history of sexual dysfunction or abnormal ejaculation. Alternately others may have had previous surgeries or injuries that may lead to problems in semen production. We find it extremely important to review the medical history of the male partner of an infertile couple.
Male Infertility Tests: Semen Analysis
The initial diagnostic study of male infertility that most men have is the semen analysis. The semen analysis is one of the few tests which has withstood the test of time and which continues to be considered an integral and important part of the evaluation of the couple. 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. The analysis consists of evaluation of a number of parameters. Basic measurements include the volume of semen ejaculated (in milliliters), the concentration of sperm within the ejaculate (usually expressed in number of sperm per milliliter of semen), the percentage of the sperm which are moving (motility), and the quality of the movement (wiggling, swimming in circles, swimming in straight lines) described as the progression. Labs may also report other parameters such as the pH, viscosity, agglutination, color of the semen, the viability (percentage of sperm which are alive and dead) or other parameters. Some laboratories will also analyze sperm with computer guided systems (CASA or Computer Assisted Semen Analysis). Through tracking of each individual sperm, these analyses can provide extremely detailed data such as the speed of movement, the lateral head displacement (how much "wiggling" there is) and other parameters such as these. Although these CASA have a role in research they are not necessary for routine clinical evaluations.
Male Infertility Tests: Urology
Many male infertility patients will be referred to an urologist for evaluation. The physician may carry out not only a physical exam but may also do blood work to establish whether hormonal levels are normal. During the exam, urologists will generally try to establish whether a varicocoele, an abnormal system of veins, is present in the scrotum. There are data implying that the presence of a varicocoele may decrease sperm number and/or quality. Since this is a surgically correctable problem, most urologists will do either a physical exam or a specialized ultrasound evaluation called a Doppler exam of the scrotum to look for these. Unfortunately, in the majority of cases of abnormal sperm parameters, a "cause" is never identified.
Male Infertility: Additional Diagnostics
There are many other diagnostic tests available to help evaluate infertility in males. Some may be useful in very specific situations such as testing for Antisperm Antibodies. Others, such as the Hamster Penetration Assay, Hemizona Assay, Hypoosmotic Swelling Test, and the Acrosome Reaction Test, have limited roles if any in the evaluation of male infertiity today. Every one of these tests was designed to give insight into the ability of a sperm to fertilize an egg. Some of these tests were useful "in the old days" but have subsequently been shown to have limited ability to predict fertilization outcomes. Some of the tests have some use in research settings. As a general statement, however, most couples will not need to have any of this kind of testing done. We rarely have to ask couples to go through the expense or bother of having any of these tests performed since the results will not change how we treat the couples.