General physical examination and medical history
During the physical exam the doctor would examine your genitals and ask about any preexisting complications, genetic conditions, surgeries, injuries, sexual habits, and other factors that would affect fertility. It’s essential that you answer honestly and openly so the exact cause of infertility can be figured out. Apart from sexual health, basic general health can be responsible for abnormal men parameters e.g. uncontrolled diabetes, HTN, morbid obesity, any chronic illness. Some of the other frequently asked questions involve:
● Lifestyle habits and exercise
● Smoking and recreational drug use
● Coital frequency
● Erectile dysfunction
● Delayed ejaculation
● Retrograde ejaculation
● Semen analysis
Semen analysis is one of the very basic tests for checking male fertility. For the procedure you must ejaculate into a special container at the clinic. Alternatively, your semen could also be collected using a special condom during intercourse. Sample should be given after 2-3 days of abstinence. Observing the semen in a lab gives information on the following:
● Volume of semen
● Sperm count
● Signs of infection
● Percentage of alive sperms (vitality)
● Percentage of moving sperm (Motility)
● The shape and size of the sperm (Morphology)
Further advanced testing is also available to find cause for abnormal men parameters:
Blood Test for Hormone Levels
Sperm production is controlled by the hypothalamus and the pituitary gland along with the testicles. There are three important hormones doctors look for when conducting your fertility test:
● Follicle Stimulating Hormone (FSH): high level of FSH can indicate that the testicles are not functioning properly. Sperm production stops when FSH drops to very low levels.
● Luteinizing Hormone (LH): Produced by the pituitary gland, LH is necessary for the production of testosterone which is in turn needed for the production of sperm.
● Testosterone: Testosterone levels in healthy men is normally in the range of 300 to 650 nanograms per deciliter (ng/dL)
Scrotal Ultrasound
Utilizing high-frequency sound waves, a scrotal ultrasound device generates detailed internal images of the scrotum. This diagnostic procedure enables your physician to identify issues such as varicoceles, abnormalities in the testicles and supporting structures, infections, cysts, tumors and fluid buildup. Detecting physical abnormalities is necessary to determine further course of treatment.
Post ejaculation Urinalysis
Post-Ejaculatory Urinalysis is a diagnostic test which analysis your urine after ejaculation. It assesses potential reproductive issues such as retrograde ejaculation where semen enters the bladder. During the procedure you will be asked to collect a urine sample in a clean cup immediately after ejaculation in the clinic.
Testicular Biopsy
Testicular biopsy might be performed at the end if all other tests come inconclusive. For the procedure a small sample of the tissue is removed from the testicles to look for normal sperm production. If it comes back to normal the problem might be with sperm transport. In case sperms found, it can be frozen and later used during IVF/ICSI process to fertilize eggs and make embryos.
Genetic testing
Genetic testing is a fairly advanced method that detects severe disorders with sperm production. It is particularly useful for ruling out chromosomal abnormalities in men who have low sperm count (oligo-zoospermia) or lack sperm in their semen (azoospermia).
Anti-sperm antibodies test
The sperm does not come in contact with the immune system or the rest of your body. However, in case of an injury, post-surgery complication or pituitary gland infections, the immune system might come in contact with the sperm. When that happens, the immune system produces antibodies which can kill the sperm. The test uses your semen to check for antibodies by using a substance that marks affected sperm.
Conclusion
Male infertility is on the rise and accounts for 40% of the cases of infertility. It can be easily diagnosed by a simple test like semen analysis. With advancement in assisted reproductive techniques, most of the male factor infertility can be easily taken care. Timely diagnosis and correct treatment are the key to success.
