Diagnostic Male Infertility Test

Male infertility test are recommended for any couple that fails to achieve pregnancy after 12 months of regular unprotected intercourse or after 6 months of failure to conceive when the partner is older than 35 yrs old.

Male infertility can be defined by abnormal semen parameters but can be present even with a normal semen analysis.

Male factor is solely responsible in 20% of infertile couples and does contribute in another 30-40% of couples.

Causes of Male Infertility

Male infertility can be due to a variety of conditions, several, but not all of them, can be identified and treated. The identification and treatment of correctable conditions will improve the partner’s fertility and possibly allow conception to be achieved naturally. Evaluation of the infertile male can also aid at identifying any underlying medical conditions.

First Steps

The initial screening evaluation of the male partner should include a reproductive history. The history should include the following:

• coital frequency and timing
• duration of the infertility
• childhood illness or developmental history
• systemic medical illness history (diabetes mellitus)
• previous surgeries medications
• sexual history including any sexually transmitted diseases
• exposure to any environmental or chemical toxins.

A baseline semen analysis helps to define the severity of the male factor. It is important for the male to be given the standardized instructions for the semen collection:

• pretest abstinence (2- 5 days)
• collection methods of masturbation vs. intercourse with a special semen collection condom, and ideally collection in the office.

The semen analysis provides information on the semen volume as well as the sperm concentration, motility and morphology. Strict sperm morphology has been used to identify couples at risk for poor or failed fertilization when using standard in vitro thus identifying who are good candidates for (ICSI) intracytoplasmic sperm injection. There are clinical reference ranges that have been established by the World Health Organization for sperm concentration, motility and morphology to help classify if a male is subfertile. Parameters that predict male subfertility are concentration <13.5 million sperm/ml, motility <32% and sperm morphology <4% normal.

If the initial screening reveals an abnormal reproductive history and or semen analysis a thorough evaluation by an urologist is indicated.

What’s Next?

The urologist will expand on the screening evaluation and include a complete medical history and physical examination.

Based on these results additional tests and procedures may be recommended. Some of the more common recommendations are

• serial semen analysis
• post ejaculate urinalysis
• endocrine lab evaluation
• ultrasound and specialized tests on the semen and sperm

The medical history can help identify any risk factors and behaviors or lifestyles that can have a significant impact on male fertility. In the medial history there should be a complete review of:

• the systems
• family reproductive history
• a detailed social history, which should include present and past use of drugs, tobacco, alcohol or anabolic steroids

The physical exam is an integral part of the evaluation by the urologist. During the exam there is an examination of:

• the penis and palpation
• measurement of the testes
• presence of the epididymides
• presence of any varicocele or secondary sex characteristics, or breast development.

Hormone Tests

Tests to check for hormonal imbalance are an important step to evaluate men that have abnormal semen parameters, or impaired sexual function. The initial hormonal evaluation includes the measurement of serum follicle stimulating hormone (FSH), and total testosterone.

If the total testosterone is low (less than 300ng/ml) more extensive evaluation is needed. These patients may benefit from taking clomiphene citrate 25 mg orally daily for a few months. Further details have been discussed in a previous blog.

Other Tests

A low-volume (less than 1 ml) or an absent ejaculate suggests incomplete semen collection, a retrograde ejaculate or ejaculatory duct obstruction. To exclude retrograde ejaculation (where the man ejaculates into the bladder) a post ejaculatory urinalysis can be performed.

Blood tests for chromosome analysis and Y-microdeletion are indicated in patients with severe male factor to see if there is a chromosomal basis for the male factor infertility. Patients with certain kinds of Y-microdeletion (AZF a and b) will have no sperm in the testes and therefore will not benefit from testicular sperm aspiration (TESA).

Tests which are seldom ordered today include

• Tests for anti-sperm antibodies (they do not change treatment protocols. The first intervention usually is intrauterine inseminations (IUI). When sperm is processed (washed) for IUI, the antibodies (if present) are washed away anyway).
• Hamster penetration test (the sperm are evaluated for the ability to fertilize hamster eggs. There is limited correlation with the ability to fertilize the partners eggs)
• Hemizona assay (HZA) (this tests the sperms ability to bind with nonfertilized human eggs. With the advent of intracytoplasmic sperm injection (ICSI); this test is generally unnecessary).

Other tests for sperm function include the sperm chromatin structure assay (SCSA) COMET assay. Their use is controversial and beyond the scope of this blog.

While much of the focus of fertility seems to be on the female, the male does play an important role.

If you have questions or concerns about male infertility, please address them with a certified physician at InVia Fertility.