Complete Male Fertility Evaluation

 

History
A full medical & social history should be taken. This includes family and personal medical issues both present and past, developmental issues as a child (i.e. undescended testis), use of medications (some negatively affect sperm, i.e. drugs for hair loss, hypertension, prostate issues), sexual history, use of proper lubricants, & occupation (exposure to toxins or heat, sedentary). Please bring all prior medical evaluation paperwork with you to your initial appointment.

• recent fevers or illness
• cancer
• infections or STI’s
• surgeries
• trauma
• Family: cryptorchidism, hypogonadism
• DES exposure
• Medications
• childhood infections: mumps
• diabetes
• thyroid issues
• tobacco, alcohol, drugs, steroids
• Proper timing of intercourse
• lubricant use
• Heat exposure
• Toxin exposure
• Occupational history
• Partner history (gynecological & obstetrical)
  
  Physical Exam

  BMI, blood pressure, secondary sex characteristics, irregularities of the penis & testicles, careful palpation of the spermatic ducts for tenderness and/or obstruction as well as varicocele, and especially if there are any abnormal urinary symptoms, a prostate & seminal vesicle exam should be performed.

  Semen Analysis
  As Dr. Paul Turek states: ‘although not a true measure of fertility, the semen analysis, if abnormal, may suggest that the probability of achieving pregnancy is statistically low.’ It is always recommended to get 2 semen tests done, at least 2-3 months apart to rule out error. As well, it is recommended to have them done at a fertility clinic and opt for more extensive style semen testing options that are available. Unfortunately, sperm DNA fragmentation Assays are not currently done in Vancouver, as this is an important test that has particular importance in bein gused when recurrent pregnancy loss is evident. Normal up-to-date semen testing values:
  – Volume: >1.5ml
  – Concentration: >15 million/ml
  – Motility: >40% forward rapid progressive
  – Morphology: >4% normal forms

  *Anti-sperm antibodies should be tested for if the following are present: should be no agglutination, white cells, increased viscosity, or raised ph. .
  *Genetic testing should be considered if sperm concentration is zero or very low.

  Sperm is evaluated into the following categories;
  – adequate
  – aspermia (absence of ejaculate)
  – azoospermia (absence of sperm in semen)
  – oligospermia (lowered sperm density)
  – poor motility and forward movement
  – high percent of abnormal sperm morphology
  – antisperm antibodies

  Lab tests
  Hormones associated with reproduction should be measured if:

  1) Sperm concentration is less then 10 million sperm/ml on semen analysis.
  2) There is impaired sexual function (erectile dysfunction, low libido)
  3) There are exam findings of a specific hormone disorder (i.e. thyroid).

• Semen analysis (ASA & round cell staining to determine leukocyte content – CD45 monoclonal antibody)
• Post-ejaculate urinalysis: check for retrograde ejaculation & seminal fructose (if absent or PH is low, seminal vesicles may be absent or obstructed)
• Thyroid TSH (Free T3 & T4, anti TPO): especially if motility or morphology or erectile health is an issue.
• Testosterone
• DHEA
• FSH
• LH
• Prolactin
• Estrogen
• Coritsol
• Fasting glucose & insulin
• Post-coital testing
• CBC
• Cholesterol (LDL, HDL)
• STI swabAdditional tests
  Any additional testing should only be ordered if it would do any of the following:
  1) Delineate treatable problems
  2) Define life-threatening problems
  3) Help guide non-surgical/alternative medical treatment efficacy & directionGenetic testing
• karyotyping
• Y-microdeletions
• kleinfelters