Back to Male Factor Infertility
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.
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).
Additional 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 & direction
Genetic testing
