Male Fertility Evaluation

The routine evaluation for male factor infertility includes:

Semen analysis:

The semen analysis is crucial to the evaluation of male fertility issues. RBA recommends that men have at least three semen analyses over the course of 2 weeks, following a history and physical exam. Multiple semen analyses are necessary due to a high amount of variability in samples such that a single analysis may not be fully representative of the individual’s fertility. At least 2 days of abstinence are needed prior to each analysis and specimens need to arrive at the laboratory no later than 1 hour after collection.

A thorough history should be obtained from the patient including:

  • Age
  • Fertility history including number of previous partners and pregnancies
  • Previous fertility work-up
  • Female partner work-up
  • Sexual history Childhood history including
  • Onset of puberty
  • Childhood diseases
  • Injuries Surgeries
  • Medical history including: diseases such as diabetes and hypertension
  • Adult surgical history including: hernia repair, bladder surgery, infections (including prostatitis, epididymitis, and venereal diseases)
  • Exposure to toxic substances including: pesticides and chemicals
  • Social history including: smoking, alcohol and recreational drug use
  • Family history including: paternal history of infertility, recurrent miscarriage, and chromosomal abnormalities

Physical Exam including:

  • Thyroid
  • Cardiac
  • Abdomen
  • Penis, Scrotum and Testicles – It is important to examine the patient in the standing position, having him perform the Valsalva maneuver (i.e. take a deep breath and bear down) in order to evaluate the presence of varicoceles. Physical structure such as testicular size, uniformity, and the presence of the vas deferens will be evaluated.

Additional testing may be required to verify physical findings. These may include:

  • Ultrasound: Examination of the prostate, testicles, spermatic cord, and kidneys
  • Hormone blood tests: FSH, LH, Testosterone and Prolactin
  • Antibody testing of the semen Sperm function testing
  • Testicular biopsy
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