EVALUATION PROCESS FOR MEN
Discussion of medical and surgical history. This includes a history of systemic diseases, such as viral infections (particularly postpubertal mumps and venereal disease), fevers, and diabetes mellitus, previous surgery, especially in the genitourinary area, duration of infertility, previous pregnancies, and sexual history. Many men had a hernia repair as babies and this occasionally causes a blockage of the vas due to scar tissue or to just bad surgical practices.
Physical exam: This includes an examination of testicle position in the scrotum (if the testicles haven't descended properly, the sperm will not be cool enough), an examination of the scrotum for varicoceles (varicose veins of the testicles), and an examination of the prostate and prostatic fluid for signs of infection. Also, fat and hair distribution is examined, for signs of hormone imbalance.
Urinalysis: Looks for signs of a urinary tract infection, presence of sperm in the urine (which, in conjunction with a low sperm count, may indicate retrograde ejaculation), and signs of systemic disorders such as kidney problems or diabetes mellitus.
Semen analysis: This is done at least three times, since sperm count varies, and a 2-3 day abstinence is required before each analysis. Normal values follow:
ejaculatory volume: 1.5-5.0 cc
sperm density: > 20 million/ml
motility: > 60%
forward progression: > 2, on a scale of 1-4
morphology: > 60% normal forms
(should have oval head and long tail)
And: 1) no significant microscopic sperm clumping,
2) no significant white or red blood cells,
3) no increased thickening of the seminal fluid (hyperviscosity).
For more information check http://matweb.hcuge.ch/matweb/endo/PGC_network/Semen_analysis_rrumbullaku.htm.
Endocrine tests: Blood tests to check levels of testosterone, FSH (follicle stimulating hormone), LH (luteinizing hormone), prolactin, estradiol, and the thyroid hormones T-4 and T-3. Usually FSH levels are measured first for men with low sperm counts, and others are measured as indicated. Some patterns of hormone abnormalities are more amenable to treatment than others. An elevated FSH is an indicator of testicular failure or the beginnings of testicular failure. If this is the case, there is little that can make a large difference in the count. Low normal or low levels of testosterone often indicate testicular atrophy (usually due to varicoceles). There is also little that can be done to change the sperm count if the levels of testosterone are low. Thyroid is an often overlooked or forgotten cause of sperm problems and is easy to check and easy to remedy. A link to general thyroid disease info is http://thyroid.miningco.com/.
Postcoital: Checks cervical mucus for presence of sperm after coitus. If a sperm count is low, generally it is just as easy to move on to intra-uterine insemination (IUI)rather than waste a cycle or more trying to do a postcoital. The sperm of men with low counts are more delicate and have more trouble surviving in mucus than do normal men's sperm.
Sperm Penetration Assay (SPA), or Hamster test (HEPA): This tests the ability of the sperm to penetrate a specially prepared hamster egg. This test is controversial and there is no clear evidence that the results are worthwhile. (FWIW, a little hamster has to die to donate the egg.)
Testicular biopsy: Takes a small piece of testicular tissue, and checks sperm-producing tubules and cells between the tubules. Possible patterns include: Normal (the tubules and the sperm in them are normal, so the problem is likely a blockage elsewhere), maturation arrest patterns, hypospermatogenesis (elements are there, but sperm isn't), and germinal cell aplasia (there just isn't any sperm there, and the only options for parenthood are donor insemination or adoption). This test is usually done as a last resort. It is often done in conjunction with an IVF cycle where donor sperm are ready as a backup in case there are no sperm in the biopsy.
Ultrasound of seminal vesicles to show their size, development, and whether they are emptying and storing sperm properly.
Vasogram: An x-ray using a dye to outline the ducts and look for obstructions
