Demystifying male infertility

IT’S NOT AS SCARY AS YOU MIGHT THINK

Dinah Olson

So you and your partner have decided you want to have a baby? For some couples this is achieved by discontinuing the use of contraception and having intercourse at the optimal time of a woman’s menstrual cycle. For other couples, despite their best effort, they do not become pregnant. If after one year of trying you’re unsuccessful, you might consider infertility. It is common for women to be the focus of attention as the source of infertility, however most professionals recommend the male partner be concurrently evaluated. Many women report their male partner as hesitant to seek care. This brief overview of the initial infertility evaluation for men is intended to demystify the process and encourage men to seek care.

The first step is to schedule an office visit with your primary care provider, an urologist or a fertility specialist. The initial evaluation normally consists of a thorough review of your medical history, a physical examination and arranging for a test called a semen analysis.

During the medical history the patient is asked detailed questions about their health history. This includes information spanning from birth to present, so taking some time to gather your medical, surgical and family history information prior to the appointment is important. Bring this information with you to your office visit. The reason to review this information is to help your healthcare provider identify factors that could contribute to infertility. Broadly speaking, these factors may create a problem making sperm or making sperm that functions properly.

These factors could be congenital - meaning something you were born with - or acquired, relating to something that happened to you or systemic illness or disease process, which could be something currently affecting your health that might possibly be treatable. The majority of your visit will likely be spent on the talking part. In addition to your medical, surgical and family history, you will be asked about your lifestyle, occupation and hobbies. Other questions will pertain to how your body is functioning during intercourse.

Once a thorough history is taken an examination should occur. Along with a general physical exam, there will be an exam of your genitals. The provider will check to see if the genitals appear normal.

In most cases, following the history and physical exam, a semen analysis will be ordered. If the history and exam uncover particular

medical concerns, other laboratory tests or imaging may also be recommended. The semen analysis evaluates the health of the semen which includes the sperm and the fluid in that comes out during ejaculation (orgasm). For a man to be fertile, healthy sperm need to be produced and transported out of the testicles into the semen, there needs to be enough sperm present and the sperm must be able to move properly to reach the female’s egg. The semen analysis test starts with the patient providing a sample of ejaculate. That is done privately via masturbation with the ejaculate entering a special sterile cup. You will receive instructions on how to collect a good specimen and you should carefully follow your provider’s instructions.

Typically, you will be asked to create a sample after abstaining from ejaculation for two to seven days prior. You will be instructed on what type of lubricants may or may not be used. If this is not done in a specialist office, you will be asked to complete the specimen collection at home and transport it to the office. The time between ejaculation and proper evaluation of the sperm is limited. You will be advised on how much time you have to get the sample to the office and how to keep the temperature in optimal range. It is important to follow these instruction carefully to get a good evaluation. There are home test kits on the market, but they are not generally recommended.

Once the sample is in the laboratory it will be evaluated. Your semen analysis report may vary but most include: • Volume: measurement of how much fluid is in the sample • Sperm concentration: how many sperm are in each milliliter of fluid • Total number: a count of number of sperm in the sample • Morphology: do the sperm have normal shape? • Vitality: Percentage of sperm that are alive • Progressive motility: Percentage of sperm that move in a straight line or large circle • Total motility: Percentage of sperm with both progressive and non progressive motility (progressive motility refers to sperm that move in a straight line or large circle)

Your sample will be compared to expected values based on studies of men whose partner successfully became pregnant within one year of trying. If the semen analysis is abnormal, you will likely be asked to repeat the test to be sure of the findings. A report will be generated and interpreted by a trained clinician.

Once the semen analysis is complete it is important that you meet with the ordering clinician to discuss your results so they can help you understand what it means. If the test is deemed abnormal, your clinician will recommend next steps. They might recommend additional evaluation such as having your blood drawn for tests to check hormones, genetics testing or imaging such as ultrasound of the genital area.

Hopefully this give couples an idea of what the initial infertility evaluation process is like for the male partner. SWM

Dinah Olson is a physician assistant at OCO Center for Reproductive Health.