Key Facts
- Infertility affects both genders, with male infertility contributing to 40-50% of cases in couples struggling to conceive.
- Male fertility assessments are recommended after one year of trying to conceive, or sooner for older couples or those with health concerns.
- An initial male fertility evaluation includes a detailed medical history, physical exam, and a semen analysis.
- Semen analysis evaluates factors like sperm count, motility, morphology, and viability, providing a snapshot of fertility health.
- Further testing may be needed based on semen analysis results, including checks for infections, hormone imbalances, or physical conditions like varicoceles.
- Genetic testing options, such as carrier screening and chromosomal analysis, may be recommended to assess potential genetic issues affecting fertility.
Despite prevalent perceptions, infertility, or the inability to conceive after one year of frequent, unprotected sexual activity, is a problem that affects everyone.
It is crucial to highlight that male infertility has a role in 40-50% of all couples who are having difficulty conceiving, despite the fact that there are numerous reasons concerning the female reproductive system that might cause pregnancy problems.
Jennifer Knudtson, MD, an OB/GYN and reproductive endocrinologist at Aspire Fertility in San Antonio, Texas, said, “We suggest male [fertility] assessment after a couple has been trying to conceive for a year.” In the case of older couples, this may occur as early as six months.
Susan Hudson, MD, a reproductive endocrinologist at the Texas Fertility Center, notes that if you have certain health concerns, such as diabetes or autoimmune disorders, it may be beneficial to undergo evaluation even sooner. According to research, diabetes may impact sperm quality, making it more difficult to conceive.
In addition, if you have a history of anything that might damage your testes or sperm production, such as cancer therapies such as chemotherapy or radiation, testicular surgery, or a previous incident of testicular torsion, you may want to have a fertility evaluation as soon as possible.
Dr Hudson states, “We’d rather know than believe everything is normal.”
What Occurs During a Male Fertility Evaluation?
Typically, an initial male fertility evaluation consists of three major components: a detailed medical history report, a physical exam that focuses on the male genitalia, and a semen study.
During the review of your medical history, your healthcare professional will evaluate you for any diseases and habits that may have an influence on your fertility. A history of testosterone usage, for example, is crucial information. According to Dr Hudson, it may reduce a man’s sperm production, sometimes permanently.
What Is a Semen Examination?
Semen analysis is the most important aspect of male fertility testing. In fact, if you and your spouse are just beginning the process of trying to conceive, your healthcare doctor may recommend beginning with a semen analysis and then proceeding based on the findings. Once you have this knowledge, you may inquire about your alternatives and undertake any required extra tests.
Semen analysis, as you would assume, needs the patient to ejaculate into a cup or other container. The sample will be collected and analysed for several factors, including the volume of semen, the number of sperm, the movement of the sperm (motility), the size and shape of the sperm (morphology), the pH level of the semen, and the viability of the sperm—that is, the proportion of living sperm present.
According to standard values for semen qualities, the following should be present in a 2 mL sample of semen on average:
40% or more progressive motility 4% or more typical forms, or normal shape and size 58% or more living spermatozoa, which means at least 58% of the sperm in the sample are alive with a pH level between 7.0 and 7.5.
It is crucial to remember that falling below these levels does not inevitably indicate infertility. “A sperm study is a snapshot in time,” explains Dr Hudson, emphasising that crucial choices are seldom based on a single test.
Some experts advocate two sperm analyses.
In this scenario, your healthcare professional may recommend more testing before discussing treatment choices. However, doctors advise not panicking if you obtain abnormal test results. Dr Knudtson states, “There is still a great deal of optimism.”
Utilising contraception When Infertility Is Diagnosed with Other Male Fertility Assessment Factors
The findings of your sperm analysis may prompt your doctor to prescribe further testing. For instance, an infection or hormone imbalance may be responsible for a less-than-desirable outcome.
Other factors that could impact your fertility include:
- Medications that inhibit ejaculatory function
- Varicoceles, or enlargement of the testicular veins
- Malignant or benign tumours
- Undescended testicles
Damage to the tubes that transport sperm
Once you know what you’re up against, you may determine whether or not to pursue therapy. Your healthcare practitioner may do a physical examination or a scrotal ultrasound to identify, for instance, that you have varicoceles in your scrotum, resulting in diminished sperm production. This is a somewhat typical occurrence that affects around 15 out of 100 males. You may then decide whether or not you wish to have surgery to repair it.
Not all individuals with infertility concerns need genetic testing
For instance, if you have a history of exposure to gonadotoxic chemo medicines — that is, cancer treatments or therapy that may have harmed your ability to produce sperm — you may not require genetic testing. The same applies to someone with a history of testicular damage.
If, however, your healthcare professional recommends genetic testing, you may be presented with a variety of alternatives.
Carrier Screening
Before attempting to procreate, individuals of both sexes are routinely provided carrier screening.
You may not even be aware that you are a carrier for a certain genetic illness, but this kind of test may determine whether you contain a gene for a condition that you may pass on to your biological kids.
Chromosomal Examination
A karyotype test is one type of chromosomal analysis that you may choose to have. It studies the number and structure of your chromosomes to see if there are any anomalies that might influence your fertility or health.
Analysis of Y Chromosome Microdeletions
This genetic test is meant to detect microscopic missing Y chromosomal segments that may be disrupting your sperm production.
Bottom Line
The decision to have a male fertility evaluation does not obligate you to pursue any form of therapy. It is just a matter of getting some knowledge that will assist you in evaluating the various possibilities and choosing the best choice.
Dr Hudson explains: “It helps [patients] pick a component of fertility therapy that is suited for that person or couple.”
Knowing the many alternatives accessible to you may be comforting, particularly if you want to maintain your fertility options for the future.
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Evan Kurzyp
Evan is the founder of Fertility2Family and is passionate about fertility education & providing affordable products to help people in their fertility journey. Evan is a qualified Registered Nurse and has expertise in guiding & managing patients through their fertility journeys.