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How is male infertility diagnosed?

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Last week, we looked at the causes of male infertility. This week I will discuss the diagnosis of male infertility. In other words, how do I know a man is infertile. Usually, he would come to see me because his partner’s gynecologist sends him with a semen test, indicating that his sperm count is low. This is the case in 8 out of 10 men.{{more}} The others come because they have been trying to get their girlfriend pregnant and they believe they are the problem, because they have never got any of their previous girlfriends pregnant. Very rarely, the men come because they are questioning paternity issues and were found to be infertile.

In questioning the couple, they are usually trying for 2-4 years before coming to see me or being referred. The woman is usually investigated thoroughly and the man’s sperm count is usually done as an afterthought, as though it is always the woman’s fault! In other words “she can’t get pregnant”. The man is usually embarrassed to realize it is he who is the problem. In questioning him, he may have children from a previous relationship, usually 10 or more years ago, but none recently. I question them about the timing and frequency of sexual intercourse. Infrequent sexual intercourse is a frequent cause of infertility.

There may be a history of marijuana use or abuse, excessive smoking or alcohol abuse. Some men, usually the farmers, have a long exposure to pesticides usually gramoxone and other industrial chemicals, especially the petrochemicals. Exposure to paints is also included. Other men would have experienced one sexually transmitted infection or more and may actually tell me that they have contracted Chlamydia in the past. Childhood problems can also affect your fertility, like surgery on an undescended testicle or older boys around the age of puberty who contract mumps. For young men who have never had children, apart from childhood problems outlined above, they do not usually have a significant history.

I examine the men trying to detect the obvious testicular problems: infections, tumors or small shriveled testicles called atrophic testicles. I also look to see if he has both testicles and they are both down, as well as looking for the presence of varicoceles or varicose veins around the testicles. I also examine the penis for evidence of strictures of the urine passage, or in men over 40, the presence of an enlarged prostate or prostate infections. A urinalysis and blood glucose is done at the same time. I also do a quick general medical including the blood pressure.

Then comes the semen-analysis. This is the analysis of the sperm count done in the lab. The man is given the form and instructed to abstain from sex for at least 4 days before collecting the specimen by masturbation. The specimen can also be collected by ejaculating into a special type of condom during sexual intercourse with one’s partner. The semen-analysis gives us information as to the number and shape of the sperms, as well as how fast they are swimming. The semen is also analyzed for its acidity, its colour and thickness or viscosity as well as its volume. All this information is used to detect the cause of the infertility. The normal parameters of the semen -analysis are:

Volume: 2-5 mls.

PH (acidity): 7-8.5

Viscosity: liquid (depends on time after ejaculation-see liquefaction time)

Color: translucent (semitransparent)

Liquefaction time (the time it takes to liquify): 30-60 minutes

Count: more than 60 million/ ml

Abnormal forms: less than 30%

Motility: more than 60%

Any one or more abnormalities can lead to sub-fertility or infertility. The more abnormalities there are, the less likely he is able to impregnate his partner. The man needs an absolute sperm count of at least 20 million /ml to be able to impregnate his partner. Counts below this is called oligozospermia while sluggish swimming sperms is called asthenospermia while poorly formed or misshaped sperms are called teratospermia. An abnormality of all three mentioned parameters is called OAT or oligoasthenoteratozospermia. Next week I will look at the causes of abnormal parameters and their treatment.

For comments or question contact:

Dr. Rohan Deshong

Tel: (784) 456-2785

email: [email protected]