To evaluate fertility, men submit a health history, blood test, semen analysis and physical exam. If a hormone imbalance is suspected, hormone levels will be tested. Genetic testing using blood tests may also be done.
During the initial physician visit, the physician and the man (or couple, if possible) will spend time discussing the possible causes of the infertility, and determining a treatment plan.
A health history will be obtained during the first visit. We will ask about past infections of the urinary tract, past medical history and surgical procedures, alcohol and tobacco use, medication use, and past testicular trauma. We will also ask about your work environment, such as exposures to chemicals and high temperatures. The health history also includes questions regarding sexual practices and habits, and timing of intercourse.
We will perform a physical exam to evaluate factors that may contribute to infertility. About 1 percent of men with a fertility problem have an underlying medical condition, such as testicular cancer, endocrine dysfunction or a genetic disorder. The exam will evaluate the body and the male reproductive organs.
The man will be asked to abstain from ejaculation for approximately 72 hours prior to the doctor visit. On the day of the visit, he will provide a semen sample at our lab. Many men have already had testing elsewhere, however, we have found that it is often inaccurate. Therefore, we require at least one semen analysis to be performed in our lab. The semen sample provides valuable information, including the volume of the ejaculate, the sperm density (count), percent motility (the percent of moving sperm), speed and progressive motility.
The semen analysis also reports the sperm’s shape, or morphology. To be considered normal, a sperm must have an oval head, a normal mid-piece and a tail. An abnormal sperm could have a tapered head or two tails.
Minimal Standards of Semen Quality
Volume of the ejaculate is measured and reported. A normal amount is at least 1.5 milliliters. Too little semen decreases the odds of the sperm reaching the egg.
Sperm count should exceed a minimum of 20 million per milliliter. A “normal” sperm count is typically 60 to 80 million, but could be much higher.
Sperm motility and speed should show quality movement. At least 50 percent of the sperm cells should be motile. They are also “graded” on the quality of their movement - on a scale from zero to four, a score of three or higher is desired.
These factors vary on a daily basis, so multiple samples (at least two and often three) are required to establish an accurate baseline. It’s important to remember that the sperm production cycle is about 70 days, with another 15 to 20 days of transit through the ductal system. Therefore, it takes about 90 days for any therapy to be reflected in the semen analysis.
In an abundance of caution, care and concern for our patients, staff and community, we are delaying fertility treatment starts until we have a greater sense of the degree of COVID-19 transmission in our region. We will closely follow ASRM and CDC recommendations as they become available.