Diagnosing male infertility guide
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Fertility testing for men
For men, basic testing begins with the medical interview and physical exam.
A complete related medical history interview will cover:
- History of undescended testicles or hernias
- Mumps after puberty
- Athletic injuries to the groin
- History of sexually transmitted diseases
- Current sexual patterns
- Surgical history
- Urinary tract infections
- Impotence or ejaculatory problems
- Lifestyle and work environment
A complete related physical examination will include:
- Hair growth pattern
- Examination of the penis and scrotum for visible abnormalities
- Prostate examination
The Semen Analysis
The semen analysis is the single most important test of male fertility. It is also relatively inexpensive and non-invasive, especially compared to many of the female infertility diagnostic tests.
Sample collection may be performed at either a laboratory, a physician’s office, or in some cases, the privacy of home. Ejaculate resulting from masturbation is collected into a special sterile cup. The semen will be examined within a few hours, to achieve the most accurate results.
Semen analysis evaluates the following:
2.0-4.0 milliliters is a normal volume. Very low volume indicates blocked or malfunctioning seminal vesicles, or a problem with the prostate gland.
40 million to 300 million is a normal range for the number of sperm per milliliter. Counts below 10 million are considered poor (low sperm count); counts of 20 million or more may be fine if motility and morphology are normal.
Motility and Velocity
The number of active sperm cells will be counted as a percentage of the total number of cells. From zero to 100 percent, at least 50 percent should be active.
On a scale of zero to four, a rating will be given as to how well the sperm move, whether in a straight path or in circles, and the amount of velocity. A satisfactory score is two or more.
At least 30 percent of sperm cells should be normally shaped according to the World Health Organization (WHO).
Kruger (strict) morphology test
The shape and size of the sperm head are compared to what is considered normal by a standard referred to as Kruger test. Normal results are given when 14 percent or more of the sperm have normal shaped heads. Men with less than four percent of normal shaped sperm may have a significant infertility problem.
Normal semen is liquid at ejaculation, immediately coagulates into a pearly gel, and again liquefies within 20 minutes. Failure to coagulate and liquefy may indicate a problem with the seminal vesicles, as would increased thickness or the presence of white blood cells.
If no sperm are present, the semen will be tested for seminal fructose, normally produced by the seminal vesicles. If no fructose is present, congenital absence of the vas deferens or seminal vesicles or obstruction of the ejaculatory duct are possible causes.
Sperm Chromatin Structure Assay (SCSA)
The SCSA is used to determine the percentage of sperm that contain fragmented DNA and the extent of fragmentation. The DNA Fragmentation Index (DFI) is used to determine to what degree the sperm’s fragmented DNA affects infertility. Men with 25% or higher DFI are classified as having fair-poor fertility. This test is performed at the SCSA Diagnostics laboratory.
Additional Male Infertility Tests
- Semen and/or the urethra may be tested for the presence of any sexually transmitted infection or other bacteria.
- Blood tests may be performed to evaluate the levels of reproductive hormones.
- The Sperm Chromatin Structure Assay (SCSA) test determines what percentage of the sperm has fragmented DNA and the degree of the DNA damage. Research shows that patients with a high percentage of DNA fragmentation in their sperm have a significantly reduced fertility potential.