Tests
Semen Analysis in the Diagnosis of Male Infertility
The most important component of a work-up for male infertility, following the collation of an initial medical history and performance of a physical examination, is the semen analysis. The basic semen analysis tests for sperm concentration (number of sperm) and sperm quality (sperm shape and motive power). Testing can be performed either in the physicians office or in an infertility clinic.
For the semen analysis, the man is asked to refrain from ejaculating for one to two days before the analysis. Then, at the test site, he is asked to ejaculate, usually by masturbation, into a sterile glass jar. For men who experience difficulty producing a sample in this way, special condoms that have not been treated with lubricants or chemicals toxic to sperm can be used to collect semen during ordinary sexual intercourse at home. An semen analysis based on two or more separate samples is deemed most reliable.
If the semen sample yields an initial abnormal result, the semen analysis will be repeated because samples from the same individual can vary widely. If repeat samples still show abnormalities in quantity or quality of sperm, the physician will then begin to look for possible causes. First, the physician will obtain an expanded medical history from the patient by asking him whether he has recently incurred a testicular disease or injury or a sudden illness or prolonged fever during the previous three months. He will also inquire about exposure to industrial or environmental toxins as well as use of steroids, drugs, or alcohol. He may then test for the presence of anti-sperm antibodies which can effectively kill otherwise healthy sperm. Other tests to determine intactness of sperm membranes and the sperm’s ability to bind to an egg and penetrate it can also be performed. Hormonal tests to check for disorders that originate in the testes or in the pituitary gland may also be ordered, as these disorders can reduce testosterone production without causing any overt signs and symptoms. Treatment, of course, will depend on the precise cause of the infertility.
