Niepłodność męska – Diagnostyka i diagnoza

Niepłodność męska
Diagnostyka i diagnoza

Niepłodność męska stanowi około 50% wszystkich przypadków niepłodności u par, z wyłącznym udziałem czynnika męskiego w 20-30% przypadków. Definiowana jest przez WHO jako niemożność zapłodnienia płodnej kobiety po roku regularnych, niezabezpieczonych stosunków. Etiologia niepłodności męskiej obejmuje zaburzenia endokrynologiczne (5-15% przypadków), problemy z produkcją i transportem nasienia, w tym azoospermię (10-15% przypadków), żylaki powrózka nasiennego, wsteczną ejakulację oraz zespoły genetyczne jak Klinefelter. Diagnostyka powinna obejmować szczegółowy wywiad, badanie fizykalne, co najmniej dwie analizy nasienia (prawidłowe wartości: objętość ≥1,5 ml, koncentracja >15 mln/ml, ruchliwość ≥50%, morfologia ≥35%), badania hormonalne (FSH, LH, testosteron, prolaktyna, TSH) oraz badania genetyczne u pacjentów z ciężką oligozoospermią (<5 mln/ml) lub azoospermią z podwyższonym FSH. Badania obrazowe (USG moszny, TRUS, doppler, MRI) oraz testy specjalistyczne (test penetracji plemników, przeciwciała przeciwplemnikowe, biopsja jądra) są wskazane w zależności od kliniki.

Niepłodność męska – Diagnostyka i rozpoznanie

Definicja niepłodności męskiej

Znaczenie diagnostyki niepłodności męskiej

Przyczyny niepłodności męskiej

Proces diagnostyczny

Wywiad medyczny i badanie fizykalne
Badanie nasienia (seminogram)
Badania hormonalne
Badania genetyczne
Badania obrazowe
Dodatkowe badania diagnostyczne

Nowe metody diagnostyczne
Diagnostyka specyficznych przypadków niepłodności męskiej

Diagnoza azoospermii
Diagnostyka żylaków powrózka nasiennego
Niepłodność męska o niewyjaśnionej przyczynie

Znaczenie kompleksowej diagnostyki
Podsumowanie diagnostyki niepłodności męskiej

Kolejne rozdziały

Niepłodność męska – Diagnostyka i rozpoznanie

Niepłodność męska jest istotnym problemem dotyczącym zdrowia reprodukcyjnego mężczyzn i stanowi znaczącą część wszystkich przypadków niepłodności u par. Według różnych źródeł, czynnik męski jest wyłączną przyczyną niepłodności w około 20-30% przypadków, a dodatkowym czynnikiem w kolejnych 30-40% przypadków par niepłodnych ¹². Oznacza to, że czynnik męski ma istotny wpływ na około 50% wszystkich przypadków niepłodności ³. Badania pokazują, że niepłodność męska dotyczy około 10-15% mężczyzn w Stanach Zjednoczonych próbujących począć dziecko ⁴.

Definicja niepłodności męskiej

Światowa Organizacja Zdrowia (WHO) definiuje niepłodność męską jako niezdolność mężczyzny do zapłodnienia płodnej kobiety po co najmniej roku regularnych, niezabezpieczonych stosunków płciowych ⁵. Niepłodność pierwotna odnosi się do par, które nigdy nie miały dziecka i nie mogą zajść w ciążę po co najmniej 12 kolejnych miesiącach współżycia bez stosowania metod antykoncepcyjnych. Niepłodność wtórna dotyczy par niepłodnych, które były w stanie zajść w ciążę przynajmniej raz wcześniej (z tym samym lub innym partnerem seksualnym) ⁶.

Znaczenie diagnostyki niepłodności męskiej

Kluczowym celem oceny mężczyzny pod kątem niepłodności jest identyfikacja czynników przyczyniających się do problemu, zaproponowanie leczenia tych, które są odwracalne, określenie, czy pacjent jest kandydatem do technik wspomaganego rozrodu (ART), oraz udzielenie poradnictwa w przypadku nieodwracalnych i nieleczalnych stanów ⁷⁸. Co ważne, do 6% mężczyzn ocenianych pod kątem niepłodności może mieć poważniejsze podstawowe schorzenia, takie jak nowotwór ⁹. Jest to dodatkowy powód, dla którego należy przeprowadzić kompleksową ocenę partnerów płci męskiej par niepłodnych, aby można było zidentyfikować i leczyć wszelkie istotne podstawowe schorzenia ¹⁰.

Przyczyny niepłodności męskiej

Istnieje wiele przyczyn niepłodności męskiej, które można szeroko sklasyfikować ze względu na ich ogólną etiologię ¹¹. Przyczyny niepłodności męskiej dzieli się najczęściej na cztery główne obszary:

Zaburzenia endokrynologiczne i ogólnoustrojowe z hipogonadyzmem hipogonadotropowym – 5-15% przypadków ¹²
Problemy z produkcją nasienia lub jego transportem ¹³
Przyczyny obstrukcyjne (zablokowanie dróg wyprowadzających nasienie) ¹⁴
Przyczyny nieobstrukcyjne (problemy z produkcją plemników) ¹⁵

Do specyficznych przyczyn niepłodności męskiej należą m.in.:

Żylaki powrózka nasiennego (varicocele), które zmniejszają liczbę i jakość plemników ¹⁶
Wsteczna ejakulacja, gdy nasienie dostaje się do pęcherza zamiast być wyrzucane z penisa ¹⁷
Brak plemników w nasieniu (azoospermia) spowodowany genetycznymi nieprawidłowościami, zaburzeniami hormonalnymi lub niedrożnością dróg wyprowadzających ¹⁸
Zespół Klinefeltera – nieprawidłowa liczba chromosomów płciowych, powodująca niską produkcję plemników lub jej brak ¹⁹

Proces diagnostyczny

W początkowej ocenie niepłodności zarówno mężczyzna, jak i kobieta powinni przejść jednoczesną ocenę ²⁰. Pierwsza ocena mężczyzny pod kątem płodności powinna obejmować wywiad zdrowotny i reprodukcyjny oraz co najmniej jedną analizę nasienia ²¹.

Wywiad medyczny i badanie fizykalne

Ocena niepłodności męskiej rozpoczyna się od szczegółowego wywiadu medycznego i badania fizykalnego ²². Wywiad powinien obejmować:

Szczegółową historię zdrowotną i reprodukcyjną ²³
Informacje o przebytych chorobach, zabiegach chirurgicznych i przyjmowanych lekach ²⁴
Pytania o choroby dziedziczne, długotrwałe problemy zdrowotne, schorzenia lub urazy mogące wpływać na płodność ²⁵
Ocenę stylu życia, w tym nawyków seksualnych i ekspozycji na czynniki toksyczne ²⁶

Badanie fizykalne powinno skupiać się na:

Badaniu narządów płciowych ²⁷
Ocenie jąder pod kątem ich wielkości i konsystencji ²⁸
Poszukiwaniu anomalii, takich jak żylaki powrózka nasiennego, wodniak jądra, niezstąpienie jąder ²⁹
Badaniu penisa pod kątem spodziectwa, stulejki i blaszek Peyroniego ³⁰

Badanie nasienia (seminogram)

Analiza nasienia jest podstawowym badaniem w diagnostyce niepłodności męskiej ³¹. Badanie to powinno być wykonane co najmniej dwukrotnie, w odstępie co najmniej tygodnia, a najlepiej miesiąca, ze względu na możliwe dzienne wahania liczby i jakości plemników ³²³³.

Przed oddaniem próbki nasienia mężczyzna powinien powstrzymać się od ejakulacji przez około 2-7 dni ³⁴. Próbka jest najczęściej pobierana przez masturbację do sterylnego pojemnika ³⁵. Nasienie należy dostarczyć do laboratorium w ciągu godziny od pobrania ³⁶.

W badaniu nasienia ocenia się następujące parametry:

Objętość ejakulatu – prawidłowa objętość wynosi co najmniej 1,5 ml ³⁷³⁸
Liczba plemników (koncentracja) – prawidłowa koncentracja to powyżej 15 milionów plemników/ml lub całkowita liczba 39 milionów w całej próbce ³⁹⁴⁰
Ruchliwość plemników (motility) – co najmniej 50% plemników powinno wykazywać ruchliwość ⁴¹
Morfologia plemników – ocena kształtu plemników; prawidłowo ukształtowane plemniki powinny stanowić co najmniej 35% wszystkich plemników ⁴²
pH nasienia ⁴³
Obecność leukocytów i niedojrzałych komórek rozrodczych ⁴⁴
Upłynnienie nasienia ⁴⁵

Nieprawidłowości w analizie nasienia mogą obejmować:

Oligozoospermia – niska liczba plemników (poniżej 15 milionów/ml) ⁴⁶
Astenozoospermia – niska ruchliwość plemników ⁴⁷
Teratozoospermia – nieprawidłowa morfologia plemników ⁴⁸
Azoospermia – brak plemników w nasieniu ⁴⁹

Kombinacja kilku parametrów ejakulatu jest lepszym wskaźnikiem sukcesu płodności niż pojedynczy parametr ⁵⁰.

Badania hormonalne

Badania hormonalne są wskazane u mężczyzn z zaburzeniami libido, zaburzeniami erekcji, oligozoospermią lub azoospermią, atrofią jąder lub objawami zaburzeń hormonalnych w badaniu fizykalnym ⁵¹. Hormony wytwarzane przez przysadkę mózgową, podwzgórze i jądra odgrywają kluczową rolę w rozwoju płciowym i produkcji plemników ⁵².

Rutynowe badania hormonalne obejmują oznaczenie:

FSH (hormon folikulotropowy) – stymuluje produkcję plemników w jądrach ⁵³
LH (hormon luteinizujący) – wpływa na produkcję testosteronu ⁵⁴
Testosteron – odpowiada za rozwój męskich cech płciowych i produkcję plemników ⁵⁵
Prolaktyna – podwyższony poziom może wpływać negatywnie na płodność ⁵⁶
TSH (hormon tyreotropowy) – ocena funkcji tarczycy ⁵⁷

Nieprawidłowości w poziomach hormonów mogą wskazywać na zaburzenia endokrynologiczne, które mogą być przyczyną niepłodności męskiej ⁵⁸.

Badania genetyczne

Badania genetyczne są zalecane w przypadku bardzo niskiej liczby plemników (poniżej 5 milionów/ml) lub azoospermii z podwyższonym poziomem FSH lub atrofią jąder ⁵⁹. Nieprawidłowości genetyczne mogą być przyczyną niepłodności u około 20% mężczyzn z problemami z produkcją plemników ⁶⁰.

Najczęściej wykonywane badania genetyczne obejmują:

Kariotyp – badanie liczby i struktury chromosomów ⁶¹
Badanie mikrodelecji chromosomu Y – u mężczyzn z azoospermią lub ciężką oligozoospermią ⁶²
Badanie mutacji w genie CFTR – u mężczyzn z wrodzonym brakiem nasieniowodów ⁶³
Badanie fragmentacji DNA plemników – ocena integralności materiału genetycznego plemników ⁶⁴

Pełna delecja obejmująca regiony AZFa i AZFb chromosomu Y jest złym czynnikiem prognostycznym dla pozyskania plemników drogą chirurgiczną ⁶⁵. Natomiast plemniki jądrowe można znaleźć u 50-75% mężczyzn z mikrodelecjami AZFc ⁶⁶.

Badania obrazowe

Badania obrazowe są ważnym elementem diagnostyki niepłodności męskiej, szczególnie w przypadkach podejrzenia nieprawidłowości anatomicznych ⁶⁷.

Najczęściej wykonywane badania obrazowe to:

Ultrasonografia moszny – do oceny jąder, wykrycia żylaków powrózka nasiennego, wodniaków, nieobecności nasieniowodów i guzów jąder ⁶⁸
Przezodbytnicze badanie ultrasonograficzne (TRUS) – do oceny gruczołu krokowego, pęcherzyków nasiennych i przewodów wytryskowych; wskazane u pacjentów z azoospermią lub ciężką oligozoospermią w celu oceny niedrożności przewodu wytryskowego ⁶⁹
Kolorowe badanie dopplerowskie – do oceny przepływu krwi i wykrywania żylaków powrózka nasiennego ⁷⁰
Rezonans magnetyczny (MRI) przysadki i podwzgórza – w przypadku podejrzenia zaburzeń hormonalnych ⁷¹

Dodatkowe badania diagnostyczne

W zależności od wyników badań podstawowych, mogą być zalecane dodatkowe testy diagnostyczne:

Badanie moczu po ejakulacji – do wykrycia wstecznej ejakulacji, gdy plemniki trafiają do pęcherza zamiast na zewnątrz ⁷²⁷³
Test penetracji plemników (test penetracji komórki jajowej chomika) – ocenia zdolność plemników do zapłodnienia komórki jajowej ⁷⁴
Test przeciwciał przeciwplemnikowych – wykrywa obecność przeciwciał, które mogą atakować plemniki i upośledzać ich funkcje ⁷⁵
Badanie integralności chromatyny plemników (SCSA) – ocenia uszkodzenia DNA plemników ⁷⁶
Biopsja jądra – wykonywana u mężczyzn z azoospermią w celu oceny produkcji plemników i wykluczenia niedrożności dróg wyprowadzających ⁷⁷

Nowe metody diagnostyczne

Badania nad nowymi metodami diagnostycznymi w niepłodności męskiej są stale prowadzone. Jednym z przykładów jest test wykrywający dwa specyficzne białka obecne tylko w żywych plemnikach, co może pomóc w nieinwazyjnej diagnostyce mężczyzn z najcięższą postacią niepłodności męskiej ⁷⁸.

Innym przykładem jest nowa metoda wykrywająca liczbę pęknięć DNA w plemnikach, co umożliwia obliczenie średniej liczby pęknięć DNA (MDB) na plemnik w próbce. Ta metoda ma silniejszy związek kliniczny z wynikami ciąży i może stanowić lepsze narzędzie do oceny jakości plemników i płodności męskiej ⁷⁹.

Diagnostyka specyficznych przypadków niepłodności męskiej

Diagnoza azoospermii

Azoospermia, czyli brak plemników w nasieniu, jest przyczyną niepłodności u około 10-15% niepłodnych mężczyzn ⁸⁰. Aby potwierdzić azoospermię, nasienie powinno być odwirowane i ocenione pod mikroskopem pod kątem obecności plemników ⁸¹.

Azoospermię dzieli się na dwa główne typy:

Azoospermia obstrukcyjna – spowodowana niedrożnością dróg wyprowadzających nasienie; plemniki są produkowane w jądrach, ale nie mogą przedostać się do ejakulatu ⁸²
Azoospermia nieobstrukcyjna – spowodowana zaburzeniami produkcji plemników w jądrach ⁸³

Mężczyźni z azoospermią powinni być klinicznie oceniani w celu rozróżnienia niedrożności dróg płciowych od zaburzeń produkcji plemników, początkowo na podstawie objętości nasienia, badania fizykalnego i poziomów FSH ⁸⁴.

Diagnostyka żylaków powrózka nasiennego

Żylaki powrózka nasiennego (varicocele) to poszerzone żyły w mosznie, które mogą wpływać na płodność męską. Są one wykrywane u płodnych i niepłodnych mężczyzn, ale występują częściej u mężczyzn niepłodnych ⁸⁵.

Żylaki powrózka nasiennego często wiążą się z mniejszą liczbą prawidłowych plemników i większą liczbą plemników o nieprawidłowym kształcie ⁸⁶. Lekarze mogą zdiagnozować żylaki powrózka nasiennego poprzez badanie fizykalne ⁸⁷ lub ultrasonografię moszny ⁸⁸.

Obecność żylaków powrózka nasiennego u niektórych mężczyzn wiąże się z postępującym uszkodzeniem jąder od okresu dojrzewania i możliwym zmniejszeniem płodności ⁸⁹. Żylaki powrózka nasiennego są również związane z podwyższoną fragmentacją DNA plemników (SDF), a interwencja chirurgiczna może zmniejszyć SDF i poprawić wyniki technik wspomaganego rozrodu ⁹⁰.

Niepłodność męska o niewyjaśnionej przyczynie

Niepłodność męska o niewyjaśnionej przyczynie to diagnoza zarezerwowana dla mężczyzn, u których rutynowe analizy nasienia dają wyniki w granicach normy, a nieprawidłowości fizyczne i endokrynologiczne zostały wykluczone ⁹¹. Średnia częstość występowania niewyjaśnionej niepłodności męskiej wynosi około 15%, chociaż doniesienia wahają się od 6% do 37% ⁹².

W przypadkach niewyjaśnionej niepłodności męskiej ważne jest przeprowadzenie dokładnej oceny początkowej, w tym szczegółowego wywiadu seksualnego i badania ginekologicznego, a także zaawansowanych badań, które sprawdzają autoimmunologiczną niepłodność i wady plemników ⁹³.

Prawidłowa analiza nasienia nie gwarantuje potencjału zapłodnienia plemników, a badania wykazały znaczące nakładanie się wartości parametrów nasienia między mężczyznami płodnymi i niepłodnymi ⁹⁴. Opracowanie i kliniczne zastosowanie nowych testów funkcji plemników, w tym technologii „omicznych”, może poprawić precyzję i wiarygodność diagnozy niepłodności męskiej ⁹⁵.

Znaczenie kompleksowej diagnostyki

Panel wytycznych AUA/ASRM (American Urological Association/American Society for Reproductive Medicine) stwierdza, że kompleksowe badanie andrologiczne jest zawsze wskazane u par niepłodnych, zarówno jeśli analiza nasienia wykazuje nieprawidłowości, jak i u mężczyzn z prawidłowymi parametrami nasienia w porównaniu z wartościami referencyjnymi ⁹⁶.

Niepłodni mężczyźni powinni otrzymać odpowiednie poradnictwo i być pod obserwacją, biorąc pod uwagę wyższe ryzyko rozwoju nowotworowych i nienowotworowych chorób współistniejących w późniejszym życiu ⁹⁷.

Ukierunkowana ocena pacjentów płci męskiej powinna obejmować: szczegółowy wywiad medyczny, reprodukcyjny i rodzinny; badanie fizykalne; analizę nasienia z rygorystycznym przestrzeganiem wartości referencyjnych Światowej Organizacji Zdrowia (WHO) dla ludzkiego nasienia; oraz ocenę hormonalną ⁹⁸. Inne badania (np. analiza genetyczna i obrazowanie) mogą być wymagane w zależności od cech klinicznych i parametrów nasienia ⁹⁹.

Podsumowanie diagnostyki niepłodności męskiej

Diagnoza niepłodności męskiej jest procesem wieloetapowym, który powinien obejmować:

Szczegółowy wywiad medyczny i reprodukcyjny ¹⁰⁰
Badanie fizykalne ze szczególnym uwzględnieniem narządów płciowych ¹⁰¹
Co najmniej dwie analizy nasienia wykonane w odstępie czasu ¹⁰²
Badania hormonalne, szczególnie u mężczyzn z zaburzeniami erekcji, niskim libido lub nieprawidłowymi parametrami nasienia ¹⁰³
Badania genetyczne u mężczyzn z bardzo niską liczbą plemników lub azoospermią ¹⁰⁴
Badania obrazowe w zależności od wskazań klinicznych ¹⁰⁵
Dodatkowe testy specjalistyczne w wybranych przypadkach ¹⁰⁶

Prawidłowa diagnoza niepłodności męskiej jest kluczowa dla wyboru odpowiedniego leczenia i określenia rokowania. W wielu przypadkach niepłodność męska może być leczona, a określenie przyczyny problemu pozwala na zastosowanie celowanej terapii ¹⁰⁷.

Nawet jeśli mężczyzna ma zdiagnozowaną niepłodność, nie oznacza to, że nigdy nie będzie mógł mieć biologicznego dziecka. Dostępne są różne opcje leczenia, a dzięki nowoczesnej technologii wiele par ma potencjał do poczęcia biologicznego dziecka ¹⁰⁸.

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Materiały źródłowe

#1 Male Infertility – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK562258/
Infertility is usually defined as the inability of a couple to conceive even after 1 year of unprotected, frequent sexual intercourse. The male is solely responsible in about 20% of cases and is a contributing factor in another 30% to 40% of all infertility cases. […] Overall, the male factor substantially contributes to about 50% of all cases of infertility. […] The initial evaluation includes a detailed sexual history and physical examination, together with 2 separate semen analyses. Hormonal testing and an optional scrotal ultrasound can then be performed if abnormalities are found. This is usually sufficient to make an initial determination of the nature and severity of the underlying problem. […] The key purpose for evaluating a male for infertility is to identify the contributing factors, offer treatment for those that are reversible, determine if the patient is a candidate for assisted reproductive techniques, and offer counseling for irreversible and untreatable conditions.
#2 The diagnosis of male infertility: an analysis of the evidence to support the development of global WHO guidanceâchallenges and future research opportunities
https://pmc.ncbi.nlm.nih.gov/articles/PMC5850791/
This evidence synthesis analysis has been conducted in a manner to be considered for global applicability for the diagnosis of male infertility. […] The initial evaluation for male factor infertility should include a PE performed by an examiner with appropriate training and expertise, a reproductive history, and at least one properly performed (high quality) semen analyses. A full evaluation by a urologist or other specialist in male reproduction should be carried out if the initial screening evaluation demonstrates an abnormal PE, an abnormal male reproductive or sexual history, or an abnormal semen analysis is found. Further evaluation of the male partner should also be considered in couples with unexplained infertility and in couples in whom there is a treated female factor and persistent infertility.
#3 Male Infertility: Causes, Symptoms, Tests & Treatment
https://my.clevelandclinic.org/health/diseases/17201-male-infertility
Infertility is a common problem for many men. […] If you have male infertility, it means you have repeated unprotected sexual intercourse for over a year but your female partner doesnt get pregnant. […] Infertility affects 186 million people worldwide, and the male partner is the cause in about half of the cases. Some studies show that male infertility affects about 10% to 15% of males in the United States who are trying to conceive. […] A primary care physician (PCP) can diagnose male infertility. Or they may refer you to a urologist who specializes in male infertility or a reproductive endocrinologist. […] A semen analysis is one of the primary tests healthcare providers use to help diagnose male infertility. Its a lab test of a semen sample that examines the volume and quality of your sperm.
#4 Male Infertility: Causes, Symptoms, Tests & Treatment
https://my.clevelandclinic.org/health/diseases/17201-male-infertility
Infertility is a common problem for many men. […] If you have male infertility, it means you have repeated unprotected sexual intercourse for over a year but your female partner doesnt get pregnant. […] Infertility affects 186 million people worldwide, and the male partner is the cause in about half of the cases. Some studies show that male infertility affects about 10% to 15% of males in the United States who are trying to conceive. […] A primary care physician (PCP) can diagnose male infertility. Or they may refer you to a urologist who specializes in male infertility or a reproductive endocrinologist. […] A semen analysis is one of the primary tests healthcare providers use to help diagnose male infertility. Its a lab test of a semen sample that examines the volume and quality of your sperm.
#5 Male Infertility – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK562258/
Male infertility is defined by the World Health Organization (WHO) as the inability of a male to make a fertile female pregnant for a minimum of at least 1 year of regular unprotected intercourse. […] The key purpose for evaluating a male for infertility is to identify his contributing factors, offer treatment for those that are reversible, determine if he is a candidate for assisted reproductive techniques (ART), and provide counseling for irreversible and untreatable conditions. […] Up to 6% of men evaluated for male infertility will be found to have more serious underlying pathology, such as cancer. […] This is an additional reason to do a comprehensive evaluation of the male partners of infertile couples so that any significant, underlying medical conditions can be identified and treated.
#6 EAU Guidelines on Sexual and Reproductive Health – Uroweb
https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-infertility
Infertility is defined by the inability of a sexually active, non-contraceptive couple to achieve spontaneous pregnancy within 12 months. Primary infertility refers to couples that have never had a child and cannot achieve pregnancy after at least 12 consecutive months having sex without using birth control methods. Secondary infertility refers to infertile couples who have been able to achieve pregnancy at least once before (with the same or different sexual partner). […] In 30-40% of cases, no male-associated factor is found to explain the underlying impairment of sperm parameters and historically was referred to as idiopathic male infertility. These men present with no previous history of diseases affecting fertility and have normal findings on physical examination and endocrine, genetic and biochemical laboratory testing, although semen analysis may reveal pathological findings. It is now believed that idiopathic male infertility may be associated with several previously unidentified pathological factors, which include but are not limited to endocrine disruption as a result of environmental pollution, generation of reactive oxygen species (ROS)/sperm DNA damage, or genetic and epigenetic abnormalities. Unexplained male infertility is defined as infertility of unknown origin with normal sperm parameters and partner evaluation. Between 20 and 30% of couples will have unexplained infertility.
#7 Male Infertility – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK562258/
Infertility is usually defined as the inability of a couple to conceive even after 1 year of unprotected, frequent sexual intercourse. The male is solely responsible in about 20% of cases and is a contributing factor in another 30% to 40% of all infertility cases. […] Overall, the male factor substantially contributes to about 50% of all cases of infertility. […] The initial evaluation includes a detailed sexual history and physical examination, together with 2 separate semen analyses. Hormonal testing and an optional scrotal ultrasound can then be performed if abnormalities are found. This is usually sufficient to make an initial determination of the nature and severity of the underlying problem. […] The key purpose for evaluating a male for infertility is to identify the contributing factors, offer treatment for those that are reversible, determine if the patient is a candidate for assisted reproductive techniques, and offer counseling for irreversible and untreatable conditions.
#8 Male Infertility – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK562258/
Male infertility is defined by the World Health Organization (WHO) as the inability of a male to make a fertile female pregnant for a minimum of at least 1 year of regular unprotected intercourse. […] The key purpose for evaluating a male for infertility is to identify his contributing factors, offer treatment for those that are reversible, determine if he is a candidate for assisted reproductive techniques (ART), and provide counseling for irreversible and untreatable conditions. […] Up to 6% of men evaluated for male infertility will be found to have more serious underlying pathology, such as cancer. […] This is an additional reason to do a comprehensive evaluation of the male partners of infertile couples so that any significant, underlying medical conditions can be identified and treated.
#9 Male Infertility – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK562258/
Male infertility is defined by the World Health Organization (WHO) as the inability of a male to make a fertile female pregnant for a minimum of at least 1 year of regular unprotected intercourse. […] The key purpose for evaluating a male for infertility is to identify his contributing factors, offer treatment for those that are reversible, determine if he is a candidate for assisted reproductive techniques (ART), and provide counseling for irreversible and untreatable conditions. […] Up to 6% of men evaluated for male infertility will be found to have more serious underlying pathology, such as cancer. […] This is an additional reason to do a comprehensive evaluation of the male partners of infertile couples so that any significant, underlying medical conditions can be identified and treated.
#10 Male Infertility – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK562258/
Male infertility is defined by the World Health Organization (WHO) as the inability of a male to make a fertile female pregnant for a minimum of at least 1 year of regular unprotected intercourse. […] The key purpose for evaluating a male for infertility is to identify his contributing factors, offer treatment for those that are reversible, determine if he is a candidate for assisted reproductive techniques (ART), and provide counseling for irreversible and untreatable conditions. […] Up to 6% of men evaluated for male infertility will be found to have more serious underlying pathology, such as cancer. […] This is an additional reason to do a comprehensive evaluation of the male partners of infertile couples so that any significant, underlying medical conditions can be identified and treated.
#11 Male Infertility – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK562258/
There are multiple causes for male infertility, which can be broadly classified due to their general underlying etiology. […] These are broad estimates only, as accurate statistics are unavailable due to general underreporting, cultural factors, and regional variations. […] The semen analysis is the cornerstone of laboratory evaluation of male infertility. At least 2 separate samples should be collected, separated by at least 1 week but optimally by a month. […] The outcomes and prognosis of male infertility greatly depend upon the semen analysis results as well as the female partner’s fertility status, along with the categorization of whether fertility is primary or secondary. […] The semen is evaluated for volume, pH, leukocytes, immature germ cells, and liquefaction, while the sperm is assessed for count, concentration, vitality, motility, progression, debris, and morphology. […] Either the WHO criteria for scoring sperm morphology or the Kruger-Tygerberg criteria should be used.
#12 Approach to the male with infertility – UpToDate
https://www.uptodate.com/contents/approach-to-the-male-with-infertility
Approach to the male with infertility […] This topic will review the evaluation of male infertility. […] The causes of male infertility can be divided into four main areas (table 1) (see „Causes of male infertility”): […] Endocrine and systemic disorders with hypogonadotropic hypogonadism â 5 to 15 percent.
#13 Azthena logo with the word Azthena
https://www.news-medical.net/health/How-is-Male-Infertility-Diagnosed.aspx
Male infertility can result if there is an inadequate production of sperm to fertilize an egg, if the sperm is not shaped properly and if the sperm is unable to swim as is required. […] In order to check if any of these issues exist, a sample of the males semen will be collected by ejaculation into a special container. […] This specimen sample will be tested in a laboratory to check for sperm count, health, shape and motility. […] Any abnormalities in the sperm morphology will also be tested along with signs of other problems and infections. […] Since nearly 40% of male infertility is caused by varicocele, it is important to exclude this before proceeding to other possible problems. […] If the hormones are not balanced, spermatogenesis does not take place and only Sertoli cells are seen when a testicular biopsy is conducted.
#14 Diagnosing Male Infertility | NYU Langone Health
https://nyulangone.org/conditions/male-infertility/diagnosis
NYU Langone urologists who specialize in male infertility work together with female reproduction specialists to diagnose and manage infertility in couples. […] About 15 percent of couples trying to conceive are unable to do so within a year, and male infertility can be a contributing factor for about half of them. […] Problems with any part of this process can lead to infertility. This can include problems with hormones, problems with sperm production, obstruction in the ducts, and genetic abnormalities. […] The causes of male infertility are broadly classified as obstructive or nonobstructive. […] A total absence of sperm is the cause of infertility in about 10 to 15 percent of infertile men. This is called azoospermia, and it can be caused by a genetic irregularity, hormone imbalance, or blockage in the tubes that carry sperm to the urethra.
#15 Diagnosing Male Infertility | NYU Langone Health
https://nyulangone.org/conditions/male-infertility/diagnosis
The causes of obstructive male infertility may include retrograde ejaculation, which is when semen enters the bladder rather than being ejaculated from the penis. […] Causes of nonobstructive male infertility include varicocele, which is when the veins in the testicles enlarge, reducing the sperm count and quality. […] Doctors can diagnose varicocele by performing a physical examination. […] To determine the cause of infertility and choose the treatment or treatments that best suit your needs, your NYU Langone urologist asks about your medical history and performs a physical examination. […] NYU Langone urologists may test a mans semen to determine causes of infertility. […] Blood tests can identify a mans levels of the reproductive hormone testosterone and other related hormones.
#16 Diagnosing Male Infertility | NYU Langone Health
https://nyulangone.org/conditions/male-infertility/diagnosis
The causes of obstructive male infertility may include retrograde ejaculation, which is when semen enters the bladder rather than being ejaculated from the penis. […] Causes of nonobstructive male infertility include varicocele, which is when the veins in the testicles enlarge, reducing the sperm count and quality. […] Doctors can diagnose varicocele by performing a physical examination. […] To determine the cause of infertility and choose the treatment or treatments that best suit your needs, your NYU Langone urologist asks about your medical history and performs a physical examination. […] NYU Langone urologists may test a mans semen to determine causes of infertility. […] Blood tests can identify a mans levels of the reproductive hormone testosterone and other related hormones.
#17 Diagnosing Male Infertility | NYU Langone Health
https://nyulangone.org/conditions/male-infertility/diagnosis
The causes of obstructive male infertility may include retrograde ejaculation, which is when semen enters the bladder rather than being ejaculated from the penis. […] Causes of nonobstructive male infertility include varicocele, which is when the veins in the testicles enlarge, reducing the sperm count and quality. […] Doctors can diagnose varicocele by performing a physical examination. […] To determine the cause of infertility and choose the treatment or treatments that best suit your needs, your NYU Langone urologist asks about your medical history and performs a physical examination. […] NYU Langone urologists may test a mans semen to determine causes of infertility. […] Blood tests can identify a mans levels of the reproductive hormone testosterone and other related hormones.
#18 Diagnosing Male Infertility | NYU Langone Health
https://nyulangone.org/conditions/male-infertility/diagnosis
NYU Langone urologists who specialize in male infertility work together with female reproduction specialists to diagnose and manage infertility in couples. […] About 15 percent of couples trying to conceive are unable to do so within a year, and male infertility can be a contributing factor for about half of them. […] Problems with any part of this process can lead to infertility. This can include problems with hormones, problems with sperm production, obstruction in the ducts, and genetic abnormalities. […] The causes of male infertility are broadly classified as obstructive or nonobstructive. […] A total absence of sperm is the cause of infertility in about 10 to 15 percent of infertile men. This is called azoospermia, and it can be caused by a genetic irregularity, hormone imbalance, or blockage in the tubes that carry sperm to the urethra.
#19 Diagnosing Male Infertility | NYU Langone Health
https://nyulangone.org/conditions/male-infertility/diagnosis
You may be asked to provide a sample of your urine after ejaculation. […] Doctors use transrectal ultrasound to detect blockages in the tubes that carry semen out of the body or problems with the prostate, such as benign prostatic hyperplasia, in which the prostate becomes enlarged. […] Doctors may perform blood tests to detect genetic causes of infertility. […] Genetic conditions that can affect male fertility include Klinefelter Syndrome, which results when a male infant is born with an abnormal number of sex chromosomes, causing few or no sperm to be produced.
#20 Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I (2020) | American Society for Reproductive Medicine | ASRM
https://www.asrm.org/practice-guidance/practice-committee-documents/diagnosis-and-treatment-of-infertility-in-men-auaasrm-guideline-part-i-2020/
For initial infertility evaluation, both male and female partners should undergo concurrent assessment. (Expert Opinion) […] Initial evaluation of the male for fertility should include a reproductive history. (Clinical Principle) Initial evaluation of the male should also include one or more semen analyses (SAs). (Strong Recommendation; Evidence Level: Grade B) […] Men with one or more abnormal semen parameters or presumed male infertility should be evaluated by a male reproductive expert for complete history and physical examination as well as other directed tests when indicated. (Expert Opinion) […] In couples with failed ART cycles or recurrent pregnancy losses (RPL) (two or more losses), evaluation of the male should be considered. (Expert Opinion) […] The SA is an important component in the initial clinical evaluation of the male and his reproductive health.
#21 Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I (2020) | American Society for Reproductive Medicine | ASRM
https://www.asrm.org/practice-guidance/practice-committee-documents/diagnosis-and-treatment-of-infertility-in-men-auaasrm-guideline-part-i-2020/
For initial infertility evaluation, both male and female partners should undergo concurrent assessment. (Expert Opinion) […] Initial evaluation of the male for fertility should include a reproductive history. (Clinical Principle) Initial evaluation of the male should also include one or more semen analyses (SAs). (Strong Recommendation; Evidence Level: Grade B) […] Men with one or more abnormal semen parameters or presumed male infertility should be evaluated by a male reproductive expert for complete history and physical examination as well as other directed tests when indicated. (Expert Opinion) […] In couples with failed ART cycles or recurrent pregnancy losses (RPL) (two or more losses), evaluation of the male should be considered. (Expert Opinion) […] The SA is an important component in the initial clinical evaluation of the male and his reproductive health.
#22 Male infertility – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/male-infertility/diagnosis-treatment/drc-20374780
Many infertile couples have more than one cause of infertility, so it’s likely you will both need to see a doctor. It might take a number of tests to determine the cause of infertility. In some cases, a cause is never identified. […] Diagnosing male infertility problems usually involves: […] Semen analysis. Semen samples can be obtained in a couple of different ways. […] Your semen is then sent to a laboratory to measure the number of sperm present and look for any abnormalities in the shape (morphology) and movement (motility) of the sperm. […] Often sperm counts fluctuate significantly from one specimen to the next. In most cases, several semen analysis tests are done over a period of time to ensure accurate results. […] Your doctor might recommend additional tests to help identify the cause of your infertility. These can include:
#23 Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I (2020) | American Society for Reproductive Medicine | ASRM
https://www.asrm.org/practice-guidance/practice-committee-documents/diagnosis-and-treatment-of-infertility-in-men-auaasrm-guideline-part-i-2020/
For initial infertility evaluation, both male and female partners should undergo concurrent assessment. (Expert Opinion) […] Initial evaluation of the male for fertility should include a reproductive history. (Clinical Principle) Initial evaluation of the male should also include one or more semen analyses (SAs). (Strong Recommendation; Evidence Level: Grade B) […] Men with one or more abnormal semen parameters or presumed male infertility should be evaluated by a male reproductive expert for complete history and physical examination as well as other directed tests when indicated. (Expert Opinion) […] In couples with failed ART cycles or recurrent pregnancy losses (RPL) (two or more losses), evaluation of the male should be considered. (Expert Opinion) […] The SA is an important component in the initial clinical evaluation of the male and his reproductive health.
#24 Low sperm count – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/low-sperm-count/diagnosis-treatment/drc-20374591
You may learn that you have a low sperm count if you get a healthcare checkup because you’re having trouble getting your partner pregnant. […] At your appointment, your healthcare professional works to find out the cause of your fertility troubles. […] Even if your healthcare professional thinks you have a low sperm count, your partner’s fertility also may need to be checked. […] This can help guide fertility treatment options for you and your partner. […] This includes an exam of your genitals. […] Your healthcare professional also asks questions about any inherited conditions, long-term health problems, illnesses, injuries or surgeries that could affect fertility. […] A sample of your semen is collected for testing as well. […] This is called a semen analysis. […] Your semen is checked under a microscope to see how many sperm are present.
#25 Low sperm count – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/low-sperm-count/diagnosis-treatment/drc-20374591
You may learn that you have a low sperm count if you get a healthcare checkup because you’re having trouble getting your partner pregnant. […] At your appointment, your healthcare professional works to find out the cause of your fertility troubles. […] Even if your healthcare professional thinks you have a low sperm count, your partner’s fertility also may need to be checked. […] This can help guide fertility treatment options for you and your partner. […] This includes an exam of your genitals. […] Your healthcare professional also asks questions about any inherited conditions, long-term health problems, illnesses, injuries or surgeries that could affect fertility. […] A sample of your semen is collected for testing as well. […] This is called a semen analysis. […] Your semen is checked under a microscope to see how many sperm are present.
#26 Low sperm count – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/low-sperm-count/diagnosis-treatment/drc-20374591
Some basic questions to ask your healthcare professional include: […] What treatments are available to raise my sperm count? […] Which do you recommend? […] Are there any restrictions that I need to follow? […] At what point should we think about trying options such as a sperm donor or adoption? […] Some questions that your healthcare professional may ask you include: […] Have you had a vasectomy or a vasectomy reversal? […] Do you use drugs such as marijuana, cocaine or anabolic steroids? […] Have you been exposed to toxins such as chemicals, pesticides, radiation or lead, especially on a regular basis?
#27 Low sperm count – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/low-sperm-count/diagnosis-treatment/drc-20374591
You may learn that you have a low sperm count if you get a healthcare checkup because you’re having trouble getting your partner pregnant. […] At your appointment, your healthcare professional works to find out the cause of your fertility troubles. […] Even if your healthcare professional thinks you have a low sperm count, your partner’s fertility also may need to be checked. […] This can help guide fertility treatment options for you and your partner. […] This includes an exam of your genitals. […] Your healthcare professional also asks questions about any inherited conditions, long-term health problems, illnesses, injuries or surgeries that could affect fertility. […] A sample of your semen is collected for testing as well. […] This is called a semen analysis. […] Your semen is checked under a microscope to see how many sperm are present.
#28 Diagnosis of Male Infertility – ROC Clinic
https://rocclinic.com/en/male-infertility/diagnosis/
Diagnostic testing of male fertility and determination of causes for accurate treatment. […] Men with fertility problems should have a complete clinical and reproductive history, physical examination, semen analysis, hormone analysis and specific semen analysis or imaging tests when necessary. […] To make a good diagnostic approach, a parallel evaluation of the fertility status of both partners, including the woman’s ovarian reserve, should be performed, as this could determine the decision making in terms of timing and therapeutic strategies. […] Risk factors and toxic behavioral patterns and habits that may affect male fertility should be evaluated. […] Typical findings in a patient with infertility include: Abnormalities of testicular descent: uni- or bilaterian cryptorchidism. […] A focused physical examination will be performed, with special attention to: Testicular size and consistency.
#29 Diagnosis of Male Infertility – ROC Clinic
https://rocclinic.com/en/male-infertility/diagnosis/
Diagnostic testing of male fertility and determination of causes for accurate treatment. […] Men with fertility problems should have a complete clinical and reproductive history, physical examination, semen analysis, hormone analysis and specific semen analysis or imaging tests when necessary. […] To make a good diagnostic approach, a parallel evaluation of the fertility status of both partners, including the woman’s ovarian reserve, should be performed, as this could determine the decision making in terms of timing and therapeutic strategies. […] Risk factors and toxic behavioral patterns and habits that may affect male fertility should be evaluated. […] Typical findings in a patient with infertility include: Abnormalities of testicular descent: uni- or bilaterian cryptorchidism. […] A focused physical examination will be performed, with special attention to: Testicular size and consistency.
#30 Male Infertility – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK562258/
The presence of a hydrocele should be noted. If a hydrocele is present, a testicular ultrasound should be used to examine the testicle since an adequate direct physical examination is not otherwise possible. […] Examination of the penis would include a check for hypospadias, phimosis, and Peyronie plaques. […] In general, if a patient has azoospermia with bilateral atrophic testes, a good outcome from treatment may be possible only with IVF and ICSI. […] The prognosis of male infertility is individualized and depends upon the cause. An appropriate workup should be done based on need and necessity.
#31 Male Infertility Workup: Laboratory Studies, Imaging Studies, Other Tests
https://emedicine.medscape.com/article/436829-workup
The semen analysis is the cornerstone of the male infertility workup. […] The sample should be processed within 1 hour, and 2-3 samples (at a minimum of 2-3 days apart) should be evaluated because of daily variations in sperm number and quality. […] The World Health Organization (WHO) published reference ranges for semen testing in 2010. […] Normal ejaculate volume is 1.5-5 mL, and the WHO lower reference limit (5th percentile) is 1.5 mL. […] Normal sperm density is greater than 20 million sperm/mL. […] To verify azoospermia, the semen should be centrifuged and evaluated under a light microscope for the presence of sperm. […] A routine part of the initial evaluation is testing of specific serum hormone levels, which usually includes FSH, LH, testosterone, and prolactin. […] TRUS is indicated in patients with azoospermia or severe oligospermia to evaluate for complete or partial ejaculatory duct obstruction.
#32 Male infertility – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/male-infertility/diagnosis-treatment/drc-20374780
Many infertile couples have more than one cause of infertility, so it’s likely you will both need to see a doctor. It might take a number of tests to determine the cause of infertility. In some cases, a cause is never identified. […] Diagnosing male infertility problems usually involves: […] Semen analysis. Semen samples can be obtained in a couple of different ways. […] Your semen is then sent to a laboratory to measure the number of sperm present and look for any abnormalities in the shape (morphology) and movement (motility) of the sperm. […] Often sperm counts fluctuate significantly from one specimen to the next. In most cases, several semen analysis tests are done over a period of time to ensure accurate results. […] Your doctor might recommend additional tests to help identify the cause of your infertility. These can include:
#33 Male Infertility Workup: Laboratory Studies, Imaging Studies, Other Tests
https://emedicine.medscape.com/article/436829-workup
The semen analysis is the cornerstone of the male infertility workup. […] The sample should be processed within 1 hour, and 2-3 samples (at a minimum of 2-3 days apart) should be evaluated because of daily variations in sperm number and quality. […] The World Health Organization (WHO) published reference ranges for semen testing in 2010. […] Normal ejaculate volume is 1.5-5 mL, and the WHO lower reference limit (5th percentile) is 1.5 mL. […] Normal sperm density is greater than 20 million sperm/mL. […] To verify azoospermia, the semen should be centrifuged and evaluated under a light microscope for the presence of sperm. […] A routine part of the initial evaluation is testing of specific serum hormone levels, which usually includes FSH, LH, testosterone, and prolactin. […] TRUS is indicated in patients with azoospermia or severe oligospermia to evaluate for complete or partial ejaculatory duct obstruction.
#34 Diagnosing Male Infertility of Wisconsin
https://www.froedtert.com/fertility/male-infertility/diagnostics
A normal sperm count is typically 60 to 80 million, but could be much higher. […] At least 50 percent of the sperm cells should be motile. […] Its 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. […] The physician may order a semen analysis depending upon your specific case. Semen should be collected after two to seven days of no ejaculation. […] However, there are many variables at outside labs that may contribute to less than accurate results. Also, because sperm counts fluctuate daily, many sperm analyses are needed to get a sense of a mans baseline parameters. […] Physicians who are trained in the area of reproductive endocrinology and infertility typically receive two to three years of intensive training (a fellowship) in infertility and endocrinology. […] On the male side, there is urologic subspecialty training in the area of male infertility. This one- to two-year fellowship emphasizes male fertility, microsurgery, endocrinology and genetics.
#35 Male Infertility – Causes, Diagnosis, & Treatment Options
https://www.advancedurologyinstitute.com/condition/male-infertility/
There are many factors that come into play for a woman to become pregnant. Male fertility is one of them. […] Male infertility is any health issue in a man that lowers the chances of his female partner getting pregnant. Males are a contributing factor in up to 50% of instances when a couple is trying but unable to conceive. […] The symptom of male infertility is typically described as the inability of a woman to become pregnant after one year of unprotected sex with her male partner. […] Causes of male infertility can be hard to diagnose. The problems are most often with sperm production or delivery. Diagnosis begins with a full history and physical exam. Your physician may also want to do blood work and semen tests. […] Semen analysis: This routine lab test helps show the cause of male infertility. The test is most often done twice. Semen is collected by having you masturbate into a sterile cup. The semen sample is studied. It can be checked for things that help or hurt conception.
#36 Male Infertility Workup: Laboratory Studies, Imaging Studies, Other Tests
https://emedicine.medscape.com/article/436829-workup
The semen analysis is the cornerstone of the male infertility workup. […] The sample should be processed within 1 hour, and 2-3 samples (at a minimum of 2-3 days apart) should be evaluated because of daily variations in sperm number and quality. […] The World Health Organization (WHO) published reference ranges for semen testing in 2010. […] Normal ejaculate volume is 1.5-5 mL, and the WHO lower reference limit (5th percentile) is 1.5 mL. […] Normal sperm density is greater than 20 million sperm/mL. […] To verify azoospermia, the semen should be centrifuged and evaluated under a light microscope for the presence of sperm. […] A routine part of the initial evaluation is testing of specific serum hormone levels, which usually includes FSH, LH, testosterone, and prolactin. […] TRUS is indicated in patients with azoospermia or severe oligospermia to evaluate for complete or partial ejaculatory duct obstruction.
#37 Male Infertility Workup: Laboratory Studies, Imaging Studies, Other Tests
https://emedicine.medscape.com/article/436829-workup
The semen analysis is the cornerstone of the male infertility workup. […] The sample should be processed within 1 hour, and 2-3 samples (at a minimum of 2-3 days apart) should be evaluated because of daily variations in sperm number and quality. […] The World Health Organization (WHO) published reference ranges for semen testing in 2010. […] Normal ejaculate volume is 1.5-5 mL, and the WHO lower reference limit (5th percentile) is 1.5 mL. […] Normal sperm density is greater than 20 million sperm/mL. […] To verify azoospermia, the semen should be centrifuged and evaluated under a light microscope for the presence of sperm. […] A routine part of the initial evaluation is testing of specific serum hormone levels, which usually includes FSH, LH, testosterone, and prolactin. […] TRUS is indicated in patients with azoospermia or severe oligospermia to evaluate for complete or partial ejaculatory duct obstruction.
#38 Diagnosing Male Infertility of Wisconsin
https://www.froedtert.com/fertility/male-infertility/diagnostics
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. […] 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. […] 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 sperms shape, or morphology. […] A normal amount is at least 1.5 milliliters.
#39 Low sperm count – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/low-sperm-count/diagnosis-treatment/drc-20374591
Sometimes, a computer helps measure sperm count. […] New sperm are regularly made in the testicles. […] The sperm take about 42 to 76 days to mature. […] So a semen analysis reflects your environment over the past three months. […] One of the most common causes of low sperm count is incomplete or improper collection of a semen sample. […] Because of these factors, most healthcare professionals check two or more semen samples over time. […] If you have a low sperm count, your semen contains fewer than 15 million sperm in each milliliter or less than 39 million sperm total for the entire sample. […] Your chance of getting your partner pregnant drops with lower sperm counts. […] Some people have no sperm in their semen at all. […] This is known as azoospermia. […] Depending on your semen analysis results, your healthcare professional might recommend more tests.
#40 Diagnosing Male Infertility of Wisconsin
https://www.froedtert.com/fertility/male-infertility/diagnostics
A normal sperm count is typically 60 to 80 million, but could be much higher. […] At least 50 percent of the sperm cells should be motile. […] Its 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. […] The physician may order a semen analysis depending upon your specific case. Semen should be collected after two to seven days of no ejaculation. […] However, there are many variables at outside labs that may contribute to less than accurate results. Also, because sperm counts fluctuate daily, many sperm analyses are needed to get a sense of a mans baseline parameters. […] Physicians who are trained in the area of reproductive endocrinology and infertility typically receive two to three years of intensive training (a fellowship) in infertility and endocrinology. […] On the male side, there is urologic subspecialty training in the area of male infertility. This one- to two-year fellowship emphasizes male fertility, microsurgery, endocrinology and genetics.
#41 Diagnosing Male Infertility of Wisconsin
https://www.froedtert.com/fertility/male-infertility/diagnostics
A normal sperm count is typically 60 to 80 million, but could be much higher. […] At least 50 percent of the sperm cells should be motile. […] Its 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. […] The physician may order a semen analysis depending upon your specific case. Semen should be collected after two to seven days of no ejaculation. […] However, there are many variables at outside labs that may contribute to less than accurate results. Also, because sperm counts fluctuate daily, many sperm analyses are needed to get a sense of a mans baseline parameters. […] Physicians who are trained in the area of reproductive endocrinology and infertility typically receive two to three years of intensive training (a fellowship) in infertility and endocrinology. […] On the male side, there is urologic subspecialty training in the area of male infertility. This one- to two-year fellowship emphasizes male fertility, microsurgery, endocrinology and genetics.
#42 Male Fertility Tests & Procedures | University of Utah Health
https://healthcare.utah.edu/fertility/treatments/diagnostic-testing/all-tests
Male Fertility Diagnostic Testing […] Our ability to diagnose and treat fertility problems has greatly advanced over the last decade. Getting a complete and accurate diagnosis is essential to finding the best treatment or therapy for you. […] Our andrology laboratory offers several diagnostic tests that can help your treatment process, including semen analysis, sperm penetration assay, and an anti-sperm antibody test. […] Semen analysis is the most efficient and inexpensive way to study male fertility. Its usually the starting point for a male infertility evaluation. Semen analysis looks at: sperm concentration (how many sperm are in each milliliter of semen), a motile sperm count (how well your sperm move and swim), and study of sperm morphology (shape). […] A normal semen sample is usually made of 35 percent normal, correctly shaped sperm. The other 65 percent of sperm are often abnormally shaped or abnormal. A smaller percentage of normal sperm could cause infertility problems.
#43 Male Infertility – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK562258/
There are multiple causes for male infertility, which can be broadly classified due to their general underlying etiology. […] These are broad estimates only, as accurate statistics are unavailable due to general underreporting, cultural factors, and regional variations. […] The semen analysis is the cornerstone of laboratory evaluation of male infertility. At least 2 separate samples should be collected, separated by at least 1 week but optimally by a month. […] The outcomes and prognosis of male infertility greatly depend upon the semen analysis results as well as the female partner’s fertility status, along with the categorization of whether fertility is primary or secondary. […] The semen is evaluated for volume, pH, leukocytes, immature germ cells, and liquefaction, while the sperm is assessed for count, concentration, vitality, motility, progression, debris, and morphology. […] Either the WHO criteria for scoring sperm morphology or the Kruger-Tygerberg criteria should be used.
#44 Male Infertility – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK562258/
There are multiple causes for male infertility, which can be broadly classified due to their general underlying etiology. […] These are broad estimates only, as accurate statistics are unavailable due to general underreporting, cultural factors, and regional variations. […] The semen analysis is the cornerstone of laboratory evaluation of male infertility. At least 2 separate samples should be collected, separated by at least 1 week but optimally by a month. […] The outcomes and prognosis of male infertility greatly depend upon the semen analysis results as well as the female partner’s fertility status, along with the categorization of whether fertility is primary or secondary. […] The semen is evaluated for volume, pH, leukocytes, immature germ cells, and liquefaction, while the sperm is assessed for count, concentration, vitality, motility, progression, debris, and morphology. […] Either the WHO criteria for scoring sperm morphology or the Kruger-Tygerberg criteria should be used.
#45 Male Infertility Tests And Diagnosis | Apollo Cradle
https://www.apollocradle.com/blog/fertility/male-infertility-tests-diagnosis
Diagnosing male infertility involves: […] A clinical examination with a complete medical history physical examination- to rule out any physical cause for infertility or clinical signs of any hormonal dysfunction. […] Semen Analysis-This is the most common male fertility test. What is checked is: Sperm count, Motility of the sperm-the ability to swim, Velocity or forward progression of the sperm, Morphology of the sperm-size and shape of the sperm, Total semen volume, The liquefaction of the semen- the change from the normal gel-like state at ejaculation to a liquid state. […] After your semen is collected, it is sent to the laboratory to measure the number of sperms present in it and to check for abnormalities in its shape. […] Your doctor may also recommend a few additional tests to help identify the cause of infertility.
#46 Diagnosis of Male Infertility – ROC Clinic
https://rocclinic.com/en/male-infertility/diagnosis/
A functional semen study (seminogram or spermiogram) will be requested. […] If alterations are observed, it is necessary to obtain a second confirmatory semen analysis. […] In cases of azoospermia and oligozoospermia (low sperm count in semen), a hormonal evaluation including serum total testosterone and follicle stimulating hormone (FSH) and luteinizing hormone (LH) should be performed. […] Finally, testicular Doppler ultrasound is a necessary test to evaluate morphological alterations of the testicles, their size and the presence of nodules and/or calcifications. […] Semen analysis has three levels of depth: Basic analysis: Sperm count is performed as accurately as possible – even at very low sperm levels. […] The presence of fast progressive spermatozoa is a clinically very important factor. […] The semen analysis does not predict 100% fertility. […] However, with an abnormal semen analysis you can be fertile. […] The 5 most useful tips are: do not smoke, do not drink alcohol, do intense physical exercise, take care of your diet (avoid processed foods) and avoid being overweight.
#47 Diagnosis and Treatment of Male Factor Infertility – IRMS Reproductive Medicine
https://sbivf.com/blog/diagnosis-and-treatment-of-male-factor-infertility/
Poor sperm motility, or asthenospermia, could suggest a history of prior testosterone use, an infection of the urogenital tract, exposure to toxins such as excessive tobacco or alcohol, use of hot baths/saunas as these can raise testicular temperature, or an unexplained etiology. […] A varicocele is an anatomical variant where vessels around the vas deferens are dilated and could cause both poor sperm motility and morphology. […] An intrauterine insemination, or an IUI, is a procedure whereby the male partner produces a sperm sample and following a sperm wash, the sperm is concentrated in a small volume. […] In cases where the count and or motility are so compromised that an IUI is not likely to lead to success, in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) may be necessary.
#48 Diagnosis and Treatment of Male Factor Infertility – IRMS Reproductive Medicine
https://sbivf.com/blog/diagnosis-and-treatment-of-male-factor-infertility/
The presence of poor sperm morphology, or teratozoospermia is associated with an increased time to pregnancy. […] Azoospermia, or no sperm found in the ejaculate can be categorized into obstructive and nonobstructive. […] The most common case of obstructive azoospermia is a history of vasectomy. […] Non-obstructive azoospermia cases have poorer prognosis with some cases such as Sertoli cell only syndrome requiring the use of donor sperm for conception. […] The diagnosis and treatment of male factor infertility is very individualized. […] Currently, there is still a paucity of studies focusing on the psychological effects of male factor infertility on the male partner.
#49 Low sperm count – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/low-sperm-count/diagnosis-treatment/drc-20374591
Sometimes, a computer helps measure sperm count. […] New sperm are regularly made in the testicles. […] The sperm take about 42 to 76 days to mature. […] So a semen analysis reflects your environment over the past three months. […] One of the most common causes of low sperm count is incomplete or improper collection of a semen sample. […] Because of these factors, most healthcare professionals check two or more semen samples over time. […] If you have a low sperm count, your semen contains fewer than 15 million sperm in each milliliter or less than 39 million sperm total for the entire sample. […] Your chance of getting your partner pregnant drops with lower sperm counts. […] Some people have no sperm in their semen at all. […] This is known as azoospermia. […] Depending on your semen analysis results, your healthcare professional might recommend more tests.
#50 The diagnosis of male infertility: an analysis of the evidence to support the development of global WHO guidanceâchallenges and future research opportunities
https://pmc.ncbi.nlm.nih.gov/articles/PMC5850791/
Assessment of a combination of several ejaculate parameters is a better predictor of fertility success than a single parameter. […] There is insufficient evidence to conclude that exposure to heat, be it occupational or as a result of clothing or body position, affect semen quality and/or male fertility. […] There are insufficient data to recommend the use of supplemental antioxidant therapies for the treatment of men with abnormal semen parameters and/or male infertility. Additionally, we strongly recommend based on very low quality of evidence that there are insufficient data to recommend the use of herbal therapies for the treatment of men with abnormal semen parameters and/or male infertility. […] Karyotype testing should be performed on all males with severe oligozoospermia (5 106/ml) or NOA prior to any therapeutic procedure.
#51 Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I (2020) | American Society for Reproductive Medicine | ASRM
https://www.asrm.org/practice-guidance/practice-committee-documents/diagnosis-and-treatment-of-infertility-in-men-auaasrm-guideline-part-i-2020/
Clinicians may discuss risk factors (i.e., lifestyle, medication usage, environmental exposures) associated with male infertility, and patients should be counseled that the current data on the majority of risk factors are limited. (Conditional Recommendation; Evidence Level: Grade C) […] The results from SA should be used to guide management of the patient. In general, results are of greatest clinical significance when multiple SA abnormalities are present. (Expert Opinion) […] Clinicians should obtain hormonal evaluation including follicle-stimulating hormone (FSH) and testosterone for infertile men with impaired libido, erectile dysfunction, oligozoospermia or azoospermia, atrophic testes, or evidence of hormonal abnormality on physical evaluation. (Expert Opinion) […] Azoospermic men should be clinically evaluated to differentiate genital tract obstruction from impaired sperm production initially based on semen volume, physical exam, and FSH levels. (Expert Opinion)
#52 Male infertility – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/male-infertility/diagnosis-treatment/drc-20374780
Hormone testing. Hormones produced by the pituitary gland, hypothalamus and testicles play a key role in sexual development and sperm production. […] Genetic tests. When sperm concentration is extremely low, there could be a genetic cause. […] Testicular biopsy. This test involves removing samples from the testicle with a needle. […] Male infertility care at Mayo Clinic. […] Treatments for male infertility include: […] Assisted reproductive technology (ART). ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. […] In rare cases, male fertility problems can’t be treated, and it’s impossible for a man to father a child.
#53 Male Infertility Diagnosis and Treatment – Assoc. Prof. A. Kadir Tepeler
https://www.drtepeler.com/en/male-infertility-diagnosis-and-treatment/
The 2 hormones related to sperm production in the testicles are FSH and LH, which are produced from the pituitary gland in the brain. FSH stimulates Sertoli cells in the testis and stimulates sperm production. […] Although sperm production in men continues at every age, there will be a decrease in sperm count and quality with advancing age. Apart from this, the sperm production process is affected by many negative environmental factors. […] Assisted reproductive methods are recommended for couples who cannot conceive naturally. These treatments can be counted as sperm infusion into the uterus (intra uterine insemination; IUI), ovulation-regulating treatments (ovulation induction) or in vitro fertilization (IVF; ICSI) and advanced fertilization treatments.
#54 Male Infertility Diagnosis and Treatment – Assoc. Prof. A. Kadir Tepeler
https://www.drtepeler.com/en/male-infertility-diagnosis-and-treatment/
The 2 hormones related to sperm production in the testicles are FSH and LH, which are produced from the pituitary gland in the brain. FSH stimulates Sertoli cells in the testis and stimulates sperm production. […] Although sperm production in men continues at every age, there will be a decrease in sperm count and quality with advancing age. Apart from this, the sperm production process is affected by many negative environmental factors. […] Assisted reproductive methods are recommended for couples who cannot conceive naturally. These treatments can be counted as sperm infusion into the uterus (intra uterine insemination; IUI), ovulation-regulating treatments (ovulation induction) or in vitro fertilization (IVF; ICSI) and advanced fertilization treatments.
#55 Low sperm count – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/low-sperm-count/diagnosis-treatment/drc-20374591
Tests to look for the cause of your low sperm count and other possible causes of male infertility can include: […] Your healthcare professional may recommend a blood test to check the levels of hormones made by the pituitary gland and testicles. […] These hormones play a key role in sexual development and in how much sperm the body makes. […] This urine test is done after you ejaculate. […] Rarely, male fertility problems can’t be treated, and the affected person’s sperm can’t be used to start a pregnancy. […] If this happens to you, it’s still possible to have a child. […] You and your partner can think about using sperm from a donor or adopting a child. […] For low sperm count, you can start by seeing your family healthcare professional. […] Then you might be referred to an infertility specialist.
#56 Male Infertility Diagnosis & Treatment | Phoenix | AZ IVF Clinic
https://arizonafertility.com/fertility-library/male-infertility/
Semen evaluation will assess sperm motility or movement, the shape and maturity of the sperm, the volume of the ejaculate, the actual sperm count, the presence of round cells which could be due to either immature sperm or white blood cells, indicating inflammation, and the liquidity of the ejaculate. […] If any of these parameters are abnormal, and evaluation by a urologist is warranted. At this visit, a physical exam will be performed and hormonal testing performed. […] Hormonal tests evaluate levels of testosterone, Estradiol, Prolactin, Thyroid stimulating hormone, and follicle-stimulating hormone (FSH) to determine the overall balance of the hormonal system. […] When a diagnosis is not obvious after the initial evaluation, further testing may be required. One or more of the following tests may be recommended:
#57 Male Infertility Diagnosis & Treatment | Phoenix | AZ IVF Clinic
https://arizonafertility.com/fertility-library/male-infertility/
Semen evaluation will assess sperm motility or movement, the shape and maturity of the sperm, the volume of the ejaculate, the actual sperm count, the presence of round cells which could be due to either immature sperm or white blood cells, indicating inflammation, and the liquidity of the ejaculate. […] If any of these parameters are abnormal, and evaluation by a urologist is warranted. At this visit, a physical exam will be performed and hormonal testing performed. […] Hormonal tests evaluate levels of testosterone, Estradiol, Prolactin, Thyroid stimulating hormone, and follicle-stimulating hormone (FSH) to determine the overall balance of the hormonal system. […] When a diagnosis is not obvious after the initial evaluation, further testing may be required. One or more of the following tests may be recommended:
#58 Male Infertility Tests And Diagnosis | Apollo Cradle
https://www.apollocradle.com/blog/fertility/male-infertility-tests-diagnosis
Hormone testing: Hormones that are produced by the pituitary gland, the hypothalamus and testicles, play a vital role in the sexual development and sperm production. […] Genetic Tests: If your sperm concentration is extremely low, there could be a possibility of a genetic cause. […] Ultrasonography: Performing an ultrasonography test on the mans scrotum helps to find out if there is any obstruction in the testicles. […] Analysis of the urine: Presence of some amount of sperm in the urine indicates that sperms are travelling into the bladder instead of coming out. […] Testicular biopsy: This involves collecting samples from the testicles and conducting tests on it. It helps to identify problems with the sperm production processes. […] Issues with fertility can be easily treated with various tests or minor surgery.
#59 Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I (2020) | American Society for Reproductive Medicine | ASRM
https://www.asrm.org/practice-guidance/practice-committee-documents/diagnosis-and-treatment-of-infertility-in-men-auaasrm-guideline-part-i-2020/
Karyotype and Y-chromosome microdeletion analysis should be recommended for men with primary infertility and azoospermia or severe oligozoospermia (5 million sperm/mL) with elevated FSH or testicular atrophy or a presumed diagnosis of impaired sperm production as the cause of azoospermia. (Expert Opinion) […] Men with congenital obstructive azoospermia, including congenital bilateral absence of the vas deferens (CBAVD) should have cystic fibrosis (CF) testing. […] Sperm DNA fragmentation may adversely affect the outcome of ART treatments as well as attempts at natural fertility, including an increased miscarriage rate. […] The clinician should discuss the importance of paternal structural autosomal defects in the evaluation of the couple with RPL and the need for the male partner to have a karyotype analysis.
#60
https://healthytodos.com/blog/male-infertility-how-is-it-diagnosed
Genetic conditions can significantly impact both the quality and quantity of sperm, necessitating specific testing beyond routine blood tests. Up to 20% of sperm production problems are attributed to abnormalities associated with genetic syndromes. […] This test might be the final step if the previous tests you’ve undergone haven’t provided clear results. […] Hormone testing involves assessing the levels of key hormones involved in sperm production. Hormones that are commonly assessed include follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone. These hormones are essential for the coordinated function of the pituitary gland, hypothalamus, and testicles in regulating sperm production. […] In summary, infertility testing is essential for diagnosing underlying causes, guiding treatment options, and addressing potential health concerns. By undergoing comprehensive testing, healthcare providers can often reveal valuable information that assists them in reaching the correct diagnosis of male infertility.
#61 Advanced techniques for the diagnosis of male infertility | INVICTA Fertility Clinic
https://www.invictaclinics.com/infertility-faq/advanced-techniques-for-the-diagnosis-of-male-infertility/
Using these criteria, we can diagnose oligozoospermia when the sperm number is below 39 million/ ejaculate. We talk about severe oligozoospermia when the sperm number is below 5 million/1 mL of ejaculate. […] Although hormone disorders are detected in only about 3% of infertile men, every patient with abnormal results of semen analysis, erectile disorders, decreased libido or features of endocrinopathy in physical examination should undergo the hormone test panel. […] In patients with abnormal semen parameters, the risk of testicular cancer is 20 times higher. Therefore, one should always consider the extended diagnosis to rule out a cancer disease. […] Genetic tests most often performed in the diagnosis of male infertility include karyotype assessment, test for mutations in the CFTR gene, assessment of the Y chromosome microdeletions and sperm DNA fragmentation.
#62 EAU Guidelines on Sexual and Reproductive Health – Uroweb
https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-infertility
Semen analysis alone cannot distinguish fertile from infertile men. Diagnosis of male infertility is associated with an increased risk of malignant and non-malignant comorbidities. Male infertility evaluation should include a medical, reproductive and family history, assessment of lifestyle and behavioural risk factors, physical examination, semen analysis and hormonal evaluation. Genetic analysis and imaging may be required depending on the clinical features and semen parameters. […] High sperm DNA fragmentation index (SDF) is associated with reduced pregnancy rates via natural conception or intra-uterine insemination, poor assisted reproductive techniques (ART) outcomes, recurrent pregnancy loss and unexplained infertility. […] The highest frequency of Y-microdeletions is found in azoospermic men followed by oligospermic men but is extremely rare with a sperm concentration 5 million/mL. Complete deletions that include the AZFa and AZFb regions are of poor prognostic significance for retrieving sperm with surgery.
#63 Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I (2020) | American Society for Reproductive Medicine | ASRM
https://www.asrm.org/practice-guidance/practice-committee-documents/diagnosis-and-treatment-of-infertility-in-men-auaasrm-guideline-part-i-2020/
Karyotype and Y-chromosome microdeletion analysis should be recommended for men with primary infertility and azoospermia or severe oligozoospermia (5 million sperm/mL) with elevated FSH or testicular atrophy or a presumed diagnosis of impaired sperm production as the cause of azoospermia. (Expert Opinion) […] Men with congenital obstructive azoospermia, including congenital bilateral absence of the vas deferens (CBAVD) should have cystic fibrosis (CF) testing. […] Sperm DNA fragmentation may adversely affect the outcome of ART treatments as well as attempts at natural fertility, including an increased miscarriage rate. […] The clinician should discuss the importance of paternal structural autosomal defects in the evaluation of the couple with RPL and the need for the male partner to have a karyotype analysis.
#64 Advanced techniques for the diagnosis of male infertility | INVICTA Fertility Clinic
https://www.invictaclinics.com/infertility-faq/advanced-techniques-for-the-diagnosis-of-male-infertility/
Using these criteria, we can diagnose oligozoospermia when the sperm number is below 39 million/ ejaculate. We talk about severe oligozoospermia when the sperm number is below 5 million/1 mL of ejaculate. […] Although hormone disorders are detected in only about 3% of infertile men, every patient with abnormal results of semen analysis, erectile disorders, decreased libido or features of endocrinopathy in physical examination should undergo the hormone test panel. […] In patients with abnormal semen parameters, the risk of testicular cancer is 20 times higher. Therefore, one should always consider the extended diagnosis to rule out a cancer disease. […] Genetic tests most often performed in the diagnosis of male infertility include karyotype assessment, test for mutations in the CFTR gene, assessment of the Y chromosome microdeletions and sperm DNA fragmentation.
#65 EAU Guidelines on Sexual and Reproductive Health – Uroweb
https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-infertility
Semen analysis alone cannot distinguish fertile from infertile men. Diagnosis of male infertility is associated with an increased risk of malignant and non-malignant comorbidities. Male infertility evaluation should include a medical, reproductive and family history, assessment of lifestyle and behavioural risk factors, physical examination, semen analysis and hormonal evaluation. Genetic analysis and imaging may be required depending on the clinical features and semen parameters. […] High sperm DNA fragmentation index (SDF) is associated with reduced pregnancy rates via natural conception or intra-uterine insemination, poor assisted reproductive techniques (ART) outcomes, recurrent pregnancy loss and unexplained infertility. […] The highest frequency of Y-microdeletions is found in azoospermic men followed by oligospermic men but is extremely rare with a sperm concentration 5 million/mL. Complete deletions that include the AZFa and AZFb regions are of poor prognostic significance for retrieving sperm with surgery.
#66 EAU Guidelines on Sexual and Reproductive Health – Uroweb
https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-infertility
Testicular sperm can be found in 50-75% of men with AZFc microdeletions. Male offspring of men with AZF microdeletions will inherit the deletion. […] The presence of varicocele in some men is associated with progressive testicular damage from adolescence onwards and a consequent potential reduction in fertility. […] Varicocele repair may improve pregnancy rates and sperm concentration in adult infertile men with abnormal semen analyses, while benefits in sperm motility and normal morphology are less clear. […] Varicocele is associated with raised sperm DNA fragmentation (SDF) and intervention has been shown to reduce SDF and may improve the outcomes from ART. […] Surgery for sperm retrieval is mandatory in NOA men before ART. Fine needle aspiration (FNA) and testicular sperm aspiration (TESA) have lower sperm retrieval rates compared to TESE in patients with NOA. […] Microdissection TESE has been associated with higher rates of sperm retrieval and lower complications than conventional TESE.
#67 Diagnosing Male Infertility | NYU Langone Health
https://nyulangone.org/conditions/male-infertility/diagnosis
You may be asked to provide a sample of your urine after ejaculation. […] Doctors use transrectal ultrasound to detect blockages in the tubes that carry semen out of the body or problems with the prostate, such as benign prostatic hyperplasia, in which the prostate becomes enlarged. […] Doctors may perform blood tests to detect genetic causes of infertility. […] Genetic conditions that can affect male fertility include Klinefelter Syndrome, which results when a male infant is born with an abnormal number of sex chromosomes, causing few or no sperm to be produced.
#68 Male infertility Diagnostics
https://intersono-ivf.com/about-infertility/male-infertility-diagnostics
Blood tests to evaluate hormone levels (Testosterone (T), follicle stimulating hormone (FSH), lutenizing hormone (LH), prolactin (PRL), thyroid stimulating hormone (TSH), and sex hormone-binding globulin). […] MAR test (Mixed Antiglobulin Reaction test is used to diagnose immunological infertility) […] Genetic tests to identify chromosomal defects (Y-chromosome microdeletions), genetic diseases (Klinefelters syndrome) or a number of other possible genetic mutations. […] DNA fragmentation (the damage of the sperm DNA, either during creation or maturation. Such sperm DNA damages are also associated with spontaneous miscarriage). […] Scrotal ultrasound (to identify most scrotal pathology: varicocle, spermatocele, absent vasa, epididymal induration and testicular masses).
#69 Male Infertility Workup: Laboratory Studies, Imaging Studies, Other Tests
https://emedicine.medscape.com/article/436829-workup
The semen analysis is the cornerstone of the male infertility workup. […] The sample should be processed within 1 hour, and 2-3 samples (at a minimum of 2-3 days apart) should be evaluated because of daily variations in sperm number and quality. […] The World Health Organization (WHO) published reference ranges for semen testing in 2010. […] Normal ejaculate volume is 1.5-5 mL, and the WHO lower reference limit (5th percentile) is 1.5 mL. […] Normal sperm density is greater than 20 million sperm/mL. […] To verify azoospermia, the semen should be centrifuged and evaluated under a light microscope for the presence of sperm. […] A routine part of the initial evaluation is testing of specific serum hormone levels, which usually includes FSH, LH, testosterone, and prolactin. […] TRUS is indicated in patients with azoospermia or severe oligospermia to evaluate for complete or partial ejaculatory duct obstruction.
#70 EAU Guidelines on Sexual and Reproductive Health – Uroweb
https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-infertility
Semen analysis alone cannot distinguish fertile from infertile men. Diagnosis of male infertility is associated with an increased risk of malignant and non-malignant comorbidities. Male infertility evaluation should include a medical, reproductive and family history, assessment of lifestyle and behavioural risk factors, physical examination, semen analysis and hormonal evaluation. Genetic analysis and imaging may be required depending on the clinical features and semen parameters. […] High sperm DNA fragmentation index (SDF) is associated with reduced pregnancy rates via natural conception or intra-uterine insemination, poor assisted reproductive techniques (ART) outcomes, recurrent pregnancy loss and unexplained infertility. […] The highest frequency of Y-microdeletions is found in azoospermic men followed by oligospermic men but is extremely rare with a sperm concentration 5 million/mL. Complete deletions that include the AZFa and AZFb regions are of poor prognostic significance for retrieving sperm with surgery.
#71 Male factor infertility – Symptoms, diagnosis and treatment | BMJ Best Practice US
https://bestpractice.bmj.com/topics/en-us/497
1st tests to order include sperm concentration, sperm motility, sperm morphology, and seminal fluid parameters. […] Tests to consider include sperm viability, sperm membrane function, hormonal assays, MRI of the pituitary and hypothalamus, color flow Doppler imaging, post-ejaculation urine testing for retrograde ejaculation, genetic analysis, sperm DNA assays, acrosome reaction test, sperm longevity test, electron microscopy, and testicular biopsy.
#72 Low sperm count – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/low-sperm-count/diagnosis-treatment/drc-20374591
Tests to look for the cause of your low sperm count and other possible causes of male infertility can include: […] Your healthcare professional may recommend a blood test to check the levels of hormones made by the pituitary gland and testicles. […] These hormones play a key role in sexual development and in how much sperm the body makes. […] This urine test is done after you ejaculate. […] Rarely, male fertility problems can’t be treated, and the affected person’s sperm can’t be used to start a pregnancy. […] If this happens to you, it’s still possible to have a child. […] You and your partner can think about using sperm from a donor or adopting a child. […] For low sperm count, you can start by seeing your family healthcare professional. […] Then you might be referred to an infertility specialist.
#73 Fertility Testing & Diagnosis for Men
https://fertility.womenandinfants.org/treatment/fertility-tests-for-men
If the sperm concentration is very low in a semen analysis, it may indicate a genetic cause for infertility. This can be confirmed through genetic testing on the sperm samples. […] Male hormones, including testosterone, are vital for sperm production and sexual development, so a blood test is commonly conducted to examine hormone levels. […] An ultrasound of the mans scrotum tests for testicle obstruction. A transrectal ultrasound closely looks at the vesicles and ejaculatory ducts that transfer semen. […] This analysis tests for the presence of sperm in a mans urine, indicating retrograde ejaculation.
#74 Male Fertility Testing: Diagnostic | University of Utah Health
https://healthcare.utah.edu/fertility/treatments/diagnostic-testing
The hamster egg penetration test (HEPT) (also known as the sperm penetration assay) is the most accurate test that predicts whether your sperm will be able to fertilize an egg. […] If fewer than 50 percent of the hamster eggs are penetrated, this means your sperm cant fertilize eggs as well as normal sperm can. […] All men have barriers that hide sperm from their bodys immune system. […] When these barriers break down, the body produces anti-sperm antibodies. […] The term strict criteria morphology analysis refers to a specific technique that looks at the shape of your sperm. […] We may recommend a retrograde semen analysis for men with a low sperm count. […] Retrograde ejaculation is when sperm ends up in your bladder. […] SCIT tests analyze the quality of your chromatin and whether there are any breaks in your DNA strands. […] If the damage is not repaired, DNA breaks inside your sperm may affect your sperms ability to fertilize an egg.
#75 Male Infertility Diagnosis | Male Fertility Testing | San Diego, CA
https://www.malefertility.com/male-infertility/diagnosis-testing
Male infertility tests (male fertility tests) provide an invaluable opportunity to address concerns about a male’s ability to father a child. There are a variety of tests such as genetic testing and semen analysis that can be performed to determine fertility. […] A semen analysis is typically the first test prescribed to evaluate male factor infertility. Semen analysis can reveal potential causes of male infertility such as low sperm count and production, irregularly shaped sperm, discover a lack of sperm in the ejaculate, and much more. […] If your semen analysis shows no sperm, a testicular biopsy can be done to evaluate whether there is sperm in the testicles. A testicular biopsy involves taking a small sample from the testicles under local anesthesia. This helps diagnose whether the lack of sperm is caused by a blockage or low sperm production. […] Genetic testing for infertility is done to test for these issues. […] This test evaluates whether your body produces antibodies that bind sperm, affecting its motility and/or viability. High levels of anti-sperm antibodies can make it difficult to conceive a child via normal intercourse.
#76 Male Fertility Testing: Diagnostic | University of Utah Health
https://healthcare.utah.edu/fertility/treatments/diagnostic-testing
The hamster egg penetration test (HEPT) (also known as the sperm penetration assay) is the most accurate test that predicts whether your sperm will be able to fertilize an egg. […] If fewer than 50 percent of the hamster eggs are penetrated, this means your sperm cant fertilize eggs as well as normal sperm can. […] All men have barriers that hide sperm from their bodys immune system. […] When these barriers break down, the body produces anti-sperm antibodies. […] The term strict criteria morphology analysis refers to a specific technique that looks at the shape of your sperm. […] We may recommend a retrograde semen analysis for men with a low sperm count. […] Retrograde ejaculation is when sperm ends up in your bladder. […] SCIT tests analyze the quality of your chromatin and whether there are any breaks in your DNA strands. […] If the damage is not repaired, DNA breaks inside your sperm may affect your sperms ability to fertilize an egg.
#77 Male Infertility Workup: Laboratory Studies, Imaging Studies, Other Tests
https://emedicine.medscape.com/article/436829-workup
An abnormal postcoital test result is observed in 10% of infertile couples. […] When a primary sperm defect is suspected or when other tests do not reveal the cause of infertility, sperm function tests may determine if a significant sperm abnormality exists. […] Testicular biopsy is performed in azoospermic men with a normal-sized testis and normal findings on hormonal studies.
#78 New testing method offers better diagnosis and treatment for the most severe form of male infertility
https://www.ualberta.ca/en/folio/2023/06/new-testing-method-offers-better-diagnosis-treatment-for-male-infertility.html
Researchers have identified two proteins found only in viable sperm, opening the door to a non-invasive testing method that could help predict which men with the most severe form of male infertility would benefit from treatment. […] Researchers have uncovered two proteins that are unique to viable sperm, offering men with the most severe form of male infertility both a non-invasive diagnostic test and more information about their chances to one day become a parent through in vitro fertilization. […] The two proteins will facilitate development of a new diagnostic test to predict whether that surgery is likely to be successful, and would help surgeons identify viable sperm during the surgery, says Drabovich. […] The routine semen tests typically show zero sperm in non-obstructive azoospermia, but is it really zero? With our approach we are able to record a million images and in some patients find only 10 spermatozoa. But even a few would be enough for in vitro fertilization, he says. […] Knowing that would benefit patients in their decision-making and help surgeons.
#79 New Male Infertility Test Could Improve Diagnosis & Treatment | Clinical Lab Products
https://clpmag.com/disease-states/womens-health/fertility-testing/new-male-infertility-test-could-improve-diagnosis-treatment/
New Male Infertility Test Could Improve Diagnosis Treatment. Researchers have identified a new test that can measure the amount of DNA damage in sperm with greater accuracy than current tests. The new method published in AACCs Clinical Chemistry journal could significantly improve diagnosis of male infertility, which is more important than ever now that infertility rates are mounting. The rise in male infertility in particular has led to a need for better ways to assess sperm DNA damage, as this information plays a crucial role in guiding fertility treatments and in selecting high-quality sperm for sperm banks. However, current tests only show whether or not sperm have DNA damage; these tests don’t measure the amount of damage, even though the latter is essential for a complete evaluation of sperm health. To address this issue, a team of researchers led by Xianjin Xiao, PhD, of Tongji Medical College in Wuhan, China, developed a method that detects the number of DNA breaks in sperm, which in turn enables the calculation of the mean number of DNA breaks (MDB) per sperm in a sample. These data indicated that the MDB parameter had stronger clinical relevance with the pregnancy outcomes and our established method could provide a better tool to evaluate sperm quality and male fertility, says Xiao. Our method involves direct detection of actual DNA fragmentation, which can measure the specific degree of sperm DNA fragmentation. The method has the advantages of short time-consumption, simple operation, high analytical sensitivity, and low requirement for instruments, which are conducive to the popularization of clinical application. […] Taken altogether, this means that MDB identifies viable sperm that lead to pregnancy with greater accuracy than conventional sperm DNA tests.
#80 Diagnosing Male Infertility | NYU Langone Health
https://nyulangone.org/conditions/male-infertility/diagnosis
NYU Langone urologists who specialize in male infertility work together with female reproduction specialists to diagnose and manage infertility in couples. […] About 15 percent of couples trying to conceive are unable to do so within a year, and male infertility can be a contributing factor for about half of them. […] Problems with any part of this process can lead to infertility. This can include problems with hormones, problems with sperm production, obstruction in the ducts, and genetic abnormalities. […] The causes of male infertility are broadly classified as obstructive or nonobstructive. […] A total absence of sperm is the cause of infertility in about 10 to 15 percent of infertile men. This is called azoospermia, and it can be caused by a genetic irregularity, hormone imbalance, or blockage in the tubes that carry sperm to the urethra.
#81 Male Infertility Workup: Laboratory Studies, Imaging Studies, Other Tests
https://emedicine.medscape.com/article/436829-workup
The semen analysis is the cornerstone of the male infertility workup. […] The sample should be processed within 1 hour, and 2-3 samples (at a minimum of 2-3 days apart) should be evaluated because of daily variations in sperm number and quality. […] The World Health Organization (WHO) published reference ranges for semen testing in 2010. […] Normal ejaculate volume is 1.5-5 mL, and the WHO lower reference limit (5th percentile) is 1.5 mL. […] Normal sperm density is greater than 20 million sperm/mL. […] To verify azoospermia, the semen should be centrifuged and evaluated under a light microscope for the presence of sperm. […] A routine part of the initial evaluation is testing of specific serum hormone levels, which usually includes FSH, LH, testosterone, and prolactin. […] TRUS is indicated in patients with azoospermia or severe oligospermia to evaluate for complete or partial ejaculatory duct obstruction.
#82 Diagnosis and Treatment of Male Factor Infertility – IRMS Reproductive Medicine
https://sbivf.com/blog/diagnosis-and-treatment-of-male-factor-infertility/
The presence of poor sperm morphology, or teratozoospermia is associated with an increased time to pregnancy. […] Azoospermia, or no sperm found in the ejaculate can be categorized into obstructive and nonobstructive. […] The most common case of obstructive azoospermia is a history of vasectomy. […] Non-obstructive azoospermia cases have poorer prognosis with some cases such as Sertoli cell only syndrome requiring the use of donor sperm for conception. […] The diagnosis and treatment of male factor infertility is very individualized. […] Currently, there is still a paucity of studies focusing on the psychological effects of male factor infertility on the male partner.
#83 Diagnosis and Treatment of Male Factor Infertility – IRMS Reproductive Medicine
https://sbivf.com/blog/diagnosis-and-treatment-of-male-factor-infertility/
The presence of poor sperm morphology, or teratozoospermia is associated with an increased time to pregnancy. […] Azoospermia, or no sperm found in the ejaculate can be categorized into obstructive and nonobstructive. […] The most common case of obstructive azoospermia is a history of vasectomy. […] Non-obstructive azoospermia cases have poorer prognosis with some cases such as Sertoli cell only syndrome requiring the use of donor sperm for conception. […] The diagnosis and treatment of male factor infertility is very individualized. […] Currently, there is still a paucity of studies focusing on the psychological effects of male factor infertility on the male partner.
#84 Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I (2020) | American Society for Reproductive Medicine | ASRM
https://www.asrm.org/practice-guidance/practice-committee-documents/diagnosis-and-treatment-of-infertility-in-men-auaasrm-guideline-part-i-2020/
Clinicians may discuss risk factors (i.e., lifestyle, medication usage, environmental exposures) associated with male infertility, and patients should be counseled that the current data on the majority of risk factors are limited. (Conditional Recommendation; Evidence Level: Grade C) […] The results from SA should be used to guide management of the patient. In general, results are of greatest clinical significance when multiple SA abnormalities are present. (Expert Opinion) […] Clinicians should obtain hormonal evaluation including follicle-stimulating hormone (FSH) and testosterone for infertile men with impaired libido, erectile dysfunction, oligozoospermia or azoospermia, atrophic testes, or evidence of hormonal abnormality on physical evaluation. (Expert Opinion) […] Azoospermic men should be clinically evaluated to differentiate genital tract obstruction from impaired sperm production initially based on semen volume, physical exam, and FSH levels. (Expert Opinion)
#85 Male Fertility Tests & Procedures | University of Utah Health
https://healthcare.utah.edu/fertility/treatments/diagnostic-testing/all-tests
If no sperm are found in your semen or if the count is extremely low, we may use a blood sample to evaluate hormone levels (FSH, LH, free testosterone, and total testosterone and prolactin). Clues from these tests may lead to possible causes and the best therapies. […] Varicoceles are swollen veins in the scrotum. They are found in fertile as well as infertile men and are extremely common. But since they happen more in infertile men, they could harm fertility. Varicoceles are often found when there are fewer normal sperm and more tapered or abnormal sperm. […] You may be referred to a urologist If the results of your semen analysis look like the semen found in men who have varicoceles. The urologist will evaluate if you have a varicocele (usually directly above the testicle) and determine the best treatment. You may not need treatment.
#86 Male Fertility Tests & Procedures | University of Utah Health
https://healthcare.utah.edu/fertility/treatments/diagnostic-testing/all-tests
If no sperm are found in your semen or if the count is extremely low, we may use a blood sample to evaluate hormone levels (FSH, LH, free testosterone, and total testosterone and prolactin). Clues from these tests may lead to possible causes and the best therapies. […] Varicoceles are swollen veins in the scrotum. They are found in fertile as well as infertile men and are extremely common. But since they happen more in infertile men, they could harm fertility. Varicoceles are often found when there are fewer normal sperm and more tapered or abnormal sperm. […] You may be referred to a urologist If the results of your semen analysis look like the semen found in men who have varicoceles. The urologist will evaluate if you have a varicocele (usually directly above the testicle) and determine the best treatment. You may not need treatment.
#87 Diagnosing Male Infertility | NYU Langone Health
https://nyulangone.org/conditions/male-infertility/diagnosis
The causes of obstructive male infertility may include retrograde ejaculation, which is when semen enters the bladder rather than being ejaculated from the penis. […] Causes of nonobstructive male infertility include varicocele, which is when the veins in the testicles enlarge, reducing the sperm count and quality. […] Doctors can diagnose varicocele by performing a physical examination. […] To determine the cause of infertility and choose the treatment or treatments that best suit your needs, your NYU Langone urologist asks about your medical history and performs a physical examination. […] NYU Langone urologists may test a mans semen to determine causes of infertility. […] Blood tests can identify a mans levels of the reproductive hormone testosterone and other related hormones.
#88 Male Infertility Diagnosis & Treatment | Phoenix | AZ IVF Clinic
https://arizonafertility.com/fertility-library/male-infertility/
Seminal Fructose Test to identify if fructose is being added properly to the semen by the seminal vesicles. […] Post-ejaculate Urinalysis to determine if obstruction or retrograde ejaculation exists. […] Semen Leukocyte Analysis to identity if there are white blood cells in the semen. […] Anti-sperm Antibodies Test to identify the presence of antibodies that may contribute to infertility. […] Ultrasound to detect varicoceles (varicose veins) or duct obstructions in the prostate, scrotum, seminal vesicles and ejaculatory ducts. […] Testicular biopsy to determine if sperm production is impaired or a blockage exists. […] Vasography to check the structure of the duct system and identify any obstructions. […] Genetic Testing to rule out underlying mutations in one or more gene regions of the Y chromosome or to test for cystic fibrosis in men missing the vas deferens.
#89 EAU Guidelines on Sexual and Reproductive Health – Uroweb
https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-infertility
Testicular sperm can be found in 50-75% of men with AZFc microdeletions. Male offspring of men with AZF microdeletions will inherit the deletion. […] The presence of varicocele in some men is associated with progressive testicular damage from adolescence onwards and a consequent potential reduction in fertility. […] Varicocele repair may improve pregnancy rates and sperm concentration in adult infertile men with abnormal semen analyses, while benefits in sperm motility and normal morphology are less clear. […] Varicocele is associated with raised sperm DNA fragmentation (SDF) and intervention has been shown to reduce SDF and may improve the outcomes from ART. […] Surgery for sperm retrieval is mandatory in NOA men before ART. Fine needle aspiration (FNA) and testicular sperm aspiration (TESA) have lower sperm retrieval rates compared to TESE in patients with NOA. […] Microdissection TESE has been associated with higher rates of sperm retrieval and lower complications than conventional TESE.
#90 EAU Guidelines on Sexual and Reproductive Health – Uroweb
https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-infertility
Testicular sperm can be found in 50-75% of men with AZFc microdeletions. Male offspring of men with AZF microdeletions will inherit the deletion. […] The presence of varicocele in some men is associated with progressive testicular damage from adolescence onwards and a consequent potential reduction in fertility. […] Varicocele repair may improve pregnancy rates and sperm concentration in adult infertile men with abnormal semen analyses, while benefits in sperm motility and normal morphology are less clear. […] Varicocele is associated with raised sperm DNA fragmentation (SDF) and intervention has been shown to reduce SDF and may improve the outcomes from ART. […] Surgery for sperm retrieval is mandatory in NOA men before ART. Fine needle aspiration (FNA) and testicular sperm aspiration (TESA) have lower sperm retrieval rates compared to TESE in patients with NOA. […] Microdissection TESE has been associated with higher rates of sperm retrieval and lower complications than conventional TESE.
#91 SciELO Brazil – Unexplained Male infertility: diagnosis and Management Unexplained Male infertility: diagnosis and Management
https://www.scielo.br/j/ibju/a/Q6Pvm3hxfpLLDF58GSBPk5g/
Unexplained male infertility is a diagnosis reserved for men in whom routine semen analyses results are within normal values and physical as well as endocrine abnormalities were ruled out. […] The objective of this article is to highlight the concept of unexplained male infertility and focuses on the diagnosis and treatment of this condition in the era of modern andrology and assisted reproductive techniques. […] Men are categorized as having UMI when they are infertile despite having normal semen analysis, normal history and physical examination and when female factor infertility has been ruled out. […] The average incidence of UMI is approximately 15%, although reports of UMI in study populations have ranged from 6% to 37%. […] It is therefore important that both a thorough initial assessment is performed, including a detailed sexual history and gynecological examination, as well as advanced investigations that test for autoimmune infertility and sperm defects.
#92 SciELO Brazil – Unexplained Male infertility: diagnosis and Management Unexplained Male infertility: diagnosis and Management
https://www.scielo.br/j/ibju/a/Q6Pvm3hxfpLLDF58GSBPk5g/
Unexplained male infertility is a diagnosis reserved for men in whom routine semen analyses results are within normal values and physical as well as endocrine abnormalities were ruled out. […] The objective of this article is to highlight the concept of unexplained male infertility and focuses on the diagnosis and treatment of this condition in the era of modern andrology and assisted reproductive techniques. […] Men are categorized as having UMI when they are infertile despite having normal semen analysis, normal history and physical examination and when female factor infertility has been ruled out. […] The average incidence of UMI is approximately 15%, although reports of UMI in study populations have ranged from 6% to 37%. […] It is therefore important that both a thorough initial assessment is performed, including a detailed sexual history and gynecological examination, as well as advanced investigations that test for autoimmune infertility and sperm defects.
#93 SciELO Brazil – Unexplained Male infertility: diagnosis and Management Unexplained Male infertility: diagnosis and Management
https://www.scielo.br/j/ibju/a/Q6Pvm3hxfpLLDF58GSBPk5g/
Unexplained male infertility is a diagnosis reserved for men in whom routine semen analyses results are within normal values and physical as well as endocrine abnormalities were ruled out. […] The objective of this article is to highlight the concept of unexplained male infertility and focuses on the diagnosis and treatment of this condition in the era of modern andrology and assisted reproductive techniques. […] Men are categorized as having UMI when they are infertile despite having normal semen analysis, normal history and physical examination and when female factor infertility has been ruled out. […] The average incidence of UMI is approximately 15%, although reports of UMI in study populations have ranged from 6% to 37%. […] It is therefore important that both a thorough initial assessment is performed, including a detailed sexual history and gynecological examination, as well as advanced investigations that test for autoimmune infertility and sperm defects.
#94 SciELO Brazil – Unexplained Male infertility: diagnosis and Management Unexplained Male infertility: diagnosis and Management
https://www.scielo.br/j/ibju/a/Q6Pvm3hxfpLLDF58GSBPk5g/
Currently, routine semen analysis remains the backbone of the evaluation of the male factor infertility, besides detailed medical history and thorough physical examination. […] Normal semen analysis does not guarantee the fertilization potential of sperm, and studies have shown significant overlap in semen parameter values between fertile and infertile men. […] Thus, it is imperative to conclude that further tests are certainly required beyond semen analysis for evaluating subfertile men. […] Development and clinical application of novel sperm function tests, including the 'omics’ technology, may improve precision and reliability to the diagnosis of male subfertility. […] It is important that the initial assessment of subfertile male patients is rigorous and detailed in order to rule out any evident cause of infertility before delving deeper into evaluating the potential etiologies of unexplained male infertility.
#95 SciELO Brazil – Unexplained Male infertility: diagnosis and Management Unexplained Male infertility: diagnosis and Management
https://www.scielo.br/j/ibju/a/Q6Pvm3hxfpLLDF58GSBPk5g/
Currently, routine semen analysis remains the backbone of the evaluation of the male factor infertility, besides detailed medical history and thorough physical examination. […] Normal semen analysis does not guarantee the fertilization potential of sperm, and studies have shown significant overlap in semen parameter values between fertile and infertile men. […] Thus, it is imperative to conclude that further tests are certainly required beyond semen analysis for evaluating subfertile men. […] Development and clinical application of novel sperm function tests, including the 'omics’ technology, may improve precision and reliability to the diagnosis of male subfertility. […] It is important that the initial assessment of subfertile male patients is rigorous and detailed in order to rule out any evident cause of infertility before delving deeper into evaluating the potential etiologies of unexplained male infertility.
#96 EAU Guidelines on Sexual and Reproductive Health – Uroweb
https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-infertility
Important treatment decisions are based on the results of semen analysis and most studies indicate semen parameters are a surrogate outcome for male fertility. However, a semen analysis per se cannot distinguish fertile from infertile men. […] The Guidelines panel concludes that a comprehensive andrological examination is always indicated in infertile couples, both if semen analysis shows abnormalities and in men with normal sperm parameters as compared with reference values. Infertile men should be properly counselled and followed up considering their higher risk of developing malignant and non-malignant comorbid conditions later in life. […] Focused evaluation of male patients should include: a medical and reproductive history; physical examination; semen analysis with strict adherence to World Health Organization (WHO) reference values for human semen characteristics, and hormonal evaluation. Other investigations (e.g., genetic analysis and imaging) may be required depending on the clinical features and semen parameters.
#97 EAU Guidelines on Sexual and Reproductive Health – Uroweb
https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-infertility
Important treatment decisions are based on the results of semen analysis and most studies indicate semen parameters are a surrogate outcome for male fertility. However, a semen analysis per se cannot distinguish fertile from infertile men. […] The Guidelines panel concludes that a comprehensive andrological examination is always indicated in infertile couples, both if semen analysis shows abnormalities and in men with normal sperm parameters as compared with reference values. Infertile men should be properly counselled and followed up considering their higher risk of developing malignant and non-malignant comorbid conditions later in life. […] Focused evaluation of male patients should include: a medical and reproductive history; physical examination; semen analysis with strict adherence to World Health Organization (WHO) reference values for human semen characteristics, and hormonal evaluation. Other investigations (e.g., genetic analysis and imaging) may be required depending on the clinical features and semen parameters.
#98 EAU Guidelines on Sexual and Reproductive Health – Uroweb
https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-infertility
Important treatment decisions are based on the results of semen analysis and most studies indicate semen parameters are a surrogate outcome for male fertility. However, a semen analysis per se cannot distinguish fertile from infertile men. […] The Guidelines panel concludes that a comprehensive andrological examination is always indicated in infertile couples, both if semen analysis shows abnormalities and in men with normal sperm parameters as compared with reference values. Infertile men should be properly counselled and followed up considering their higher risk of developing malignant and non-malignant comorbid conditions later in life. […] Focused evaluation of male patients should include: a medical and reproductive history; physical examination; semen analysis with strict adherence to World Health Organization (WHO) reference values for human semen characteristics, and hormonal evaluation. Other investigations (e.g., genetic analysis and imaging) may be required depending on the clinical features and semen parameters.
#99 EAU Guidelines on Sexual and Reproductive Health – Uroweb
https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-infertility
Important treatment decisions are based on the results of semen analysis and most studies indicate semen parameters are a surrogate outcome for male fertility. However, a semen analysis per se cannot distinguish fertile from infertile men. […] The Guidelines panel concludes that a comprehensive andrological examination is always indicated in infertile couples, both if semen analysis shows abnormalities and in men with normal sperm parameters as compared with reference values. Infertile men should be properly counselled and followed up considering their higher risk of developing malignant and non-malignant comorbid conditions later in life. […] Focused evaluation of male patients should include: a medical and reproductive history; physical examination; semen analysis with strict adherence to World Health Organization (WHO) reference values for human semen characteristics, and hormonal evaluation. Other investigations (e.g., genetic analysis and imaging) may be required depending on the clinical features and semen parameters.
#100 Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I (2020) | American Society for Reproductive Medicine | ASRM
https://www.asrm.org/practice-guidance/practice-committee-documents/diagnosis-and-treatment-of-infertility-in-men-auaasrm-guideline-part-i-2020/
For initial infertility evaluation, both male and female partners should undergo concurrent assessment. (Expert Opinion) […] Initial evaluation of the male for fertility should include a reproductive history. (Clinical Principle) Initial evaluation of the male should also include one or more semen analyses (SAs). (Strong Recommendation; Evidence Level: Grade B) […] Men with one or more abnormal semen parameters or presumed male infertility should be evaluated by a male reproductive expert for complete history and physical examination as well as other directed tests when indicated. (Expert Opinion) […] In couples with failed ART cycles or recurrent pregnancy losses (RPL) (two or more losses), evaluation of the male should be considered. (Expert Opinion) […] The SA is an important component in the initial clinical evaluation of the male and his reproductive health.
#101 Low sperm count – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/low-sperm-count/diagnosis-treatment/drc-20374591
You may learn that you have a low sperm count if you get a healthcare checkup because you’re having trouble getting your partner pregnant. […] At your appointment, your healthcare professional works to find out the cause of your fertility troubles. […] Even if your healthcare professional thinks you have a low sperm count, your partner’s fertility also may need to be checked. […] This can help guide fertility treatment options for you and your partner. […] This includes an exam of your genitals. […] Your healthcare professional also asks questions about any inherited conditions, long-term health problems, illnesses, injuries or surgeries that could affect fertility. […] A sample of your semen is collected for testing as well. […] This is called a semen analysis. […] Your semen is checked under a microscope to see how many sperm are present.
#102 Male Infertility Workup: Laboratory Studies, Imaging Studies, Other Tests
https://emedicine.medscape.com/article/436829-workup
The semen analysis is the cornerstone of the male infertility workup. […] The sample should be processed within 1 hour, and 2-3 samples (at a minimum of 2-3 days apart) should be evaluated because of daily variations in sperm number and quality. […] The World Health Organization (WHO) published reference ranges for semen testing in 2010. […] Normal ejaculate volume is 1.5-5 mL, and the WHO lower reference limit (5th percentile) is 1.5 mL. […] Normal sperm density is greater than 20 million sperm/mL. […] To verify azoospermia, the semen should be centrifuged and evaluated under a light microscope for the presence of sperm. […] A routine part of the initial evaluation is testing of specific serum hormone levels, which usually includes FSH, LH, testosterone, and prolactin. […] TRUS is indicated in patients with azoospermia or severe oligospermia to evaluate for complete or partial ejaculatory duct obstruction.
#103 Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I (2020) | American Society for Reproductive Medicine | ASRM
https://www.asrm.org/practice-guidance/practice-committee-documents/diagnosis-and-treatment-of-infertility-in-men-auaasrm-guideline-part-i-2020/
Clinicians may discuss risk factors (i.e., lifestyle, medication usage, environmental exposures) associated with male infertility, and patients should be counseled that the current data on the majority of risk factors are limited. (Conditional Recommendation; Evidence Level: Grade C) […] The results from SA should be used to guide management of the patient. In general, results are of greatest clinical significance when multiple SA abnormalities are present. (Expert Opinion) […] Clinicians should obtain hormonal evaluation including follicle-stimulating hormone (FSH) and testosterone for infertile men with impaired libido, erectile dysfunction, oligozoospermia or azoospermia, atrophic testes, or evidence of hormonal abnormality on physical evaluation. (Expert Opinion) […] Azoospermic men should be clinically evaluated to differentiate genital tract obstruction from impaired sperm production initially based on semen volume, physical exam, and FSH levels. (Expert Opinion)
#104 Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I (2020) | American Society for Reproductive Medicine | ASRM
https://www.asrm.org/practice-guidance/practice-committee-documents/diagnosis-and-treatment-of-infertility-in-men-auaasrm-guideline-part-i-2020/
Karyotype and Y-chromosome microdeletion analysis should be recommended for men with primary infertility and azoospermia or severe oligozoospermia (5 million sperm/mL) with elevated FSH or testicular atrophy or a presumed diagnosis of impaired sperm production as the cause of azoospermia. (Expert Opinion) […] Men with congenital obstructive azoospermia, including congenital bilateral absence of the vas deferens (CBAVD) should have cystic fibrosis (CF) testing. […] Sperm DNA fragmentation may adversely affect the outcome of ART treatments as well as attempts at natural fertility, including an increased miscarriage rate. […] The clinician should discuss the importance of paternal structural autosomal defects in the evaluation of the couple with RPL and the need for the male partner to have a karyotype analysis.
#105 Diagnosing Male Infertility | NYU Langone Health
https://nyulangone.org/conditions/male-infertility/diagnosis
You may be asked to provide a sample of your urine after ejaculation. […] Doctors use transrectal ultrasound to detect blockages in the tubes that carry semen out of the body or problems with the prostate, such as benign prostatic hyperplasia, in which the prostate becomes enlarged. […] Doctors may perform blood tests to detect genetic causes of infertility. […] Genetic conditions that can affect male fertility include Klinefelter Syndrome, which results when a male infant is born with an abnormal number of sex chromosomes, causing few or no sperm to be produced.
#106 Male Infertility Workup: Laboratory Studies, Imaging Studies, Other Tests
https://emedicine.medscape.com/article/436829-workup
An abnormal postcoital test result is observed in 10% of infertile couples. […] When a primary sperm defect is suspected or when other tests do not reveal the cause of infertility, sperm function tests may determine if a significant sperm abnormality exists. […] Testicular biopsy is performed in azoospermic men with a normal-sized testis and normal findings on hormonal studies.
#107 Male Infertility: Causes, Symptoms, Tests & Treatment
https://my.clevelandclinic.org/health/diseases/17201-male-infertility
Yes, many different treatment options can reverse male infertility. […] In most cases, male infertility requires treatment. […] Just because you have male infertility, it doesnt mean youll never be able to have a biological child. Treatment options are available. […] Male infertility can be very challenging. It affects up to 15% of males in the United States who are attempting to have a biological child. But because of modern technology, many couples have the potential to conceive a biological child.
#108 Male Infertility: Causes, Symptoms, Tests & Treatment
https://my.clevelandclinic.org/health/diseases/17201-male-infertility
Yes, many different treatment options can reverse male infertility. […] In most cases, male infertility requires treatment. […] Just because you have male infertility, it doesnt mean youll never be able to have a biological child. Treatment options are available. […] Male infertility can be very challenging. It affects up to 15% of males in the United States who are attempting to have a biological child. But because of modern technology, many couples have the potential to conceive a biological child.