Evaluation and diagnosis of Male Infertility
Male infertility can be due to a variety of conditions. Some of these conditions are identifiable and reversible, such as ductal obstruction and hypogonadotropic hypogonadism. Other conditions are identifiable but not reversible, such as bilateral testicular atrophy secondary to viral orchitis. When identification of the etiology of an abnormal semen analysis is not possible, as is the case in many patients, the condition is termed idiopathic.
When the reason for infertility is not clear, with a normal semen analysis and partner evaluation, the infertility is termed unexplained. Rarely patients with normal semen analyses have sperm that do not function in a manner necessary for fertility.
The purpose of the male evaluation is to identify these conditions when present. Identification and treatment of reversible conditions may improve the male's fertility and allow for conception through intercourse. Even azoospermic patients may have active sperm production or could have sperm production induced with treatment. Detection of conditions for which there is no treatment will spare couples the distress of attempting ineffective therapies.
Detection of certain genetic causes of male infertility allows couples to be informed about the potential to transmit genetic abnormalities that may affect the health of offspring. Thus, an appropriate male evaluation may allow the couple to better understand the basis of their infertility and to obtain genetic counseling when appropriate. If specific corrective treatment is not available, it still may be possible to employ assisted reproductive techniques such as testicular or epididymal sperm retrieval with intracytoplasmic sperm injection (ICSI).
Alternatively, such couples may consider therapeutic donor insemination or adoption.
Evaluation when to do?
An initial screening evaluation of the male partner of an infertile couple should be done if pregnancy has not occurred within one year of unprotected intercourse. An earlier evaluation may be warranted if a known male or female infertility risk factor exists or if a man questions his fertility potential. The initial evaluation for male factor infertility should include a reproductive history and two properly performed semen analyses.
A full evaluation by a urologist or other specialist in male reproduction should be done if the initial screening evaluation demonstrates an abnormal male reproductive history or an abnormal semen analysis. 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.