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Male Fertility

Evaluation

It is important that men present for fertility evaluation along with their partners. Often times, a lot of time is spent with the woman before the male partner turns up at the clinic only to find out that he has Azoospermia. Evaluation of male fertility begins with a thorough history. Duration of fertility issues is noted and any prior treatment/ tests are recorded. A thorough sexual history with frequency of intercourse, erection/ejaculatory problems and desire is asked for. Medical problems like diabetes, hypertension, tuberculosis and endocrine problems like thyroid and prolactin tumors are noted. Childhood history of viral infections, surgeries for congenital hydrocele/hernia are asked for. Also injuries to the testis like twisting, cricket ball/ cycle bar trauma are noted. Family history of fertility problems is very significant. History of infertility in siblings is asked for. Occupational history suggestive of increased exposure to heat like welding, truck driving is asked for. Also stress, anxiety and sleep disorders are job related and noted. Excessive lap top usage increases scrotal temperatures and can be detrimental to sperm. A genetic profiling of men presenting with long duration of infertility is key. Genetic mutations are responsible for 30% of Oligo/Azoospermia and should be probed into.

Physical examination should include assessment of height, weight, Blood pressure, thyroid, body habitus, general appearance and an examination of genitals. Semen analysis is a very important test in evaluation. A blood count, lipid profile and diabetic status are assessed. Hormone assays are required for some patients.

Variability of Spermatozoa Concentration

Semen Analysis

Though an important test, semen analysis is not always a measure of the fertility potential in the male. It is often a test that is the subject of heated debate world over. What constitutes normal semen? As always, science relies heavily on evidence and on statutory bodies, like in this instance, the World Health Organisation (WHO) which submitted recently its fifth report on the matter. However, it has to be understood that this is a report based on a study of 1800 couples from a few continents and missed out the Indian subcontinent. Hence, though it may be used as a guideline, by no means it is the last word in semen analysis. The figure above shows sperm count of a single male followed up over 120 weeks and one can see how highly variable the count is even in a normal fertile man.

Semen Volume

  • Prostate Gland – 30% of Semen Volume
  • Seminal Vesicles – 60% of Semen Volume, Fructose
  • Bulbo Urethral Gland secretions also contribute

Variables in Semen Analysis

  • Sperm Concentration- Denotes the number of spermatozoa in 1ml of semen
  • Sperm Count- The number of spermatozoa in the entire volume of semen
  • Sperm Motility- Denotes sperm movement and includes Progressively motile and Non Progressive sperm
  • Volume- Total volume of semen
  • Round Cells- Immature sperms and cells denoting infection

Hormone Assays

Follicle stimulating Hormone (FSH) is a hormone produced by the Anterior pituitary which regulates sperm production by the testis. A very high FSH level denotes that the testis is failing. Lutenizing Hormone (LH) causes the production of the hormone testosterone produced by the Leydig cells from the testsis.