Male Fertility Evaluation – It is important that men present for fertility evaluation along with their partners (if available). 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 or some other fertility problem.
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.