- In This Feature
- How Do You Obtain a Sample?
- How Are Samples Analyzed?
- What Other Sperm Tests Are Available?
- What Can Cause Abnormal Sperm Counts?
- What Treatment Options Are Available?
- What Is a Urologist Evaluation?
- How Does the Infertility Evaluation Proceed?
- When to Test His Fertility
- What Happens if We Still Have Trouble Conceiving?
What Is a Urologist Evaluation?
It's important to realize that it takes about 70 days for the testicles to produce a sperm that is fully mature and ready to achieve fertilization. Any significant physical event during that 70-day period can significantly affect the sperm count for two to three months. For example, if you have a very high fever today as the result of the flu or an infection, it may be three months before your sperm count will fully return to normal. Keep this in mind when scheduling your sperm counts—if you have any reason to think there may have been some event that could interfere with sperm production, it may be wise to wait a while.
Remember to avoid toxins; it's that simple. You don't necessarily have to abstain from drinking alcohol, but be reasonable. And, if there is any evidence of infection, treat it. It's straightforward, inexpensive, non-invasive, and it may help.
Evaluation by a urologist, particularly one who has a special interest in male fertility, is usually the first step in evaluating abnormal semen analyses. There are several problems that urologists treat effectively.
- Varicocele: A varicocele is a dilated vein or veins around the testicles. It is thought that these dilated veins increase the heat of the testicle and thereby impair sperm production and the motility of the sperm that are produced. This effect of a varicocele can be progressive over time. Significant varicoceles can usually be appreciated on a simple physical exam. Correction of a varicocele requires a minor surgical procedure and can result in dramatic improvements in sperm numbers and function if the varicocele is large. Smaller varicoceles may or may not be important, and correction of small varicoceles is not likely to result in clinically significant improvements in the sperm count.
- Obstruction: Most obstructions of the male reproductive tract are due to prior vasectomies, although they may occur as a result of infection, prior surgery (for example: hernia repair), or may even be congenital. Microsurgery by a physician experienced in this technique can be very successful in reversing obstruction. The chances of successfully reversing an obstruction decrease the longer the obstruction has been present.
- Failure of ejaculation: There are medications available that can remedy this problem for a large number of individuals. In others (for example, men who have suffered a spinal cord injury) electroejaculation has been very successful.
- Retrograde ejaculation: In some individuals, the sperm are actually ejaculated backward into the bladder rather than out through the penis. This can be a congenital abnormality, or it may occur as the result of surgery, illness (for example: diabetes), or medications. This can often be corrected through the use of medications, but if this does not work, the sperm can be isolated from the urine and used for insemination.
- Testicular cooling: The testicles don't work well if they are too hot. Taking steps to keep the testicles cool is a very reasonable thing to do. Wear boxer shorts instead of jockey shorts. Avoid long or frequent saunas or hot tubs. Sleep naked. Finally, there is some suggestion that actually placing a small ice pack in a sock and then sitting on it for a while in the evening may be worthwhile.