When to Test His Fertility

If the post-coital test is abnormal, it should be repeated. This test is very dependent on proper timing in the cycle. If the test remains abnormal, there are a couple of possibilities:

1. Poor cervical mucus: Is there infection or prior surgery on the cervix, or is the woman on medications (for example: clomiphene) that might account for poor cervical mucus? Intrauterine inseminations (see below) may be suggested as a means of dealing with this problem.
2. Poor sperm motility: This can suggest the presence of sperm antibodies. Sperm antibody testing should be considered. The presence of sperm antibodies would suggest that either inseminations or an assisted reproductive technology (ART) procedure such as IVF or zygote intrafallopian transfer (ZIFT) be considered.

If the post-coital test is normal, evaluation of other possible factors should proceed. Sperm function testing should be considered before initiating treatments such as superovulation or an ART procedure.

If the semen analyses are repeatedly abnormal, sperm function testing and urologic referral should be obtained. If no significant improvement in the semen analysis is obtainable, then the TMNS should be calculated, the results of the sperm function testing taken into account, and the appropriate interventions or treatments considered. The number of TMNS that is adequate for each intervention will vary from lab to lab and physician to physician, but the alternatives include the following:

1. Inseminations (also known as AIH): A semen sample is collected (preferably by masturbation although intercourse with a special condom is an option) and provided to the laboratory in a sterile specimen container. The semen sample obviously contains much more than just the sperm, including proteins, sugars, and prostaglandins. The laboratory will treat the semen sample in such a fashion that a pure sperm sample suspended in a specially designed buffer is obtained. This sample is then placed in a small syringe to which is attached a small plastic tube, or catheter. A speculum is placed in the vagina, the catheter is directed through the cervix and into the uterus, and the sperm preparation is slowly injected. While this procedure may cause slight cramping, it is generally painless. This procedure allows a far greater number of sperm to reach the uterine cavity and fallopian tubes than would normally occur with intercourse.
2. ART (assisted reproductive technologies): Far fewer sperm are needed for these procedures to be successful than is the case even with inseminations, let alone intercourse.
   • ICSI (intracytoplasmic sperm injection): In short this procedure involves injecting a single sperm into an egg using a microscope and micromanipulation instruments. Fertilization and pregnancies can be achieved even if only a few sperm are present.
   • Donor sperm: If there is complete absence of sperm (azoospermia), this may be the only option for achieving conception. Some couples will also opt to use donor sperm rather than resorting to some of the more high-tech procedures, often because of cost considerations.

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