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Evaluating the Male
The male should be questioned about his history. Has he ever fathered a child? Is there any history of trauma to the testes? Did he have mumps as an adult? Does he have any reason to believe that he may be sub fertile? Has he had a prior semen analysis? Is there any history of infection? Is there any family history of infertility? The possibility of sexual dysfunction must also be explored. Is there any problem with maintaining an erection or with premature ejaculation? Does he ejaculate during intercourse? What is the frequency of sexual intercourse?
An initial semen analysis should almost always be ordered. Although it will undoubtedly produce some anxiety on the part of the husband, it has all of the characteristics of a test that should be ordered early; it is relatively easy, inexpensive, and noninvasive. And since up to 40 percent of all infertility is related to some type of male factor, this is not a test that should be neglected.
Not all laboratories do semen analyses the same way. Try to find a lab that does a lot of semen analyses, or even better, one that specializes in semen analyses. If a specialized lab is not available, it's OK. Go ahead and get it done anyhow. It's too important to skip and any information is worthwhile.
Many specialists state that a male must have three semen analyses before anything can be said about the results. This is based on a couple of observations. First of all, producing a sample (masturbating) for a semen analysis for the first time can be rather unnerving. Often an initial sample will suggest a problem only to have later samples be perfectly normal. Secondly, sperm counts vary tremendously from day to day. If the first count is low, by all means repeat it. If the first count is normal, there is probably no need for three counts to confirm it.
Since most physicians specializing in infertility are obstetrician-gynecologists, or reproductive endocrinologists (obstetrician-gynecologists with specialty training), men are frequently not examined unless the initial semen analysis suggests that there is a problem. If the semen analysis is abnormal, the male may be referred to a urologist. The urologist will check the testes for abnormalities. They will also check for the presence of a varicocele, which is a dilated vein around the testes that can result in decreased sperm production. Some hormonal testing may also be ordered to try to discover the reason for decreased sperm production. Some urologists will recommend a testicular biopsy to further evaluate the problem, but there are very few, if any, cases in which a testicular biopsy will provide information that will allow improvement in a case of decreased sperm production. Be very certain why a testicular biopsy is being suggested and what the physician hopes to gain before undergoing this test.
Most importantly, the development of a procedure known as ICSI (intracytoplasmic sperm injection) has changed much of the focus in the treatment of male infertility. Rather than trying to improve sperm production, much more success has been achieved by developing techniques that allow us to use what sperm are produced. In the past, attempts to increase sperm production have been disappointing at best. Recent developments such as ICSI have resulted in tremendous success, making fertilization and pregnancy with absolutely minimal numbers of sperm possible.