In men, the ability to conceive a child depends on healthy sperm production and delivery. Infertility is caused by a variety of factors, including smoking, drug use and exposure to certain chemicals.
A comprehensive male fertility evaluation typically begins with a physical exam and review of the patient’s medical history. A semen analysis may also be performed.
Testicular Biopsies
For men who do not have an obvious reason for their infertility, a testicular biopsy can help find the cause. This test involves creating a small incision in the skin of the scrotum, removing a piece of tissue from the testicle and cutting it into tiny pieces for testing. The most common reasons for a testicular biopsy are to diagnose an unusual lump, determine the cause of obstructive azoospermia (where the sperm cannot reach semen and ejaculate) or to recover sperm for in vitro fertilization (IVF).
A testicular biopsy is done under local or general anesthesia and is usually performed as day-care surgery. The area around the testicle is cleaned with germ-killing medicine, and then covered with a sterile towel. A surgical cut is then made, and a piece of the testicle is removed. Each piece of tissue is aspirated and then analyzed under the microscope to look for signs of sperm morphology and movement.
If the sample shows a problem with sperm production or movement, other tests can be used to find the cause. These may include scrotal and transrectal ultrasound, hormone testing, post-ejaculation urinalysis, antisperm antibody testing, specialized tests of sperm function and genetic testing to check for chromosomal abnormalities. This information helps the doctor to determine the best treatment options for each patient. These may include medication, hormone therapy or surgery.
Blood Tests
A number of factors can cause male infertility. Most often these are problems with sperm production or delivery to an egg. To evaluate this, a man usually has a semen analysis. This is done at a fertility or urology office that has an andrology laboratory. In some cases, a blood test may be needed to help diagnose more complex conditions.
A man’s ability to produce sperm may be impacted by genetic conditions (such as Klinefelter syndrome, or chromosome microdeletions on the Y chromosome) or medical issues that affect hormone levels. Unhealthy habits such as heavy alcohol use, smoking and drug abuse can also cause male infertility. Certain medications, such as steroids or some antidepressants can also impact a man’s ability to produce and deliver sperm.
Semen analysis tests for things such as sperm count, sperm motility and sperm morphology. It can also identify abnormalities such as a varicocele (dilated or twisted veins in the scrotum that drain blood from the testicles).
In addition to physical tests, your healthcare provider will ask you about your family history, your past health problems and how long you have been trying to get pregnant. If you have a partner, your healthcare providers will also need to know their health history as well. For couples, it is important to remember that the process of infertility can lead to feelings of depression, loss and grief. For this reason, if you have these emotions, it is important to see a therapist or psychiatrist that specializes in reproductive disorders.
Rectal Probe Electroejaculation (RPE)
If your sperm test results show low numbers of healthy sperm or no sperm, a healthcare provider may perform a rectal probe electroejaculation. During this procedure, a healthcare provider inserts a small electric probe into your rectum and beams mild electrical current to the prostate gland. This causes ejaculation, which is collected in a wide-mouth plastic container. Unlike penile vibratory stimulation, RPE allows your physician to control the number of stimulus cycles required to achieve a full erection and ejaculation.
This test also helps your doctor determine if your ejaculatory ducts are properly functioning or obstructed. It is sometimes done in conjunction with a transrectal ultrasound, which places an imaging probe into your rectum and sends high-frequency sound waves to detect the location of the ejaculatory ducts and whether they are blocked by cysts or calcifications.
Your healthcare provider can also check your semen to look at the number and quality of sperm that are present. For example, a sperm count below the normal range or a lack of fructose in the semen indicates that your seminal vesicles are not working properly or that the ejaculatory duct is blocked.
If a healthcare provider finds that your sperm are not healthy, he or she may use medications to improve sperm production and prevent a blockage in the ejaculatory ducts. These medications can include hormones that stimulate gonadotropin production, antibiotics to cure infections that compromise sperm and anti-inflammatory drugs that reduce the formation of reactive oxygen species, which damage sperm.
Vasectomy
Men can experience infertility due to a variety of health problems. These can include anything that blocks the flow of semen through the genital tract, including genetic or birth defects, surgery scar tissue, twisted or swollen veins in the scrotum, and a variety of medical conditions like varicocele, diabetes, some infections, autoimmune disorders, and cancer treatments. In rare cases, infertility can be caused by a condition that affects the hypothalamus and pituitary gland.
In some cases, a man’s infertility can be fixed with male fertility treatment. This includes procedures like vasectomy and ejaculation stimulation. Vasectomy is a surgical procedure that involves cutting and sealing 2 tubes called the vas deferens that carry sperm from the testicles to the urethra, which is the tube inside the penis. This is a permanent male birth control procedure.
During this procedure, a doctor first numbs your scrotum with an anesthetic. They make a small hole in your scrotum to reach the tubes and then cut them, using a scalpel or another surgical instrument. Then, they seal the ends of each tube with either stitches or a special type of glue.
After the surgery, your urologist will recommend that you perform ejaculation stimulation to check if sperm are still being produced. You will need to have 20 ejaculations over 10 weeks for the test to be accurate.
