Infertility
A man's fertility can be affected by factors such as a low sperm count, poor sperm movement (motility), clumped or agglutinated sperm that is unable to swim to the egg, abnormally shaped sperm, enlarged veins around the testes (varicoceles), obstructions that prevent sperm from being released during ejaculation, and genetic or congenital conditions that impair the reproductive environment. The most common anatomic abnormality in men is varicoceles.
A history of having mumps, testicular injury, exposure to chemicals or toxins, acute illness or prolonged fever, drug or alcohol use, and ingestion of anabolic steroids can negatively impact male reproductive capabilities. Temperature also affects sperm efficiency. Exposure of the testicles to excessive heat or a prolonged fever can adversely affect the sperm count, motility, and shape. Age-related problems include decreased testosterone production, declining sperm mobility or production, and prostate, erectile, or ejaculation problems. Some of these problems can be exacerbated by excessive alcohol use.
For men, a medical history and physical examination to detect anatomic abnormalities may be all that is necessary to diagnose an infertility problem. Examination using trans-rectal ultrasound (TRUS) may be required to identify specific abnormalities such as obstructions blocking the sperm from being released during ejaculation.
Laboratory Tests
Semen analysis. Semen analysis is the mainstay of male testing. Collection and prompt evaluation of an ejaculate can quickly determine any abnormalities in the number of sperm, their shape, and their ability to swim toward the egg. Computer-assisted technology is often used to evaluate sperm functionality.
Blood tests are used to determine hormone levels or the presence of sperm antibodies. Blood test measurements may include:
- Free and total testosterone
- Luteinizing hormone (LH)
- Follicle-stimulating hormone (FSH)
- Prolactin (PRL)
Biopsy. In some instances, a biopsy of testicular tissue can identify the problem, for example, sperm production, abnormal growths, tumors, or incomplete growth or maturation of reproductive organs.
