The Fertility Evaluation - Male

A male fertility evaluation is a thorough process designed to figure out why a couple might be having trouble conceiving. Here's what it usually includes:

1. Medical History

• Past illnesses - especially childhood illnesses like mumps
• Surgeries - especially hernia repair, undescended testes, or prostate surgery
• Medications - including anabolic steroids, testosterone, opioid pain management, medications for hypertension, ulcers, auto-immune conditions, hair loss, or depression, and chemotherapy for malignancies
• Exposure to toxins - pesticides, radiation, industrial chemicals
• Lifestyle factors – smoking (or other tobacco use), alcohol, marijuana, stress, exercise habits
• Sexual history - erectile or ejaculatory problems, sexually transmitted infections (STIs), lubricant use

2. Physical Examination

• General health - height, weight, BMI, signs of hormonal issues (e.g. hair distribution)
• Genital exam - testicle size, presence of varicoceles, prostate exam if indicated

3. Semen Analysis

• Volume - how much semen is produced per ejaculate
• Concentration or Count - how many sperm per mL of semen
• Motility - how well the sperm are moving
• Morphology - sperm shape and structure
• Vitality - percentage of live sperm

4. Hormone Testing

Blood tests for hormones:

• FSH (follicle-stimulating hormone)
• LH (luteinizing hormone)
• Testosterone
• Prolactin
• Estradiol

5. Genetic Testing (if indicated)

• Karyotype analysis - chromosomal abnormalities
• Y-chromosome microdeletion testing
• CFTR gene mutation (linked to cystic fibrosis)

6. Imaging Studies (if needed)

• Scrotal ultrasound - to check for varicocele, tumors, blockages
• Transrectal ultrasound - to examine the prostate and seminal vesicles

7. Specialized Sperm Function Tests (only if indicated)

• DNA fragmentation testing
• Anti-sperm antibody testing
• Reactive oxygen species testing

8. Additional Tests (in certain cases)

• Post-ejaculatory urine analysis - to check for retrograde ejaculation
• Testicular biopsy – rare (done for some cases of azoospermia)

It is standard care (best practice) to start with the basic investigations (history, physical exam, semen analysis) and only add on the more advanced tests if problems are found.