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Both male and female partners are tested if pregnancy fails to occur after a year of regular unprotected sexual intercourse in any fertility diagnosis. It should be done earlier if a woman is over age 35 or if either partner has known risk factors for infertility.
Fertility history of any medical or sexual factors that might affect fertility is taken into consideration by the specialist. They include; Frequency and timing of sexual intercourse, duration of infertility and any previous fertility events, childhood illnesses and any problems in development, any serious illness (diabetes, respiratory infections, cancer, previous surgeries), sexual history, including any sexually transmitted diseases, exposure to toxins, such as chemicals or radiation, history of any medications and allergies and family history of reproductive problems.
A physical examination of the scrotum, including the testes, is performed by a urologist. It is useful for detecting large varicoceles, undescended testes, and absence of vas deferens, cysts, or other physical abnormalities. Smaller-sized and softer testicles along with tests that show low sperm count are strongly associated with problems in sperm formation. Normal testicles accompanied by a low sperm count, however, suggest possible obstruction. The doctor may also take the temperature of the scrotum with a test called scrotal thermography. The prostate gland is also checked for abnormalities. The penis is checked for warts, discharge from the urinary tract, and incorrect location of the urethra opening (hypospadias).
Post-Ejaculatory Urine Sample:
A urine sample to detect sperm after ejaculation may rule out or indicate retrograde ejaculation. It also may be used to test for infections.
It is the basic test to evaluate a man's fertility. A semen analysis should be repeated at least three times over several months. A semen analysis will provide information on: volume, concentration, count, motility and morphology of sperm. Normal semen is liquefied within 20 minutes after adding certain enzymes. Abnormal results may suggest prostate gland problems or lack of sperm. The absence of sugar (fructose) in semen is another important factor which gives the indication of obstruction to epididymis since fructose is added to the semen in epididymis. Other factors may also be measured: White blood cell counts are taken to detect infection, low levels of inhibin B in the testes which indicate blockage or other defects in the seminiferous tubules, low levels of alpha-glucosidase which indicate blockage in the epididymis.
- Sperm count: A low sperm count is only one indicator of a fertility problem. 20 million per milliliter of semenis considered as a normal sperm count.
- Sperm motility: Motility or the speed and quality of movement are graded as 1 - 4. Motility should be greater than 2 for a man to be fertile. And more than 63% of sperm should be motile for normal fertility. Testing for sperm motility is particularly valuable for predicting the success of artificial insemination and which men might be candidates for the intracytoplasmic sperm injection (ICSI).
- Sperm Morphology: Morphology is the shape and structure of the sperm. One of the important factoror the determine the success of the fertility treatments in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) is sperm morphology.
Several factors that might affect fertility can be measured in blood tests. Tests for certain hormone levels are indicated if semen analysis is abnormal or there are other indications of hormonal disorders. Blood tests for testosterone and follicle-stimulating hormone (FSH) levels are preliminary tests. If testosterone levels are low, then luteinizing hormone (LH) is measured. Low levels of FSH, LH, and testosterone indicate a diagnosis of hypogonadotropic hypogonadism. Very high FSH levels with normal levels of other hormones indicate abnormalities in initial sperm production. Other hormones, such as prolactin, estrogen, or stress hormones may be measured if there are symptoms of other problems, such as low sexual drive or the presence of breasts. Blood tests can also determine the presence of any infections that might affect fertility, including HIV, hepatitis, and Chlamydia.
The size of the testes or presence of cysts, tumors, abnormal blood flow, or varicoceles that are too small for physical detection can be accurately determined through ultrasound imaging. It can also help detect testicular cancer.
Sperm Penetration Tests
- Cervical Mucus Penetration Test: This is a post-coital test which evaluates the effect of a woman's cervical mucus on a man's sperm. A small sample of cervical mucus from a woman is collected within 2 - 24 hours after intercourse during ovulation period (mid-cycle) and is examined under a microscope. Cervical mucus is cultured for checking infection if the sperm is absent in the sample. The test cannot evaluate sperm movement from the cervix into the fallopian tubes or the sperm's ability to fertilize an egg.
- Micro-Penetration Assay Test. This test checks to see if sperm can penetrate hamster eggs that have had their covering removed. Infertility is diagnosed if less than 5 - 20% of the eggs are penetrated. This test best assists reproductive treatment options for men with infertility.
Genetic testing may be recommended in men who are severely deficient in sperm and who there is no obstruction to sperm pathways, particularly in men undergoing the intracytoplasmic sperm injection (ICSI) procedure. Genetic testing identifies DNA fragmentation, chromosomal defects, or the possibility of genetic diseases that can be passed on to children. If genetic abnormalities are suspected in either partner, counseling is recommended.