Therefore, it is recommended that you and your doctor include the male in the reproductive evaluation and workup for infertility. An infertility evaluation should be performed if a couple has not achieved conception after one year of unprotected intercourse. An evaluation should be performed earlier if male or female infertility risk factors exist, if the female is over 35 years of age, and also if the couple simply questions the man's fertility potential. Male infertility can result from a variety of conditions.

The purpose of the evaluation of the male is to identify conditions contributing to infertility that are either potentially reversible, irreversible but suited to assisted reproductive techniques, or potentially life- or health-threatening. Current diagnostic and advanced treatment modalities have significantly improved prognosis and created a new era in the treatment of male-factor infertility.

The Center for Male Reproductive Health at KJK, led by director Dr. K JayaKrishanan, is dedicated exclusively to providing the most current and innovative therapies for the treatment of male infertility.

This unique facility offers ultramodern andrology testing, the latest advancements in assisted reproductive technologies including intracytoplasmic sperm injection (ICSI) and state-of-the-art microsurgical techniques. Couples are thus able to receive their treatment under one roof so that their goal of conceiving is accomplished in an expeditious and caring manner.

The Male Infertility Workup

History and Physical Examination

The initial male fertility evaluation consists of a thorough history and physical examination. The couple's marital history is important, particularly with regard to prior marriages and sex partners. All miscarriages, elective terminations, and pregnancies initiated by the patient or partner should be elicited. Childhood and developmental conditions that may have an impact on fertility include a history of undescended testicles, testicular torsion, trauma, and precocious or delayed puberty.

Systemic illnesses such as diabetes mellitus, multiple sclerosis, and spinal-cord injury may impair normal ejaculation. Any previous retroperitoneal, pelvic, inguinal, or scrotal surgery should be noted. Prior exposure to sexually transmitted diseases may lead to reproductive-tract scarring. Because intratesticular sperm maturation requires 74 days, exposure during the past several months to systemic illness, fevers, excessive heat, or various medications should be elicited. Prior exposure to gonadotoxins such as chemotherapy, radiation, exogenous androgenic steroids, as well as excessive alcohol use, cigarette smoking, and use of marijuana and other recreational drugs have all been associated with decreased fertility.

Finally, it is important to inquire about the couple's sexual history including the frequency and timing of intercourse. To achieve conception, sexual intercourse should be initiated prior to ovulation and continued at a frequency of every other day during the ovulatory period. In preparation for the initial consultation consider the following questions: Is there a pattern of infertility in your family? Have you ever achieved a pregnancy? Have you had pelvic or scrotal surgery? Have you had any abdominal surgeries, like a hernia operation, that could scar or injure delicate internal structures? Were or are you exposed to toxins. This category includes a wide range of substances from chemotherapy drugs to pesticides to workplace chemicals.

How much alcohol do you consume? Do you use recreational drugs, like marijuana? Are you exposed to heat for long periods of time (ex. sauna or steam)? Do you have a condition or disease that requires medications? Which medications are you taking? Some prescription drugs interfere with sperm production. Some diseases, (ex. diabetes) may hinder normal ejaculation. Have you had any sexually transmitted diseases?

Semen Analysis

semen analysis forms the basis of the initial evaluation for assessing male-factor infertility. Prior to establishing a reliable fertility baseline, two to three semen analyses should be performed. Multiple analyses are necessary because semen findings normally fluctuate for a given individual. For each analysis, patients are instructed to abstain from intercourse for 2 to 3 days. Abstinence for a shorter period can decrease ejaculate volume and sperm count whereas prolonged abstinence may impair sperm motility.

It is critical that the specimen be collected in a nontoxic container, that there be no inadvertent loss of the specimen, and that the analysis be performed within 2 hours of collection. A semen analysis reveals the volume of ejaculate, the concentration or density of sperm, their motility and the morphology (shape). There are minimal standards of adequacy for each parameter and anything below those standards is called "abnormal." An abnormal finding is an indicator that infertility may be a problem, not a declaration of sterility.

Standards for a normal semen analysis include: Ejaculate volume of between 2.0 and 5.0 ml. Sperm concentration of at least 20 million per ml or a total count of greater than 40 million. Motility, quantitatively at least 50% of the sperm should demonstrate movement. Morphology, (the shape of each sperm) which evaluates the proportions of head to body to tail of an individual sperm. Blood Tests The blood assays performed may include an Follicle Stimulating Hormone (FSH) level, the hormone which the brain sends to the testicle to produce sperm, and the Luteinizing Hormone (LH) level, a hormone responsible for motivating the testicles to produce testosterone.

A low testosterone level not only has an impact on sperm production, but also has significant implications for a man' s health in general including sexual dysfunction, depression, fatigue, bone density and muscle integrity. Other blood tests performed will evaluate genetic causes for infertility. Between 30% and 40% of the patients with low or no sperm in the ejaculate have a genetic problem. For example, an extra X chromosome indicates a condition called Kleinfelter' s Syndrome. Pieces of the Y chromosome may be missing, or there may be mutations associated with cystic fibrosis.