The diagnosis of infertility begins with a medical history and physical exam by a urologist, preferably one with experience or who specializes in male infertility. The provider may order blood tests to look for hormone imbalances or disease. A semen sample will be needed. Blood tests may indicate genetic causes.
In the majority of cases of male infertility and low sperm quality, no clear cause can be identified with current diagnostic methods.
The cornerstone of the male partner evaluation is the history. It should note the duration of infertility, earlier pregnancies with present or past partners, and whether there was previous difficulty with conception.
Sexual habits, frequency and timing of intercourse, use of lubricants, and each partner's previous fertility experiences are important.
Loss of libido and headaches or visual disturbances may indicate a pituitary tumor.
The past medical or surgical history may reveal thyroid or liver disease (abnormalities of spermatogenesis), diabetic neuropathy (retrograde ejaculation), radical pelvic or retroperitoneal surgery (absent seminal emission secondary to sympathetic nerve injury), or hernia repair (damage to the vas deferens or testicular blood supply).
A complete examination of the infertile male is important to identify general health issues associated with infertility. For example, the patient should be adequately virilized; signs of decreased body hair or gynecomastia may suggest androgen deficiency.
The scrotal contents should be carefully palpated with the patient standing. As it is often psychologically uncomfortable for men to be examined, one helpful hint is to make the examination as efficient and as matter of fact as possible.
The peritesticular area should also be examined. Irregularities of the epididymis, located posterior-lateral to the testis, include induration, tenderness, or cysts.
Wearing protection over the scrotum during athletic activities.
In cases of posttesticular causes, infertility may often be treated surgically. However, for sperm quality causes, e.g. oligospermia, there is no effective medication. Still, IVF or even ICSI may be an alternative.
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