What is the evaluation process for a male partner after a blighted ovum (anembryonic pregnancy)?

Male Evaluation After a Blighted Ovum (Anembryonic Pregnancy)

A comprehensive male fertility evaluation should be performed after a blighted ovum, including reproductive history, physical examination, and at least two semen analyses, as this approach can identify potentially correctable conditions affecting future pregnancy outcomes. 1, 2

Initial Evaluation Components

Reproductive History

• Obtain detailed information about:
  • Frequency and timing of intercourse 1
  • Duration of current infertility and prior fertility history 1, 2
  • Childhood illnesses and developmental history 1
  • Systemic medical conditions (e.g., diabetes mellitus) 1
  • Previous surgeries and medical treatments 1
  • Current medications and allergies 1
  • Sexual history, including sexually transmitted infections 1
  • Exposure to gonadotoxins (environmental/chemical toxins, heat) 1, 2

Physical Examination

• Complete genital examination by a provider with appropriate training should include:
  • Examination of the penis, including urethral meatus location 1, 2
  • Measurement and palpation of the testes 1, 2
  • Assessment of vasa and epididymides presence and consistency 1, 2
  • Checking for varicocele 1, 2
  • Evaluation of body habitus and secondary sex characteristics 1, 2
  • Digital rectal examination 1, 2

Semen Analysis

• Collect at least two samples at minimum one month apart 1

• Provide standardized instructions:

  • 2-3 days of sexual abstinence before collection 1
  • Proper collection method (masturbation or specialized condom) 1
  • Appropriate transport conditions (room/body temperature) 1
  • Examination within one hour of collection 1

• Key parameters to evaluate:

  • Volume (1.5-5.0 mL) 1
  • pH (>7.2) 1
  • Sperm concentration (>20 million/mL) 1
  • Motility 1, 3
  • Morphology 1, 3

Advanced Testing When Indicated

Endocrine Evaluation

• Consider hormonal testing if:
  • Sperm concentration <10 million/mL 1
  • Impaired sexual function 1
  • Clinical findings suggesting specific endocrinopathy 1

Genetic Testing

• Consider karyotype testing in cases of:
  • Recurrent pregnancy loss 1
  • Failed assisted reproductive technology cycles 1

Sperm DNA Fragmentation Testing

• Consider when there is:
  • Recurrent pregnancy loss (two or more) 1
  • Failed assisted reproductive technology cycles 1
  • High suspicion of oxidative stress 1

Clinical Considerations

Diagnostic Limitations

• Semen parameters alone cannot reliably distinguish between fertile and infertile men 3, 4
• There is significant overlap in semen parameters between fertile and infertile populations 3
• Sperm morphology has the greatest discriminatory power among basic semen parameters 3

Health Implications

• Male infertility may be associated with other significant medical conditions 1, 2
• Men with abnormal semen parameters have higher rates of testicular cancer and general cancer 2
• Identifying genetic causes is important as they could affect treatment success or offspring health 1

Timing of Evaluation

• The European Association of Urology (EAU) and American Urological Association (AUA) recommend evaluation of both partners simultaneously 1
• A full evaluation is particularly important in cases of unexplained infertility or recurrent pregnancy loss 1

Potential Pitfalls

• Relying solely on a single semen analysis may lead to misdiagnosis due to natural biological variability 1
• Limiting evaluation to only reproductive history and semen analysis may miss significant medical conditions (reported in 0.16% of men with normal semen parameters) 1
• Point-of-care and mail-in semen tests may provide incomplete or inaccurate information compared to specialized andrology laboratory testing 1