What pre‑conception investigations for a male planning pregnancy are covered by the Australian Medicare Benefits Schedule?

Pre-Conception Tests for Males Under Australian Medicare MBS

For males planning pregnancy in Australia, the essential Medicare-covered pre-conception investigations are semen analysis (at least one, preferably two if abnormal), reproductive and medical history, and physical examination including scrotal assessment. 1, 2

Core Initial Evaluation (MBS-Covered)

All males should undergo initial screening consisting of:

• Semen analysis performed in a specialized andrology laboratory following WHO guidelines, with at least two analyses obtained one month apart if initial results are abnormal 1, 3
• Comprehensive reproductive history including coital frequency and timing, duration of infertility, previous fertility, childhood illnesses, systemic medical conditions (diabetes, respiratory diseases), previous surgeries, medications, sexual history including sexually transmitted infections, and exposures to gonadotoxins 1
• Physical examination by an examiner with appropriate training, including scrotal examination to assess testicular volume, presence of varicoceles, and anatomical abnormalities 1, 2

The Australian evidence-based guidelines specifically emphasize that initial evaluation must include all three components simultaneously with evaluation of the female partner 2.

Semen Analysis Specifications

Collection and handling requirements:

• Abstain from sexual activity for 2-3 days before collection 3
• Collect via masturbation or specialized semen collection condoms 3
• Keep specimen at room or body temperature during transport 3
• Examine within one hour of collection 3
• If azoospermia detected, laboratory should centrifuge ejaculate and examine pellet under microscopy for rare sperm 1, 3

Critical caveat: Point-of-care and mail-in semen tests cannot substitute for laboratory-based analysis and should not be relied upon for comprehensive evaluation 1, 3

Additional Testing Based on Initial Findings

If semen analysis is abnormal (particularly sperm concentration <10 million/ml) or physical examination reveals abnormalities:

• Hormonal evaluation including total testosterone, FSH, and LH 2
• Testicular volume estimation 2
• Karyotype testing if severe oligozoospermia or azoospermia present 1
• Sperm DNA fragmentation testing in cases of recurrent pregnancy loss (two or more) or failed ART cycles 1

Specific Clinical Scenarios Requiring Specialist Referral

Men should be evaluated by male reproductive experts when:

• Abnormal semen parameters are detected 1
• Clinical varicocele(s) present with associated clinical indications 2
• Azoospermia requiring differentiation between obstructive and non-obstructive types 2
• Recurrent pregnancy losses (two or more) or failed ART cycles 1
• Unexplained infertility in the couple 1

Important Clinical Pitfalls

Avoid these common errors:

• Do not limit evaluation to reproductive history and semen analysis alone, as this misses 0.16% of men with significant medical conditions but normal semen parameters 1
• Do not rely on a single semen analysis, as parameters are highly variable biological measures that fluctuate substantially between tests 1, 3
• Do not prescribe testosterone monotherapy to men desiring children, as it suppresses spermatogenesis 4
• Do not skip physical examination, as conditions affecting male health and fertility will be missed 1, 2

Lifestyle and Risk Factor Counseling

Discuss modifiable risk factors including:

• Tobacco smoking, alcohol consumption, and drug use 1
• Occupational and environmental exposures to gonadotoxins 1
• Body mass index optimization 1
• Sexually transmitted infection screening and prevention 1
• Implications for partner's pregnancy (secondhand smoke exposure) 1

The Australian guidelines emphasize counseling men regarding potentially modifiable risk factors, associated health conditions, and implications for their future health and offspring 2.

Medicare Coverage Context

While specific MBS item numbers are not detailed in the clinical guidelines, the core investigations (semen analysis, hormonal testing when indicated, and specialist consultation) are standard Medicare-covered services when clinically indicated for infertility evaluation 2. Advanced genetic testing and sperm DNA fragmentation may require specific clinical justification for Medicare coverage 2.