From the Guidelines
Male infertility diagnosis should involve a comprehensive evaluation, including a detailed medical history, physical examination, and semen analysis, to identify the underlying causes of a man's inability to conceive. The initial assessment should include a reproductive history, physical examination, and at least one properly performed semen analysis, as recommended by the American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM) 1. For semen analysis, patients should abstain from ejaculation for 2-5 days before providing a sample, which will be evaluated for sperm count, motility, morphology, and volume. If abnormalities are detected, the test should be repeated after 2-3 months since sperm parameters can fluctuate.
Additional testing may include:
- Hormonal evaluation (FSH, LH, testosterone, prolactin)
- Genetic testing (karyotype, Y-chromosome microdeletion analysis)
- Scrotal ultrasound to assess for varicoceles or other anatomical issues
- Specialized sperm function tests in certain cases.
Urologists or reproductive endocrinologists typically manage male infertility evaluations, and early referral is recommended if the couple has been trying to conceive for over a year (or six months if the female partner is over 35) 1. The diagnostic process helps guide appropriate treatment options, which may include lifestyle modifications, medication, surgical interventions, or assisted reproductive technologies depending on the identified cause. A single ejaculate analysis is sufficient to determine the most appropriate investigation and treatment pathway, although semen analysis could be repeated if one or more abnormalities are found 1.
From the Research
Male Infertility Diagnosis
- Male infertility is a significant contributor to couple infertility, accounting for 30-35% of total couple infertility, and affecting approximately 7-8% of all men 2.
- The evaluation of male infertility involves a comprehensive approach, including a detailed history, physical examination, and semen analysis, which is considered the golden triple helix of basic evaluation of the infertile male 2, 3.
- A thorough medical history, physical examination, and semen analysis are essential components of the initial evaluation of men being assessed for infertility 3.
- Advanced diagnostic tests, such as sperm DNA fragmentation index, may be required in selected cases, and hormonal evaluation, including total testosterone, follicle stimulating hormone, and luteinising hormone, should be performed in men with oligozoospermia or azoospermia 3, 4.
- Genetic testing should be offered to azoospermic men and those with severe oligozoospermia, and ultrasound of the genitourinary tract can provide additional information in select cases 3.
- A comprehensive and individualized approach to male infertility work-up is essential for personalized management, and a thorough diagnostic assessment can identify at least one underlying cause of male factor infertility in most infertile men 5.
- Hormonal regulation plays a crucial role in spermatogenesis, and certain hormone profiles, such as testosterone and prolactin, may be used as predictive markers for better semen quality in patients with oligoasthenoteratozoospermia (OAT) syndrome 6.