Examining Male Infertility

Susanne Quallich

Disclosures

Urol Nurs. 2006;26(4):277-288. 

In This Article

Semen Analysis and Laboratory Evaluation

The semen analysis yields a tremendous amount of information as to the potential causes of male infertility. The primary values that are evaluated are the volume of the ejaculate, sperm motility, total sperm count, and sperm morphology (shape) (see Table 4 ). Patients should receive notification in advance that they will need to provide a semen sample after a period of abstinence of 2 to 5 days. This sample is collected through masturbation, and must be collected into a container that is not toxic to sperm, or by using a special condom designed for semen collection (latex condoms alter sperm viability, especially if they are lubricated). Patients should be discouraged from attempting to collect a sample through intercourse as coitus interruptus is not a recommended, or reliable, means for sample collection (AUA & ASRM, 2001b). The ideal circumstances for specimen collection are in close proximity to the laboratory to prevent any delay in processing. If the sample is collected at home it should arrive to the lab within 60 minutes to ensure the accuracy of the results.

When determining a course of treatment, it is common to require serial analyses to avoid any spurious results, ideally with the same period of abstinence each time. For instance, patients could be scheduled for three specimens, with 3 days abstinence, a minimum of 3 weeks apart. It is common for patients to repeat their semen analysis every 3 months after starting any treatment, due to the length of time it takes sperm to mature. The results of the semen analysis can indicate any additional testing that might be useful.

There are several additional tests that can be performed on a semen sample, including a sperm penetration assay, peroxidase staining, direct immunobead testing, and computer-aided semen analysis. The clinical usefulness of specialized sperm testing remains controversial, however.

An endocrine evaluation can yield a great deal of information (see Table 5 ), and may be ordered if there is any suspicion of endocrinopathy or evidence of oligospermia. This will include total testosterone, free testosterone, LH, FSH, and prolactin levels; estradiol level may be included if the patient has a high body mass index.

If the semen analysis shows severe oligospermia or azoospermia and/or the physical examination yields abnormalities as far as testicular size or the male's overall physical development, then karyotype analysis and Y-chromosome microdeletion testing are also indicated.

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