For men the first thing is the semen assessment. We will check the semen, we will look at the three major headings: the number of sperm, the motility of the sperm and the morphology, so how many of them are normal. If there are any issues with the semen parameters, then this triggers further investigation, looking into the hormone profile of the man, depending on what the problems are that we are seeing in the semen assessment. I would refer them to an andrologist and also for an ultrasound of the scrotal region to see if there are any varicoceles, any dilated veins, lumps or cysts in the testicles and also perform a male hormone profile which would include FSH, LH and testosterone levels to see if there is a reason such as is it starting from the brain, in the center where all the hormones are being released. Also are there any endonagatrophic reasons or hormonal reasons that we could find while the sperm production is not normal.
If it comes to the point where there is no sperm found, it then leads to further investigations where we would do blood tests for their karyotype, look at their chromosomal arrangement of the male partner, look for Y chromosome deletion (specific deletions) or oligozoospermia which means decreased sperm count or azoospermia where there is no sperm. Again, a male hormone profile and look for mutations like cystic fibrosis where we can have an absence of vas deferens which means there is no transfer of the sperm into the semen. If we are looking at the sperm, another thing that we have now with more and more research that is still not validated, is looking into sperm defragmentation. This tells us a little bit about the quality of the sperm. This would be the way that we would go about doing the male investigation.
For men the first test is the sperm test or semen analysis, if the semen analysis is normal then there is no further value in doing any more tests for the man but if the semens analysis shows an abnormality then we tend not to make a diagnosis of infertility based on just one test, we always ask the man to repeat it. Now, typically we ask the man to repeat the test in about 10 to 12 weeks, so about three months in practice. The reason for this is that it takes about three months for a fresh cycle for a whole sperm cycle to be complete. So typically we’ll wait three months but in cases where there seems to be quite a severe abnormality, so very very low numbers of sperm or no sperm, then it’s okay to repeat it in a few weeks time.
