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When a couple seeks advice for infertility, an in-depth study of both partners must be conducted. Male infertility analysis involves the following steps:
- In-depth medical history: including research on issues such as duration of infertility (the time that the couple has been trying to conceive), history of prior pregnancies, types of contraceptives used by the couple in the past, frequency of sexual intercourse, the couple’s awareness of the female’s menstrual cycle, the use of any lubricants during sexual intercourse (as many of these substances can alter sperm motility). It is also necessary to inquire about the male patient’s erectile function and ejaculation.
Physicians need to find out whether the patient experienced any of the following: any sexual development disorders during puberty; cryptorchidism during infancy; surgery on the genitourinary region; testicular trauma or torsion, which could have led to testicular atrophy; any sexually transmitted diseases or urinary tract infections; parotiditis or “mumps”, and at what age; and any history of diabetes, multiple sclerosis, renal insufficiency, tuberculosis, or currently undergoing or having undergone chemotherapy or radiotherapy during the last four or five years.
Also, ask the patient whether he takes any type of medication, about any toxic habits (such as alcohol, tobacco, marihuana, cocaine, etc.) and the likelihood of professional exposure to pesticides and other toxic substances.
- Physical examination: physical examinations must look for any alteration that could have a connection with infertility, and focus specifically on the genitals, exploring the penis, scrotum and its contents, testicles (size and consistency) and prostate (digital rectal examination). The examination must include a search for asymptomatic varicoceli.
- Laboratory tests: the evaluation of males must include the following:
A basic analysis, including hemogram, biochemical and urine analyses
- Semen analysis or seminogram: , this is the most important test for patients with probable infertility. It involves the analysis of a patient’s ejaculate, generally obtained via masturbation or use of special condoms. The ejaculate’s normal values are: volume of 2 millilitres or higher, pH of 7.2 – 8, sperm count of at least 20 million per millilitre, with at least 50% active and mobile spermatozoa, and standard morphology for at least 30% of said spermatozoa. In the event of obtaining abnormal results, this test shall be repeated 4 times with monthly intervals for 3 months.
- Postcoital test: involves microscope analysis of the reaction between the male’s sperm and the female’s uterine mucous.
The determination of anti-sperm antibodies in the body is also a possibility.
- Testicular biopsy: ethis is an option for any patients whose seminogram has detected azoospermia (total absence of spermatozoa in semen), in normal-sized testicles, to find out whether it is due to a obstruction in the sperm duct or to spermatogenesis.
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