Prior to genetic testing, one should meet with a genetic counselor to discuss the prognosis, testing options and psychological consequences of genetic findings.
Yesh Tikva
A Jewish Fertility Community
Fertility Roadmap
Module 3
Male Diagnostics
Male Diagnostics
When a couple is attempting to conceive, two factors are at play in achieving a pregnancy, sperm and egg. It is a common misconception that infertility is a woman’s problem. But the reality is according to the American Society for Reproductive Medicine (ASRM), nearly 50% of those with a fertility diagnosis have a male factor diagnosis. Approximately 20%–30% are solely male factor and it is a contributing factor in another 20%–30% of couples facing infertility.
According to ASRM, male factor infertility can stem from different issues including:
Producing too few sperm
Sperm that are abnormally shaped or move properly
A blockage in a man’s reproductive tract that keeps sperm from getting out
If you are struggling to conceive, your doctor will perform a complete medical history, physical examination, and diagnostic tests.
Note to self: This may not have been your ideal plan for expanding your family but many of these issues can be helped with In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI) {which will be explained later}.
A female factor diagnosis does not rule out the presence of a male factor diagnosis. Prior to beginning treatment make sure to speak with your Reproductive Endocrinologist (RE) about male diagnostics to avoid wasting time on treatments that may not be effective due to an undiagnosed male factor.
What are you doing to support yourself through this process?
Male factor infertility can cause feelings of stress, depression, guilt, or anxiety.
Find a friend to confide in
Speak with a therapist
Join a support group
Sperm count ranges to keep in mind:
Average: range from 15 million to greater than 200 million sperm per milliliter
Low: fewer than 15 million sperm per mL
Very Low: fewer than five million sperm per mL
The coming sections will discuss the next phase of diagnostic tests. Keep in mind that your doctor may not prescribe all of these tests and if your doctor does they may not occur in this order.
Akiva the Diagnosis
What are the 5 tests?
Genetic Tests
Men with absent (azoospermia) or low sperm concentration (severe oligozoospermia), could have an underlying genetic cause. To test for this, a saliva or blood sample is taken.
What it Diagnoses:
There are multiple genetic factors that may cause male factor infertility. In the case of absent or low sperm count (fewer than five million sperm per mL) in a semen analysis, the doctor may analyze the chromosomes (tightly packed DNA) to determine if there are any anomalies. They will look for things like changes in the amount or structure of the chromosomes.
Better Understanding of Your Genetics:
Some abnormalities include extra chromosomes, extra parts of chromosomes, parts of chromosome in the wrong places (translocation or inversion), or missing parts of the Y-chromosome, which can cause problems with sperm production.
When it’s recommended:
Genetic testing may be recommended if one has a very low sperm count, no sperm in semen or physical defects such as small testicles, or if one has experienced multiple miscarriages.
Preparing for your Appointment:
For additional information you can visit the American Society for Reproductive Medicine and Fertility and Sterility Publication.
Hormone Testing
A blood test that measures the level of hormones including: testosterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin, and others to determine the overall balance of the hormonal system relating to reproduction.
What it Diagnoses:
Hormones are vital for normal sperm production. They drive sexual desire, and affect a man’s ability to have sex. These hormones are produced by the pituitary gland, and hypothalamus in the brain. There are many underlying conditions that may cause hormone imbalances, including (but not limited to): Diabetes, thyroid dysfunction, hypogonadism, congenital adrenal hyperplasia, adrenal insufficiency, hormone therapy, some tumors (benign or cancerous), eating disorders, medications, stress, injury or trauma and/or cancer treatment.
Signs of Hormonal Issues:
Some signs that may indicate a hormonal issue include decrease in beard and body hair growth, fatigue, weight gain, erectile dysfunction, depression, low sex drive, memory loss, loss of muscle mass and mood swings.
When to Schedule your Appointment:
Because hormone levels fluctuate during the day, timing of the hormone test is important. Testosterone naturally peaks in the morning, therefore an early blood test will be essential to accurately measure hormone levels.
For additional information you can visit the American Society for Reproductive Medicine.
It is ok to share your distress with your wife. She really wants to know and understand what is going on. Vulnerability breeds connection.
Post Ejaculation Urinalysis
Post-ejaculation urinalysis is an examination of the urine after ejaculation.
This test is done by collecting a sample of the urine following ejaculation. After collecting the sample it is examined to identify if sperm is present.
What it Diagnoses:
Post ejaculation urinalysis can diagnose retrograde ejaculation. Retrograde ejaculation is when the semen flows backwards into the bladder, instead of flowing out through the urethra and penis, at the time of ejaculation.
Retrograde ejaculation is often diagnosed in men with diabetes who have nerve damage. The damaged nerves cause the sperm to flow backwards into the bladder. Retrograde ejaculation is also sometimes diagnosed in men after they have had operations in the bladder neck, prostate, or the stomach.
Signs of Retrograde Ejaculation:
Signs of retrograde ejaculation may include cloudy urine after ejaculation and less fluid or a “dry” ejaculation.
When it’s recommended:
The doctor will typically recommend post-ejaculation urinalysis when the sperm count is extremely low in the semen analysis.
Preparing for your Appointment:
One is asked to abstain from ejaculation for 2 to 7 days prior to testing.
All semen and urine testing will be scheduled ahead of time. The collection of the sperm and urine is usually completed at the physician’s office although nearby locations are acceptable as long as the semen specimen is kept at body temperature and arrives at the lab within 45 minutes of ejaculation.
If you will be consulting a Rabbinic/Halakhic Advisor about this process, keep in mind: There is more than one way to collect a semen sample. Speak with both your doctor and advisor to determine the best way to do so in your situation and discuss the practical, medical, and emotional implications.
For more information visit Specialists In Reproductive Medicine & Surgery.
Scrotal/Testicular Ultrasound
The scrotum is the thin external sac of skin that houses the testicles.
A scrotal or testicular ultrasound is a diagnostic test to obtain images of the testicle and surrounding tissues in the scrotum. This painless procedure involves a probe which is rolled on the testicle and moves across the scrotum.
What it Diagnoses:
A scrotal/testicular ultrasound is used to diagnose abnormalities in the testicles.
These images can lead to the diagnosis of:
– a tumor
– a cyst
– trauma to the scrotum
– twisted testicle called testicular torsion
– enlarged veins in the scrotum called varicoceles
– blockages interfering with the flow of semen
Preparing for your appointment:
This procedure is not invasive and requires little to no special preparation. There is no need to avoid eating or drinking before the appointment. Be prepared to stay as still as possible during the examination so that the ultrasound equipment can create clear images of the scrotum and testicles.
For additional information you can visit the American Society for Reproductive Medicine.
Men are often concerned about taking care of their wives. When he is the patient he internalizes the distress and there is a deep sense of responsibility. Especially because he may feel as if he is imposing the infertility on his partner.
Always remember this is not your fault! Infertility is no ones fault.
What Men Are Saying
Semen Analysis
Semen analysis is the microscopic examination of an ejaculate (containing sperm), to determine its volume, the number of sperm (sperm count), their shapes (morphology), and their ability to move (motility).
The semen is collected in a sterile specimen cup and given to your doctor’s office for analysis. In addition to collecting this sample directly into the sterile cup at the doctor’s office, there are other ways to obtain this specimen- speak with your Doctor (and if applicable to your Rabbinic/Halakhic Advisor) to determine the medically ideal process for obtaining this sample.
What it Tells You:
Once a sample is procured, the sample is analyzed with a microscope, producing quick results as to the quality of the specimen.
A basic semen analysis covers 5 main categories:
1. Volume: The amount of semen present in an ejaculate
2. Concentration: How much sperm is in the ejaculate
3. Count: Total amount of sperm
4. Motility: The movement of the sperm
5. Morphology: The shape of the sperm
Preparing for your Appointment:
Prior to a semen analysis you will be asked to refrain from ejaculating for 2 to 5 days but not longer than that in order to get a healthy sample. The sample must then be tested within an hour of collection.
If you will be consulting a Rabbinic/Halakhic Advisor about this process, keep in mind: There is more than one way to collect a sample. Speak with both your doctor and advisor to determine the best way to do so in your situation and discuss the practical, medical, and emotional implications.
For additional information you can visit the American Society for Reproductive Medicine.
REMINDER: Sperm counts and infertility do not define your masculinity.
Contact us to receive a set of procedures cards
Specialized Sperm Function & DNA Sperm Fragmentation Test
Specialized sperm functioning is the microscopic examination of ejaculate to determine whether the sperm has the ability to reach and fertilize an egg.
What it Diagnoses:
Sperm function testing checks how well your sperm survive after ejaculation, how well they can penetrate an egg, and abnormalities in the sperm which cause infertility.
Preparing for your appointment:
To obtain the sample for testing a semen sample will be collected. You will be asked to refrain from ejaculating for 2 to 5 days but not longer than that in order to get a healthy sample. The sample must be kept at body temperature and tested within an hour of collection.
If you will be consulting a Rabbinic/Halakhic Advisor about this process, keep in mind: There is more than one way to collect a semen sample. Speak with both your doctor and advisor to determine the best way to do so in your situation and discuss the practical, medical, and emotional implications.
Transrectal ultrasound
A transrectal ultrasound provides a high resolution image of your prostate and looks for blockages of the tubes that carry semen.
About the procedure:
A small, lubricated wand is inserted into your rectum.
When it is done:
The test is usually performed when a semen analysis indicates an absence of sperm in the semen, and the other tests have not determined the cause.
What it diagnoses:
The ultrasound can diagnose an obstruction of the ejaculatory system, that may be the cause of azoospermia, the absence of sperm in the semen.
Preparing for your Appointment:
In the days leading up to the ultrasound, make sure your doctor is aware of any allergies you have to medication, especially antibiotics. You may be given an enema prior to the ultrasound to clean out the bowel and allow for a clearer view. Some doctors may also instruct you to avoid taking blood thinners, such as aspirin, several days prior to this procedure.
Testicular Biopsy
A testicular biopsy is a tissue sample taken from one’s testicle and then examined under a microscope.
When it is Necessary:
The test is usually performed when a semen analysis suggests that there is absent or abnormal sperm, and other tests have not determined the cause.
In addition, testicular biopsies may be performed to obtain sperm for in-vitro fertilization (IVF) also known as micro TESE.
What it diagnoses:
A testicular biopsy is used to determine the cause of the underlying issues with sperm quality, sperm production, or hormone function.
About the Procedure:
A testicular biopsy is an outpatient procedure, meaning you go home the same day. The procedure itself usually takes just 15-20 minutes. (describe procedure)
Things to keep in mind:
Let your doctor know if you are taking any medications, because some may pose a special risk during the procedure.
If you are receiving general anesthesia, you will need to fast from food and drink before your test, your doctor will specify the exact amount of time and you will not be able to drive after the procedure. If you are given a sedative to take at home before the biopsy, you will not be able to drive yourself to and from the procedure.
Post OP care:
Recovery is generally minimal and usually involves refraining from sexual activity for one to two weeks, wearing an athletic undergarment supporter for several days to a week, and keeping the biopsy dry for several days. Your doctor should provide you with specific instructions.
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