Yesh Tikva
A Jewish Fertility Community
Fertility Roadmap
Module 3
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
What are the 3 tests?
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.
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.
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.
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