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A. Your doctor will take your medical history, examine your abdomen, penis and testes, sometimes also the prostate.
Then you may have ultrasound (echo scan) of your scrotum, semen analysis, blood test or even urine analysis.
The medical history is a conversation with your doctor. The doctor will try to determine whether any lifestyle factors could affect your fertility. The interview might focus on different known causes:
Some medications can also affect male fertility:
The doctor will examine the male genitalia. This is done by looking at the genitals and then using a hand to feel them. Any abnormalities will be noted, such as lumps in the scrotum. In addition, your height and weight will be measured.
Body mass index can affect:
A. Hormone blood tests: Hormones circulate in the blood stream. They can be taken from a vein with a simple blood sample and can give information about the function of the testicles. Other blood tests can show your doctor other diseases that can affect your fertility.
Some typical blood tests may be run:
Your semen might be collected by ejaculating into a sterile container. The semen is then analysed at a laboratory.
Not having an ejaculation for 1-2 days before semen collection can provide a better sample for more precise semen analysis.
A short time between collection and analysis also helps the accuracy of the test.
Semen quality can change within days.
Having at least two (or more) tests will give a clearer result.
The lab will assess the amount of semen and its colour, odour, and thickness. A microscope study will show the number of sperm cells and their health in the semen. Signs of infection can also be seen. What is normal for semen is described in the norms of World Health
Organisation (called WHO 5). Current standards come from 2010.
Ultrasound can be used to examine the tissue of the testicles and epididymis. It may show enlargement, cysts, calcifications or tumours. If there is low semen volume and obstruction of genital tract is suspected, a transrectal ultrasound (TRUS) is needed.
A urine test and/or a urethral swab can be done to rule out any infections in the urogenital tract.
In case of non-obstructive azoospermia (NOA), when there is no or hardly any spermatozoa in ejaculated semen and there is no evidence of blockage in the genital tract, a biopsy is needed.
It is called TESE (Testicular Sperm Extraction). If the spermatozoa are found and your genetic tests are normal, it can be used in assisted reproduction technologies (ART).
In case of low sperm count a karyotype analysis is made.
A karyotype is a complete set of chromosomes in an individual man. Normal karyotype for man is 46, XY, meaning that there are 22 pairs of autosomal chromosomes (44 pieces) and one pair of sex chromosomes. Males have one X and one Y sex chromosome.
If the karyotype is not normal, it may influence fertility. Abnormal sexual chromosomes can also cause low levels of testosterone.
Klinefelter syndrome (47,XXY) is the most common sexual chromosome abnormality. In some patients, this condition can cause characteristic features like long limbs, small firm testicles, and female-type hair distribution.
In some men, a genetic testing of Y chromosome is needed. Based on all examination findings, a specialist in Urology or Andrology will decide if you need genetic testing, and which tests should be done.