Male Reproductive History:

Duration of unprotected intercourse- In the past, evaluation began after one year of unprotected intercourse, but the current philosphy is to begin evaluation when the patient expresses concern.

Previous pregnancies attributable to the patient with the current partner or previous partners is an important factor to know.

Previous infertility evaluations and treatments.

Age of the male patient- A recent study in the European journal, Human Reproduction, showed that the probability it would take more than a year to conceive nearly doubled from 8% when the man was under 25 to about 15% when he was over 35. Therefore, one can expect 90% of normal, fertile men under the age of 25 to achieve pregnancy within a year in the absence of a female factor.


Female Reproductive History:

Age- It is important to evaluate the male's fertility in the context of his partner since it obviously takes "two to tango." An important factor for female fertility is her age.

Female ovulation and fertility status.

Previous pregnancies and successful births in the female, with current partner and previous partners.


Personal History of the Male:

Developmental- Age of onset of puberty (normal/delayed/precocious).

Surgical history- hernia repair, undescended testes, congenital abnormalities, procedures involving the bladder, urethra or prostate, or any pelvic procedure.

Medical history- diabetes, chemotherapy, radiation therapy, neurological, immunological, or hormonal problems, as well as other previous and current medical illnesses. Headaches, visual disturbances, loss of the sense of smell, breast changes (enlargement, tenderness, or nipple discharge), excessive growth (hands, feet or jaw), retardation of hair growth (facial, body), vasomotor symptoms.

Infections- mumps, urinary tract infections, sexually transmitted diseases, venereal diseases, epididymitis, prostatitis, etc.

Penoscrotal trauma- Sometimes even a seemingly remote, minor injury to the testicles can result in obstruction to the flow of sperm. Testicular torsion, or spontaneous twisting of a testicle, can impair infertility.

Occupational exposure to chemicals, toxins, fumes, or radiation. Pesticide exposure has been suspected as a cause of decreasing sperm counts.

Exposure to excessive heat at work or from hot tubs, saunas, jacuzzis, or whirlpools. There remains controversy on the significance of jockey briefs increasing scrotal temperature.

Social history- The use of tobacco and alcohol have been linked to decreased fertility. Recreational drugs, especially marijuana, has been shown to decrease sperm counts. Other drugs, including heroin and methadone, also impair fertility. Emotional stress may be a factor, but has never been scientifically proven since there is no accurate means to measure stress.

Sexual history- The recommended timing for intercourse is every 48 hours (about every other day) when ovulation is most likely (usually at the female's midcycle). However, there seems to be a lot of variablity for optimal timing and frequency for a particlar couple. Lubricants should be used only if necessary, and in limited amounts. Certain lubricants, and even saliva, can be toxic to sperm. The male sexual drive, or libido, should be assessed as an indication of a possible hormonal imbalance. Coital technique should be discussed with a professional. Pain with ejaculation or small semen volumes suggest a possible blockage.


Medications, Toxins, and Drugs Associated with Male Infertility A partial list includes:

Allopurinol, Androgenic Steroids, Antihypertensives, Cancer Chemotherapy, Colchicine, Cyclosporine, Erythromycin, Gentamicin, H2 Blockers, Ketoconazole, Nitrofurantoin, Spironolactone, Steroids, Sulfasalazine, Tetracycline, Agent Orange, Anesthetic gases, Benzene, Dibromochloropropane (DBCP), Lead, Manganese, Alcohol, Heroin, Marijuana, Methadone, Tobacco.


Physical Exam -

Urologists are probably the best qualified to evaluate a patient for male infertility. The urologist will check for morbid obesity, signs of hormonal imbalance, and a complete exam of the penis, scrotum and prostate. An important finding is the presence of a varicocele, or dilated veins around the testicle. Usually found on the left side, the stagnant blood in the varicocele somehow poisons the production of sperm.


Laboratory Tests -

The most important test is the semen analysis. From there the physician may decide to obtain blood tests, urine tests, additional semen tests, scrotal ultrasound, and a transrectal ultrasound of the prostate and ejaculatory ducts. Additional studies for appropriate patients include a testicular biopsy or a vasogram to check for the production of sperm or a blockage.


Treatment -

Many patients with subfertility are borderline and can probably be helped with minimal intervention such as with the use of MRC and lifestyle changes.

In the majority of male infertility patients, the cause of the problem remains unknown or idiopathic. Often, the patient themselves are perfectly healthy and never suspected that there could be a problem. In more extreme cases, the treatment is tailored to the individual's needs as determined by the above evaluation by a qualified Reproductive Medicine specialist.

The frequency of primary hormonal defects in infertile men is less than 3%. Such defects are rare in men whose sperm concentration is greater than 5 million per milliliter.

A varicocele can be treated surgically. Improvement in semen quality following varicocele repair occurs in 50% to 70% of men, with a greater improvement in semen quality following repair of large varicoceles than small varicoceles. Besides microsurgery to reverse a relatively recent vasectomy, surgeries to correct obstruction have had low success rates.

Advanced Reproductive Technology (ART) includes In Vitro Fertilization (IVF) and IntraCytoplasmic Sperm Injection (ICSI). These high tech procedures have changed the management of severe male infertility. The female is stimulated with hormonal injections to produce more than the usual one egg per cycle, the eggs are aspirated out of the ovaries, and under a microscope, single sperm are literally injected directly into each egg. These are highly technical, expensive and invasive procedures reserved only for the most severe male infertility patients. Most Reproductive Health specialists would agree that MRC should be included as part of the treatment regimen to maximize sperm count, quality, and function as well as reproductive health. Improvement in sperm increases the likelihood of spontaneous conception, or the chances for success with Assisted Reproductive Technology.

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