INTEGRIS Bennett Fertility

Urological Evaluation

Since male factors are responsible for approximately 30 percent of infertility, the semen analysis is one of the earliest tests in the infertility work-up. The semen sample is usually obtained by masturbation, preferably at a facility near the laboratory. The most important parameters checked are sperm count, motility, morphology, and the presence of inflammation cells. Sperm count, expressed as millions per cubic millimeter, should be over 20 million. Motility, or the percentage of forward-moving sperm out of the total sperm population, should be above 50 percent. Morphology, or sperm shape, is a very important criterion that best correlates with the ability of sperm to penetrate the egg. Under strict morphology criteria (called Kruger’s criteria), at least five percent of the sperm or more should be of normal shape. Inflammation cells often indicate prostate or epididymal infection. They reduce the effectiveness of sperm. Inflammation should be treated, usually with antibiotics.

Evaluation by a urologist experienced in diagnosing and treating male factor infertility is recommended in most cases of unresolved sperm problems. The urologist will often perform a physical examination on the male and, when indicated, blood tests for certain hormones. Infection, varicocele, and hormonal abnormalities are fairly common among males with sperm abnormalities. Adverse environmental factors such as smoking (tobacco or marijuana), alcohol, pesticides, strong solvents, or excess heat or stress can be identified and eliminated. The chief purpose of sending a male for urological infertility evaluation is to find the least expensive or invasive way to remedy an issue that will otherwise require assisted reproductive technology (in-vitro fertilization).

Therapies for male factor may include elimination of adverse environmental factors; surgery for varicocele (dilated veins); antibiotics; certain vitamins; or hormonal treatment. In-vitro fertilization combined with Intracytoplasmic sperm injection (IVF-ICSI) or inseminations are the most common treatments for a couple in which the urologist may not be able to successfully treat the male partner.