INFERTILITY

Over 15% of couples experience difficulty in conceiving a child after attempting for one year. Although in the past infertility problems were attributed to the woman, we now know that a male factor plays a role in almost one half of cases. Since a male fertility problem is much more common than initially thought, any infertility evaluation should include a thorough male history and physical examination and two semen analysis. The optimal evaluation should recognize and treat the couple as a unit.

The male infertility evaluation begins with a complete fertility and medical history. Important information includes past pregnancies, febrile illnesses, history of mumps, undescended testicles, hernia repair, genital trauma, sexually transmitted diseases or urinary tract infections. A developmental and past sexual history with attention to onset of puberty and libido is elicited. Occupational, environmental and recreational factors such as high levels of stress, disturbances in the sleep cycle, drugs, smoking, excessive alcohol intake, lubricants, toxins, chemical or heat exposure, and prolonged use of a Jacuzzi or hot baths can all have a negative effect on fertility. A review of other medical problems, surgeries, prior and current medications and family history is obtained. Questions are asked regarding every organ system in the body to ensure that no undetected serious illness is responsible for infertility.

A complete physical examination is performed paying attention to male features such as hair distribution, breast size and the external genitalia. The scrotum and its contents are evaluated for the location, size and consistency of the the testicles, epididymis and vas deferens. The presence of a varicocele (dilated testicular veins), testicular masses, cysts and irregularities of the prostate are noted.

After the examination, a urine and semen sample is collected. A routine urine analysis and semen analysis is performed in our certified andrology laboratory. Based on these results, blood tests or more specialized tests of the sperm may be recommended.

Once all the information is collected, the couple is given a presentation on male reproductive anatomy and physiology with particular attention to their specific problem by our andrologist. The nature of the problem, causes and treatment options are set forth. An opportunity for questions and discussion is welcome. We believe that couples need to be completely informed on all the currently available methods of conceiving a child, risks, potential complications, success rates and costs, so they can make a choice that is best suited for them.