Male Infertility
The American Urological Association (AUA) recommends an initial screening evaluation of the male partner of an infertile couple if pregnancy has not occurred within one year of regular, unprotected intercourse. An earlier evaluation is reasonable if a known infertility factor exists or a male doubts his fertility potential. A previous history of fertility does not exclude the possibility of secondary infertility. Men with secondary infertility are evaluated in the same manner as men who have never initiated pregnancy. The female partner should also undergo evaluation during this time period.
The basic components for the evaluation of male infertility include a detailed review of patient history (Table 2), physical examination, at least two semen analyses, and hormonal assessment of the HPG axis. The patient's history may identify risk factors and/or behavior patterns that affect fertility potential. During the physical examination, particular attention is given to body habitus and secondary sex characteristics. The scrotum, testes, and prostate are evaluated for signs of infection, obstruction, or varicocele. Additional tests include transrectal or scrotal ultrasonography, post-ejaculatory urinalysis, and genetic testing, which are obtained on an individual basis when indicated.
Semen analysis is the fundamental laboratory test in the evaluation of male infertility. It provides information about semen quality and volume, sperm concentration, motility, and morphology. These results may be compared with reference ranges and used to identify men with abnormal semen parameters who may benefit from ART such as intrauterine insemination (IUI) or in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI). Men with normal semen analyses rarely have sperm that contribute to infertility.
Evaluation
The American Urological Association (AUA) recommends an initial screening evaluation of the male partner of an infertile couple if pregnancy has not occurred within one year of regular, unprotected intercourse. An earlier evaluation is reasonable if a known infertility factor exists or a male doubts his fertility potential. A previous history of fertility does not exclude the possibility of secondary infertility. Men with secondary infertility are evaluated in the same manner as men who have never initiated pregnancy. The female partner should also undergo evaluation during this time period.
The basic components for the evaluation of male infertility include a detailed review of patient history (Table 2), physical examination, at least two semen analyses, and hormonal assessment of the HPG axis. The patient's history may identify risk factors and/or behavior patterns that affect fertility potential. During the physical examination, particular attention is given to body habitus and secondary sex characteristics. The scrotum, testes, and prostate are evaluated for signs of infection, obstruction, or varicocele. Additional tests include transrectal or scrotal ultrasonography, post-ejaculatory urinalysis, and genetic testing, which are obtained on an individual basis when indicated.
Semen analysis is the fundamental laboratory test in the evaluation of male infertility. It provides information about semen quality and volume, sperm concentration, motility, and morphology. These results may be compared with reference ranges and used to identify men with abnormal semen parameters who may benefit from ART such as intrauterine insemination (IUI) or in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI). Men with normal semen analyses rarely have sperm that contribute to infertility.
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