gynecology and obstetrics
Sperm Disorders
Other tests
Endocrine evaluationis warranted if the semen analysis is abnormal and especially if the sperm concentration is<10 million/mL. Minimum initial testing should include Serum follicle-stimulating hormone (FSH) levels Testosteronelevels Iftestosteroneis low, serum luteinizing hormone (LH) and prolactin should also be measured. Men with abnormal spermatogenesis often have normal FSH levels, but any increase in FSH is a clear indication of abnormal spermatogenesis. Elevations in prolactin require evaluation for a tumor involving or impinging on the anterior pituitary or may indicate ingestion of various prescription or illicit drugs. Evaluation for an infection(eg, gonorrhea, chlamydial infection), including microbiologic testing, is done if the white blood cell (WBC) count in semen is ≥1,000,000/mL. Specialized sperm tests,available at some infertility centers, may be considered if routine tests of both partners do not explain infertility and in vitro fertilization or gamete intrafallopian tube transfer is being contemplated. They include the following: Sperm antibody tests, most commonly the direct immunobead test Sperm viability tests (eg, the hypo-osmotic swelling test, exclusion of a supravital dye from sperm) Sperm DNA fragmentation tests, including the single-cell gel electrophoresis assay (Comet assay) and the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate (dUTP) nick-end labeling assay (TUNEL) The usefulness of these specialized tests is controversial and unproved. Some clinicians believe that one or more of these tests may be useful in predicting success with in vitro fertilization. If necessary,testicular biopsycan distinguish between obstructive and nonobstructive azoospermia. 