women s health issues
Problems With Sperm
Diagnosis of Sperm Problems
A doctor's evaluation A semen analysis Sometimes testing for hormonal or genetic abnormalities When couples have infertility, the man is always evaluated for sperm disorders. Doctors ask the man about his medical history and do a physical examination to try to identify the cause. Doctors ask about past disorders and surgery, use of medications, and possible exposure to toxins. They check for physical abnormalities, such as undescended testes, and for signs of hormonal or genetic disorders that can cause infertility. Levels of hormones (includingtestosterone) may be measured in the blood. A semen analysis, the main screening procedure for male infertility, is needed. For this procedure, men are often asked not to ejaculate for 2 to 3 days before the analysis. The reason is to make sure the semen contains as many sperm as possible. (However, research suggests that daily ejaculation does not reduce the sperm count in men unless there is a problem with sperm production.) The men are then asked to ejaculate by masturbation into a sterile jar, preferably at the laboratory site. For men who have difficulty producing a semen sample this way, special condoms that have no lubricants or chemicals toxic to sperm can be used to collect semen during intercourse. Because the number of sperm varies, the test requires at least two samples obtained at least 1 week apart. When several samples are tested, results are more accurate than when only one is tested. The volume of the semen sample is measured. Whether the color, consistency, thickness, and chemical composition of semen are normal is determined. The sperm are counted. A low sperm count may mean that fertility is reduced, but not always. Sperm are also examined under a microscope to determine whether they are abnormal in shape, size, or movement. If the semen still seems to be abnormal, the doctor tries to identify the cause. If there are too few or no sperm, doctors measure levels of certain hormones, such astestosteroneand follicle-stimulating hormone (which stimulates production of sperm in men), and genetic testing may be done. Also, urine may be checked for sperm after ejaculation to determine whether retrograde ejaculation is occurring. Sometimes a biopsy of the testes is done to help identify the cause of infertility. Other tests, which use a sample of blood or semen, can be done to evaluate sperm function and quality if routine tests of both partners do not explain infertility. These tests may check for antibodies to sperm, determine whether sperm membranes are intact, or assess the sperm's ability to bind to an egg and penetrate it. However, how useful these tests are is unclear. Hormone testsare done if results of semen analysis are abnormal, especially if the sperm count is very low. Levels of follicle-stimulating hormone (which stimulates the testes to produce sperm) andtestosteroneare measured. If thetestosteronelevel is low, luteinizing hormone (which stimulates the testes to producetestosterone) and prolactin (which stimulates milk production in men and women) are measured. A high level of prolactin suggests that the cause of infertility may be a pituitary tumor or use of certain medications. is done if doctors determine that there are too few or no sperm. For Genetic Screening Before Pregnancy , almost any tissue, including blood, can be used. Tests include chromosome analysis (called karyotyping). The 