In order to determine the causes of infertility, the fertility specialist will take a fertility history. The partners will be asked about:
- The duration of infertility
- The frequency and timing of sexual intercourse
- Childhood illnesses or development problems
- Serious illnesses (cancer, diabetes, respiratory problems, previous surgeries) or injuries
- Sexual history (sexually transmitted diseases, etc.)
- Medication allergies
- Exposure to toxins (radiations or chemicals)
- Family history of fertility problems
A physician (urologist) will examine the scrotum, testicles, prostate and penis to detect any abnormalities.
Post-ejaculatory urine sample test
This test will indicate retrograde ejaculation (semen that should be ejaculated via the urethra that is redirected through the bladder) or reproductive system infections.
Important information obtained from the semen analysis
The analysis provides valuable information about:
- Amount of semen produced: Semen (the fluid that contains the sperm) is checked for abnormal cells, color, and viscosity, the amount of time it takes to liquefy after ejaculation. Sperm cells make up only 1 - 2 percent of semen volume; therefore, problems with this liquid can adversely affect sperm function and movement.
- Sperm count: Sperm count is the measure of the number of sperm in each milliliter of seminal fluid. The average sperm concentration is over 60 million per milliliter, while a count of less than 20 million per milliliter is considered a low sperm count or a sub-fertile level (a lower than normal capacity for reproduction).
- Percentage of moving sperm: An important fertility factor in fertility is the ability for sperm to "swim." Fifty percent or more sperm in a semen sample should be moving rapidly in a forward progression.
- Sperm morphology: Morphology is the microscope-based examination to determine if the sperm cells meet certain sets of structural criteria. For example, at least 14% of sperm should appear "normal." This examination scans for abnormal head or tail formations as well as immature germ cells (IGC).
- Ejaculate volume: A normal ejaculation for a healthy man is 2 to 6 ml. To measure volume, it is important for the whole ejaculate to be collected in the sample cup. While collecting the fluid, anxiety may cause the man to spill semen. The doctor should be informed if this has occurred. The correct measurement cannot be taken if only a partial semen sample has been collected. Both overly high or low volume can indicate a problem with the seminal vesicles or the prostate gland. If fluid volume is too high, it may be too diluted to successfully enable the sperm to travel to the egg. If the fluid volume is too low, the sperm may be slowed down, making it difficult to reach the woman’s cervix.
- pH level: The pH level is evaluated to see if it is in the normal range (7.2 - 8). A level below this amount (acidic pH) may be associated with a seminal vesicle abnormality. A level above pH 8 (alkaline) may be caused by an infection.
For semen analysis, prior to semen collection, the patient should abstain from ejaculation for two to three days but no more than five days. He should then collect the semen sample. (It is recommended to collect the initial portion of the ejaculate (with the highest concentration of sperm) in a special jar. The sample should be kept at body temperature and delivered to the lab within 30 minutes of collection.
If abnormalities have been detected in the examinations conducted, additional tests may be requested by the fertility specialist. Some of the most common tests are:
If abnormal sperm morphology has been determined, then the Kruger morphology test allows the fertility specialist to examine the sperm structure in more detail. Specifically, the sperm head, midpiece and tail are examined.
In some instances, the man may have anti-sperm antibodies. This means that the man's body has created an immunological response toward the sperm cells. The immune system treats the sperm as foreign bodies and the antibodies attack the sperm. Reasons why this could occur include reproductive system surgery or a testicular injury.
In this test, the sperm is examined for cell clumping (agglutinating). If the sperm "sticks" together, they will have great difficulty in swimming through the woman's cervical mucus, and will not be able to reach the egg. Sperm antibodies or a bacterial infection can cause agglutination.
Fructose is a sugar found in the semen that provides energy for the sperm. The fructose analysis is conducted for men with a low sperm count or men who have no measurable level of sperm in the semen (azoospermia). The test helps diagnose a blockage or whether no sperm is being produced.
Post-ejaculate urine analysis
This analysis determines whether some or all of the sperm was ejaculated backwards into the bladder (called retrograde ejaculation). With this test, the man provides a urine sample immediately following a sperm sample, and this sample is checked for the presence of sperm.
Diagnosis of infertility