AN OVERVIEW OF THE TESTS FOR MALE INFERTILITY

The general testing procedure for male infertility begins with a visit to the urologist or fertility doctor. During the initial evaluation, a patient’s complete medical and reproductive histories are noted. Questions are asked about one’s sexual life, past infections, surgeries and chronic or genetic conditions.

Physical Exam

A physical examination of the genitals is performed at this time. The urologist or fertility doctor will note testicular sizes and any physical abnormalities, such as the presence of varicoceles (enlarged vein within the scrotum).

Semen Analysis

The next step of fertility evaluation is semen analysis. This test has to be performed quickly following semen donation. Semen volume, sperm count and concentration, sperm shape (morphology), sperm motility and the presence of infection are observed using the semen sample. Several semen samples may be required from an individual to correct for variations.

Hormone Evaluation

A low sperm count from the semen analysis would likely require additional blood tests to determine hormone levels of testosterone, FSH, LH and prolactin. Hormones from the hypothalamus and pituitary control sperm production and development, and therefore are good indicators of underlying infertility causes.

Genetic Testing

Genetic tests can help diagnose congenital disorders that may affect male reproductive functions. These tests identify DNA fragmentation or chromosomal defects in the sperm.

Urine Analysis

The analysis of urine is done to detect underlying infection as observed by the presence of white blood cells. In addition, urinalysis helps detect retrograde ejaculation, wherein sperm is ejaculated into the bladder and is found in urine.

Specialized tests for male infertility, which may be recommended by your doctor, include:

• Vital Staining can be performed on the semen sample to count the number of live sperm.

• Antisperm Antibody Test helps detect if antibodies are attached to the sperm. These antibodies reduce sperm motility and viability.
• Peroxidase staining of the semen sample can be used to identify infection or inflammation.

• Test for sperm agglutination: When the sperms clump together, it limits their mobility, and this can be detected by semen analysis under the microscope.
• Sperm penetration assay: Rarely, a laboratory test may be performed using hamster eggs to evaluate the penetration capability of the sperm.
• Hemizona assay: This laboratory test uses a surplus human egg (from IVF procedures) to test whether the sperm can penetrate the outer egg layer. Studies have demonstrated the great predictive potential of this assay for successful fertilization.
• Acrosome reaction: This test evaluates the ability of the sperm head to chemically dissolve the outer egg layer. A sperm during penetration of the egg undergoes a process of capacitation, which is measured through this test.
• Hypo-osmotic swelling: This test determines the sperm tail’s ability to penetrate the egg. It is performed using specialized solutions, which cause healthy sperm tails to swell.
• Testicular biopsy: A needle is used to extract a small piece of tissue from testicular tubules. It evaluates the normal production of sperm.
• Vasography is an x-ray examination of the vas deferens to detect the blockage of sperm.
• Ultrasonography utilizes high frequency sound waves to visualize body organs. Ultrasound may be used to observe male reproductive structures (e.g. seminal vesicles, ejaculatory ducts and prostrate) to detect the presence of abnormalities. Scrotal and transrectal ultrasounds are commonly performed.

Women, who are unable to conceive by natural means, may be prescribed fertility medications to increase their likelihood of conceiving. However, some past studies had associated the use of fertility medications with an increased risk for developing breast cancer. Recently, a large study concluded that there was no such link between the two.

Fertility medications work similar to a woman’s hormones, and stimulate the release of eggs from the ovaries. These medications may be used alone or in conjunction with other types of assisted reproductive technologies, such as in vitro fertilization (IVF). For many years, there was growing speculations regarding the long term health risks (particularly, breast cancer) of using fertility medications.

The most recent study looked at 12,913 women who were treated for infertility in 5 different US hospitals between the years 1965 and 1988. Out of these women, 9,892 individuals were followed up until 2010. It was observed that 749 patients developed breast cancer. However, the study found no increased risk for breast cancer with the use of clomiphene citrate (Clomid) or gonadotropins.

The current research, published in the journal of Cancer Epidemiology, Biomarkers & Prevention, has several strengths worth mentioning. This was a large study, looking at a significant number of women with established infertility issues. Furthermore, in order to reach an objective conclusion, the researchers had controlled for other known causative factors for breast cancer or infertility.

Although a link was not found between the use of clomiphene citrate or gonadotropins on breast cancer incidence in this population, a few likely associations were reported by this study. For example, women who were given 12 or more cycles of clomiphene citrate showed a 1.5 times more likelihood of developing breast cancer, as compared with women who were not using fertility medications. However, 12 cycles of fertility medications far exceeds current practice standard of 3 – 6 cycles. Moreover, current guidelines recommend medication doses are up to 100 mg, as compared with the 250 mg dose used in the study.

In addition, the study noted an increased risk of developing breast cancer in women who were unable to conceive even after the clomiphene citrate or gonadotropin cycles, as compared with women receiving no fertility drugs. According to the researchers, the increased incidence of breast cancer in this subpopulation of patients may be due to their persistent infertility. Therefore, a direct correlation cannot be made in this subset between breast cancer risk and fertility medication usage.

Finally, the study reported that the average age of women who developed breast cancer in this study was 53; this age is slightly lower than the typical age for developing breast cancer. Therefore, the researchers have stressed the importance of constant monitoring of women who start fertility medications and are close to the typical age range for breast cancer.

Overall, this recent study throws valuable light on the lack of a clear connection between the use of fertility medications and the risk for breast cancer. By following the established guidelines for fertility drug treatments, women can now feel reassured knowing that they are not increasing their likelihood of developing breast cancer.