As mentioned before, about 40% of cases of infertility are due to factors involving the male partner. To determine if the male partner has a problem that is contributing to the difficulty conceiving, a variety of examinations will be conducted.
Urological Evaluation: This is a medical exam done by a urologist or a doctor who specializes in the urogenital tract. In males this includes the prostate, testes, and penis. The doctor can help determine if there are anatomical abnormalities that are causing the man to be unable to impregnate a woman. An example of such an abnormality is the previously mentioned varicocele, a mass of enlarged veins, which develops in the testes that can inhibit the ability to make adequate sperm.
Evaluation of sperm: For this test, a sample of semen (male ejaculate) will be obtained to look at the sperm for any abnormalities. Sexual relations should be avoided for three days prior to producing a semen sample for analysis. The sample should be kept warm and delivered to the laboratory within 45 minutes. It is then evaluated for the concentration of sperm within semen, as well as the motility, size and shape of the sperm. A normal concentration of sperm should be 20 million per milliliter, with a total of 40 million sperm per sample. The motility of sperm is their ability to swim through the cervical mucous; 'normal' is when 50% of sperm are able to move quickly and straight. Sperm are also supposed to have an oval 'head' with a long tail. Normally 15% of the sperm have this shape.
If a male's sperm is abnormal in its quantity, shape, or activity, further testing will be employed. This testing includes:
Sperm Penetration Assay: This test places sperm in non-human products that mimic a woman's cervical mucous and egg, and monitors the sperm's ability to penetrate them. In order for sperm to fertilize a woman's egg, it must be able to access the inside of the egg, first by traveling through cervical mucous and then by getting through the outside layers of the egg.
Hyperosmolar Swelling Test: This test looks at the ability of the enzymes (special chemicals that facilitate bodily processes) in the sperm to transport fluid from the outside of the sperm to the inside.
Hormone Tests: A blood sample taken from the male will be used to evaluate levels of various hormones that are important in the formation and ejaculation of sperm. These hormones include FSH (Follicle-Stimulating Hormone), LH (Leutinizing Hormone), testosterone, estradiol, and prolactin.
Postcoital Test: This test also involves the man's partner, and is used to evaluate the sperm inside the cervical mucous. This test is performed just before the woman ovulates using the basal body method of determining ovulation (see 'Timing of Intercourse' section). Timing is important because cervical mucous at ovulation, under the influence of estrogen, is the optimal consistency for conception. Within 12 hours of sexual intercourse, the sample of cervical mucous is collected. The sample is evaluated for amount and elasticity, number of sperm, and motility. The sperm should be moving and the mucous should have a stretchy consistency.
Sperm Antibodies Test: It is possible for either the male or female partner to have antibodies against the male's sperm. Antibodies are immune cells which the body produces to fight foreign cells or other threats. Either a man or woman can form antibodies to sperm. The antibodies will attack the sperm and cause it to become immobile or lead to its death.
Ultrasound Imaging: An ultrasound uses sound waves which are converted into an image which is used to help locate anatomical abnormalities of the testicles or other male anatomy. A doctor may use this imaging technique to determine if an anatomical abnormality is contributing to infertility.
Testicular Biopsy: On rare occasions a testicular biopsy will be done. Biopsies are especially helpful if cancerous or non-cancerous growths are suspected. A biopsy is when a sample of tissue is taken out of a body part. This tissue is sent to a lab where the cells are examined to determine if they are normal, cancerous, or non-cancerous (called benign). If a cancerous or benign growth is found, surgical intervention may be used to remove it.
Hemizona Assay: This test exposes sperm to the outside layer of human oocytes (eggs) called the zona pellicuida. The sperm are then evaluated for their ability to penetrate the zona pellucida. Often this test will be used if a couple is considering in vitro fertilization, as it is a good predictor of the success of such attempts to conceive.
Sperm-Cervical Mucous Contact Test: This mixes the male's sperm and the female's cervical mucous in a test tube to determine whether sperm antibodies are present. The appearance of immobilized 'shaking' motile sperm is considered indicative of the presence of antibodies. The use of donor sperm or donor cervical mucous can help to narrow down the source of the antibodies. If the sperm are normal in donor cervical mucous, then the antibodies are likely from the woman. Similarly, if donor sperm act normal in the woman's cervical mucous, then the antibodies are likely from the male partner.
