EFFECTIVE COMMUNICATION WITH YOUR MALE INFERTILITY DOCTOR
Past-President, Society for Male Reproduction and Urology
Professor, Division of Urology, University of Tennessee Graduate School of Medicine
Fertility Within Reach Medical Advisory Council Member
Infertility is a disease, defined by the failure to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse. Earlier evaluation and treatment may be justified based on medical history and physical findings and is warranted after 6 months for women over age 35 years. A common misconception is that infertility is a woman’s problem. However, a male factor may be contributory in to up to 50% of infertile couples. Most commonly, urologists evaluate and treat conditions associated with male infertility. If there is a significant abnormality identified on semen testing, request an evaluation with a male infertility specialist to determine if there is a correctable or reversible underlying cause.
The purpose of the male evaluation is to determine:
- Is there a problem with the male that is contributing to infertility?
- Are there any underlying causes for such abnormalities?
- Can any of these causes be treated?
- What method may be best for utilization of the available sperm?
Preparing for the Initial Visit:
The initial consultation with a male infertility specialist can be more productive for you and your physician with these helpful hints:
It is not uncommon to be nervous at the first visit.
Often times, men of reproductive age do not see doctors on a regular or annual basis and are not used to being in a physician’s office. The sensitive nature of the issue at hand and concerns about the examination may contribute to the apprehension. This article will hopefully alleviate many of these concerns.
Bring copy of any prior semen analyses and laboratory testing, if available, to your initial visit.
Many men will have prior semen analysis testing that is abnormal prior to referral to a male infertility specialist. Your doctor will then be better able to direct further evaluation and treatment recommendations. Don’t assume that all the testing has been faxed or sent prior to your visit.
It is very helpful to have your spouse at the visits.
Your spouse can provide answers to many of the essential questions necessary for the evaluation of the infertile couple. For example, who is her gynecologist? Does she have normal menses? What evaluation has she had performed? What fertility medications has she used?
Make sure the physician you are consulting with is comfortable with the evaluation of the subfertile male.
Urologists with fellowship training (advanced education beyond a urology residency) in male infertility will have a detailed knowledge of conditions that may be contributory to the infertile couple. The availability of male infertility specialists varies considerably on a regional basis. For many urologists, male infertility is an infrequent urological condition seen in daily practice.
Common questions asked at the first visit include:
- How long have you been trying to initiate a pregnancy? Do you have children?
- What type of contraception have you used, and how long have you stopped using this form of birth control?
- What type of prior evaluation have you had?
- What pertinent medical/family history is present?
- Prior surgery/trauma to the scrotum or lower abdomen
- Smoking and occupational/environmental toxin exposures
- Use of testosterone therapies and other medications
- Cancer treatments
- Prior diagnosis of a varicocele
The examination focuses on the penis and scrotum. The doctor will carefully assess for
- Testicular size and consistency
- Status of the epididymis and vas deferens
- Varicocele (dilated veins within scrotum)
- Abnormalities of the penis
- Virilization and general medical status
Laboratory testing is typically initiated with 2-3 semen analyses and a serum (blood) testosterone and FSH level for hormonal evaluation. Semen analyses should be obtained after 2-3 days abstinence. Ideally, the semen analysis should be kept at body temperature and checked within an hour of collection. The basic components of a semen analysis are
- Sperm count/density (How many sperm are present per milliliter)
- Motility (What percentage of the sperm are swimming)
- Forward progression (To what degree are the sperm moving forward)
- Morphology (What percentage of the sperm are normally shaped)
While a discussion of treatments is beyond the scope of this article, the key is the making the proper diagnosis. For example, men with severely impaired sperm counts may have an underlying genetic abnormality. In contrast, men with varicoceles may benefit from a minor outpatient procedure of surgical correction. Men with no sperm in the ejaculate may benefit from the surgical expertise of the urologist in retrieving sperm.
A visit to the male infertility specialist can be more rewarding and less stressful once the basic steps of an evaluation are understood. These steps include a detailed history and physical examination, as well as semen analysis and hormonal testing. These findings will guide further evaluation and therapy.