About ninety-five percent of couples will conceive after a year of trying. A fertility evaluation is recommended for those who do not conceive. Women are generally evaluated by their gynecologist. The doctor will take a history asking about child hood illnesses, surgeries, the menstrual cycle and so forth and then perform a physical examination. Then, generally, blood tests and imaging studies may be recommended.
Men are generally evaluated by a urologist, and may be best evaluated by those with a special interest or fellowship training in infertility, also sometimes referred to as Male Reproductive Medicine. Similar to the female evaluation, a urologist will ask the male about his history including childhood issues, prior surgery on the male genital system, exposures, and so forth. Unlike the female evaluation, however, the first laboratory test is generally a semen analysis. Sometimes the patient is referred to the urologist in the setting of an abnormal semen analysis.
A semen analysis is an examination of a semen specimen typically produced by masturbation into a sterile specimen cup. The specimen may be produced on site or at home as long as it can be brought in within in a reasonable period of time as defined by the lab. For those who cannot produce a specimen by masturbation, a special condom collection device is available.
The semen specimen itself is examined for a variety of characteristics. The volume is measured (a low volume can be significant) as well as the pH or acid-base level. The specimen is allowed to liquefy and a droplet is placed on a slide to evaluate characteristics related to sperm including the count (or density which is the number of sperm per milliliter), the motility (the quality of sperm movement) and the shape (also called the morphology). For the sperm density, the sperm are examined on a slide with a counting grid and a series of counts are performed. For the motility, both the percent of sperm moving and the number of rapidly progressive sperm are observed. For the morphology, sperm are generally examined on a stained slide that stains the cells and allows for a more precise determination.
As of the writing of this blog, the system currently endorsed by the World Health Organization or WHO is the Kruger system of strict morphology also known as the Tygerberg criteria. A variety of characteristics of sperm are looked at. The criteria are so strict that a measurement of four or five percent is considered acceptable in many laboratories.
If an initial semen analysis is abnormal, it may lead the physician to order additional testing which may include a repeat analysis, imaging studies and or blood work. Testing can often lead to the discovery of an underlying cause and or recommendations to attempt to improve sperm production.