Infertility Tests

Infertility Tests

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QUESTION: We have tried unsuccessfully to have a child for 3 years now. I
have gone through all the tests, and now my husband realizes that he too must
be tested. What are the chances that the problem may be with him and how will
they discover it?
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ANSWER: Infertility affects 15% of marriages, and studies estimate that a
"male factor" is responsible in one-third of these cases. Through careful,
sympathetic evaluation, the underlying causes can often be pinpointed and
corrected, leading to successful pregnancy for many of these couples.
First, the doctor must gather a complete sexual history of the couple,
noting any factors that may affect or inhibit pregnancy, such as the frequency
of sex and its timing in relation to the menstrual cycle. Lubricants, douches
or other substances used in conjunction with sex may have a spermicidal effect
and be preventing the sperm from reaching the uterus.
One factor that reduces fertility in the male is cryptorchidism--in
childhood, the failure of one or both of the testes to descend into the
scrotum. If this condition remains uncorrected past the age of 5,
irreversible changes take place in the testes which reduce their fertility.
Mumps orchitis, an inflammation of the testes, also negatively affects their
reproductive ability; if both are infected, sterility may result.
Miscellaneous infections, emotional or physical stress, certain
medications and even the treatment of hernias can impair fertility. To get
the complete picture, it is necessary for the doctor to examine the genitals,
with an eye towards any physical abnormalities in the structure of the penis
or the scrotum.
Analysis of the semen itself yields the most important data regarding
fertility. Since semen takes 75 days to develop, at least two samples should
be taken at two to three-week intervals. The various characteristics of semen
(volume, shape and their degree of movement) can vary tremendously between
samples. Semen volume in an ejaculation is usually between one and a half and
five milliliters, while the density of spermatozoa present should be above 20
million per milliliter. Their degree of movement, or motility, should be
active in at least 60% of sperm observed under a microscope within two to
three hours of the sample being taken.
Oval sperm heads are considered normal in such an evaluation; large,
small, tapering, duplicated and amorphous heads may also be present. Fertile
semen contains 10% abnormal, and between 60 and 70% normal forms.
These tests may reveal the presence of azoospermia--a deformation in the
testes preventing the creation of healthy sperm; while patients testing
abnormal in all these characteristics are likely to have varicocele--a
collection of dilated veins in the spermatic cord, the most responsive to
surgery.
Hormones are less likely to play a role in infertility, but can be tested
if semen analysis fails to yield answers. A biopsy of testicular tissue is
reserved for isolated cases.
In unraveling these questions, emotional support from the spouse and
physician is critical in resolving the psychological and physical stress
resulting from infertility.