Optimal Evaluation of the Man in Fertility Evaluation (part 1)
I thought it might be helpful to review Best Practice Guidelines for evaluation of the male half of a couple – according to the Male Infertility Best Practice Policy Committee of the American Urological Association and the Practice Committee of the American Society for Reproductive Medicine (Fert & Ster 2006;86:S202). In general there is a lot of misinformation out there about men and fertility. Men are responsible for a couple’s infertility 20% of the time, with another 30-40% of the couples having both a male and a female portion. So male fertility problems are not uncommon! It is important for men to be evaluated before the couple has gone through that magic “one year of trying without success” if:
- * a problem with his fertility is suspected (e.g. family history of a problem, history of problem with the parts – such as testicular trauma, previous cancer etc…)
- * female infertility risks are known—this includes partners over 35 years of age or more; or,
- * the man is concerned about his fertility potential.
The goals for evaluating the man are to identify:
- * things that can be fixed;
- * irreversible conditions where assisted reproduction with the man’s sperm can be used;
- * irreversible conditions where this can’t be done, and rather donor semen or adoption may be the option;
- * health threatening conditions that underlie the infertility and require medical attention; and,
- * genetic conditions that could impact a baby if assisted reproduction is done.
Often when a person who is not an andrologist or fertility urologist talks to couples about male fertility, they won’t even exam the man, and just look at a sperm sample. This is not appropriate. Remember he/you is/are more than just a sperm donor, and if someone isn’t talking to you about identifying a pathway with the outcome goals mentioned here….find someone who does. Most often, that someone will not be the woman’s ObGyn. Male fertility is a specialty and deserves specialized attention 
Continued later…
Dr. E
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