Optimal Evaluation of the Man in Fertility Evaluation (part 2)
Continuing on summarizing the best way to evaluate the man’s reproductive status (according to Male Infertility Best Practice Policy Committee of the American Urological Association and the Practice Committee of the American Society for Reproductive Medicine in Fert & Ster 2006;86:S202).
Once you have decided to have a male fertility work up, the “required” elements are a physical exam, a reproductive history and TWO semen analyses, preferably one month a part.
A physical exam by a male fertility specialist is important. It can identify problems that may be impacting reproduction such as diabetes, varicoceles (a “plumbing” problem), erectile dysfunction or even if there is some kind of hormone imbalance (for example from exposure to toxins at work or supplements for body building). It is important to know if the man is taking certain antidepressants, or even if he has been ill with a fever recently. Knowing what types of problems can negatively impact male reproduction is a specialty, and General Practice docs may not always know all the subtle things to look for.
The reproductive history is VITAL, but often overlooked. Go ahead and write these things down before you go in, unless some of it is for your doc’s ears only.
- how often and when in the month do you have intercourse
- how do you figure out when the woman is ovulating and when to have intercourse
- how long have you been trying to conceive
- has the man ever caused a pregnancy- did it result in a baby or end in some other way (terminated pregnancy or a miscarriage)—tell everything here, even if it is something the man doesn’t want his wife to know ( you can tell the doc this)
- any childhood illness or problems developing (such as one testicle not descending)
- prior major illness or surgery- especially anything having to do with hormones or a lot of medications (thyroid, heavy medications for allergies or asthma, cancer, antidepressants)
- sexual history – especially sexually transmitted diseases—no one likes to talk about them, lots of people have had them- tell your doc!
- Exposure to toxins, including heat – such as working in a factory or agriculture or even just exposure to a lot of heat, like working outside in the southern US in the summer time.
This history tells the physician if you have likely always been infertile or if it is maybe something new. It really can help pinpoint what is going on. So choose someone that wants to hear all this, and write it down before your appointment.
Did you see at the top of this post that you need TWO semen analyses for an adequate evaluation? We will come back to that after I am back April 8th…
Send me lots of energy. We are having a big family reunion at the beach (my parents 50th), and I still can’t walk and am in a lot of pain from my January accident 
… Not sure how it will go…
Take care-
Dr. E
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