Evaluation of male fertility should be considered in any couple who has a diagnosis of infertility (no pregnancy after timed intercourse for 1 year in women under age 35 or 6 months in women over age 35).
Men who have significant risk factors for infertility such as testicular surgery, severe trauma, chemotherapy, radiation, known genetic risks for infertility, or any other risks should be evaluated earlier.
The initial step in an evaluation is a comprehensive history and semen analysis. The reproductive history includes prior pregnancies, timing and frequency of sex, duration of infertility, medical history, surgical history, family history, and history of exposure to toxins or radiation.
When conducting a semen analysis, semen is generally collected by masturbation 2-5 days after the last ejaculation. Analysis includes evaluation of the semen volume, sperm concentration (how many million sperm per milliliter), motility (what percent are moving), and morphology (shape). Sperm parameters that predict male fertility are concentrations >48 million/ml, >63% motility, and >12% normally shaped sperm. Sperm parameters that predict subfertility are concentrations <13.5 million/ml, <32% motility, and <9% normally shaped sperm. Semen parameters fluctuate so a second semen analysis allows for assessment of variability. Abnormalities on semen analysis may prompt further evaluation and/or referral to a Urologist for further assessment and treatment.