Men require a detailed evaluation including an in-depth history and physical examination. The importance of a careful and thoughtful evaluation may highlight causes of infertility that may be reversible.
*If fertility is an issue, please bring your female partner to assess OB/GYN history including menstrual pattern.
History:
The history includes a survey about medical problems and medications taken. Medical issues such as obesity, diabetes, kidney failure are just a few issues that may affect fertility. Medications such as propecia (finasteride), sulfa medications, calcium channel or alpha-blockers, allopurinol, opioid pain medication, or chemotherapy are just a few of the many medications that may impact fertility. Surgical history is critical since history of groin hernia repair (inguinal herniorraphy), undescended testis requiring orchiopexy, pelvic (bladder or prostate) procedures, or trauma may also affect fertility. Reproductive history (prior pregnancy with another partner, prior normal semen analysis), social history (including smoking and alcohol), sexual history (timing and methods of intercourse including lubricant selection, low semen volume), and working (occupational history with exposure to radiation, industrial chemicals or pesticides) as well as family history (birth defects, cystic fibrosis) are discussed. Finally the female partner’s OBGYN/reproductive history and age are critical factors that must be considered when formulating the treatment plan.
Physical Examination:
A comprehensive head-to-toe exam is very important for analyzing issues with men’s health. In addition to a detailed examination of the testis and epididymis (assessing testis and epididymal consistency and size, presence of varicocele) other parts of the body are important. Many organ systems interact, and evaluation of vital signs, body mass index (BMI), heart, lungs, endocrine (hormonal), GI, neurologic systems is critical. For example, erectile dysfunction can be an early sign of heart/vascular issues. A lack of smell can reflect issues with hormonal production. Lung issues could represent cystic fibrosis or cilia issues which may affect semen analysis results.
Evaluation of male infertility includes a comprehensive examination.
Lab testing/Imaging:
Findings are then synthesized with necessary laboratory (hormone tests, semen analysis) or other tests such as imaging. As Dr. Wosnitzer has published, genetic testing may play an important role in the evaluation of certain cases of male infertility. Semen analysis is a sperm test that measures sperm count, movement (motility), shape (morphology), and other characteristics of the ejaculate. Two semen analyses are often helpful since variation can occur between tests. Scrotal or penile ultrasound doppler evaluation may be helpful given the clinical history. All results are then reviewed with patients in the context of the latest research and literature in the fields of men’s urologic health, reproductive medicine, and andrology.
More about Evaluation:
Ultimately, men’s health and fertility must be managed by a multi-disciplinary team including urologists, endocrinologists, cardiologists and with the partner considered by gynecologists and reproductive endocrinologists. At CMHR, we excel at collaboration for the most comprehensive treatment of all aspects of men’s fertility and health. This is important since each organ system of the body overlaps: for example, low testosterone may be associated with poorly controlled blood sugar (diabetes) or low bone density (osteoporosis). More details about evaluation of male fertility/infertility, erectile dysfunction, low testosterone, and sexual dysfunction can be found throughout this site. We are pleased to welcome patients from throughout Connecticut, New York, the United States, and internationally.
- Men’s fertility, sexual health, and general health require a detailed investigation to avoid unnecessary testing and to create a customized treatment plan.
- At CMHR of Connecticut, we collaborate with physicians from many disciplines including endocrinology and cardiology to encompass all aspects of your wellness.
