It makes sense to see a male fertility specialist, if you have been trying to get pregnant for a while without any success. Usually, the prospective mother is examined first; the levels of particular hormones in her body are measured at a routine appointment with a gynaecologist.
If, however, these tests do not reveal any problems, then the male partner should also visit a specialist before the woman undertakes any further complicated diagnostic procedures, such as a laparoscopy (an examination through keyhole surgery).
Around half the cases of inability to conceive are the result of a problem with the male’s reproductive capacity. Many men don’t like the idea of going to see a specialist, but they should nevertheless overcome these reservations if they want a child.
Both urologists and andrologists can carry out the examination. Urologists specialise in the organs of the urinary system, but also treat disorders pertaining to the male sex organ.
Andrology (medicine concerned with male health) is an area of medicine where different fields work together. Andrologists are the specialists in the area of male reproduction. Often, andrologists are urologists who have specialised further, and their main task in this role is the diagnosis and treatment of infertility.
Preliminary Talk with the Doctor
Before the male fertility specialist begins their examination, they will ask you questions about your general state of health. They will need to know about any chronic illnesses – like diabetes mellitus – and past treatments – like chemotherapy – as well as accidents involving or surgical procedures on the sex organ.
A case of mumps in adolescence or adulthood can also help the doctor determine the possible cause of infertility. The specialist will also want to know how long you have been trying for a baby, if you are taking any regular medication, if you suffer from any inherited conditions and whether or not you are frequently exposed to extreme heat or harmful environmental influences either privately or through your job.
If erectile problems are the reason behind infertility, then this is also obviously of interest to the doctor, as the treatment for this is very different to the treatment, for example, of poor quality sperm.
During the physical examination, the specialist will feel your scrotum, and the testes and epididymis inside it. He will be able to tell from this if you have varicocele (varicose veins next to the testes).
The prostrate and the seminal vesicle (the gland which produces semen) are examined through the rectum. By using a painless ultrasound examination, the specialist will also be able to determine other abnormalities of the sex organ and the urinary tract. The doctor will also examine your penis and mammary glands.
Examination of the Sperm
The quality of the sperm can give an indication as to the causes of any possible infertility. The number, shape and mobility of the sperm will be examined under a microscope. For this purpose, fresh semen must be produced through masturbation.
For the results to be accurate, it is important that you abstain from sexual activity for a few days before the examination. Most doctors recommend three days without sex as sufficient, but your doctor will discuss the specifics with you.
Understanding your Spermiogram
After the examination, you will receive a so-called spermiogram, which details the exact findings alongside the normal values. According to the criteria of the WHO (World Health Organisation) in 2011, 1.5 millilitres of sperm volume is normal.
15 million sperms in one millilitre of seminal fluid is, according to global calculations, sufficient for successfully conceiving, where the sperm cells have 40 per cent motility and 58 per cent vitality. Moreover, the number of leukocytes (white blood cells) present, the morphology and the pH-value of the sperm will be measured.
Many doctors still work along the old WHO guidelines, and the values they use are slightly different from those determined in 2011. Measurements can also – despite standardisation – differ from laboratory to laboratory. For this reason, any questions arising from your spermiogram should be discussed with the doctor who is treating you.
An extensive PDF document detailing the WHO guidelines for the interpretation of spermiograms is available to the public. 1
As the male body is continually producing new sperm cells (spermiogenesis), it is advisable to repeat the examination after a period of two to three months if the initial process demonstrates abnormal values. A spermiogram only ever shows the situation as it is at that moment.
A lower sperm quality does not mean that you are totally infertile. Men with less sperm can also conceive children, as the guidelines are based on the average values from fertile men. The probability of conceiving successfully is however reduced in every cycle where there is a low sperm count.
The chances of conceiving can be improved through a balanced diet or the consumption of specific nutritional supplements, which contain as much L-Arginine as possible. The poorer the quality of the sperm, however, the less likely is a successful conception using only natural methods.
The reduced quality of the sperm does not reveal the reasons for infertility. The spermiogram merely indicates if the reason for the lack of conception lies with the male.
Sometimes it can make sense to have a blood test to look for any hormonal inconsistencies. A lack of male sexual hormones can also be the cause of male infertility. Hormone levels can be of importance when there are few sperm cells present in the ejaculate, especially if there is no other reason for this to occur.
Some genetic defects can also be detected by blood tests, for example, a different number of chromosomes. Blood samples are for this reason reproduced in laboratories and examined for indications of defects in the genetic material.
In cases of erectile dysfunction, remedies containing L-Arginine are often recommended as a remedy. L-Arginine can also quadruple the number and motility of sperm cells, also improving erectile capacity on the side.
Testicular Biopsy (Tissue Sample)
If your spermiogram results are poor, then you can request a testicular biopsy. Doctors can determine if you are producing sperm at all through examining a tissue sample. You will be given a local anaesthetic so that a small piece of your testicular tissue can be removed through a needle in a surgical procedure.
Sometimes, spinal anaesthesia (spinal cord anaesthesia) or full anaesthesia is used. The tissue can then be examined under a microscope for the presence of sperm cells.
The whole procedure only lasts, as a rule, around 20 minutes. After the operation, you may experience pain in your testes for a few days. You should avoid having sex for around two weeks afterwards.
Because of this, doctors only really recommend a testicular biopsy when you and your partner are considering artificial conception. To avoid any later operations, it is advisable to freeze any sperm cells found during the process to be able to use these in the future in the process of infertility treatment.