Male infertility: what gets investigated and where to start

Infertility is the term used when a couple does not achieve a pregnancy after a year of unprotected intercourse. In roughly half of cases, a male factor is involved, either alone or combined with a female factor. That’s why the work-up should be carried out in both partners at the same time.

What the work-up includes

The urological assessment is based on three elements:

1. Medical history: a history of undescended testicle (cryptorchidism), infections, inguinal or testicular surgery, cancer treatment, medication and lifestyle habits.
2. Physical examination, which can detect, for example, a varicocele or changes in testicular volume.
3. Semen analysis, the basic test. It looks at sperm count, motility and shape (morphology). It’s worth repeating before drawing conclusions, as results vary from one sample to another.

Additional tests

Depending on the findings, it may be supplemented with hormone blood tests, scrotal ultrasound or genetic testing.

Common, treatable causes

• Varicocele: dilation of the veins in the scrotum. It’s the most common correctable cause.
• Hormonal disorders, including testosterone deficiency.
• Obstructions of the seminal tract.
• Genitourinary infections.

Lifestyle factors that matter

Modifiable factors also play a role: smoking, alcohol, being overweight, sustained local heat and certain medications.

When to see a doctor

If pregnancy hasn’t happened after a year, or sooner if the woman is over 35 or there is a relevant urological history. The work-up is simple and minimally invasive, and in many cases identifies a cause that can be treated.