Male Infertility - Investigations

Men's Health - Male Infertility
Investigations

discussion group for Patients

INVESTIGATIONS

A- SEMEN ANALYSIS

VOLUME:

· 1.5 - 6 ml; ASPERMIA: absence of an ejaculate, suspect:

Retrograde ejaculation into the bladder: Sperm present in post ejaculatory
urine.

· Anejaculation (failed emission)

· Ejaculatory duct obstruction

· Congenital absence of vas deferens and seminal vesicles.

COUNT (sperm density) :

20.000.000 or more /ml

OLIGOZOOSPERMIA: <20.000.000 sperm /ml; exclude:

· Pretesticular causes: (evaluate for male secondary sex characters; hormones
LH, FSH, Testosterone, Prolactin).

· Testicular causes: e.g. Varicocele; Gonadotoxics

· Post-testicular causes: e.g. Prostatitis.

AZOOSPERMIA: Absence of sperm from the ejaculate.

TESTICULAR BIOPSY differentiates functional azoospermia due to testicular
and pretesticular causes from obstructive azoospermia due to post testicular
causes.

MOTILITY

60% or more progressively motile with a forward progression (F.P.) of 3 to
4 (0 = no movement; 1 = minimal circular movements; 2 = slow forward movement;
3 good forward speed; 4 = excellent speed)

ASTHENOZOOSPERMIA: <60% Progressively motile sperm; exclude

disorders of sperm function (e.g. genital infection;

antisperm antibodies; Gonadotoxics) & varicocele.

MORPHOLOGY

TERATOZOOSPERMIA: >40% abnormal forms; very difficult to treat. Exclude varicocele,
infection, gonadotoxics.

ROUND CELLS

Pus cells & immature germ cells are difficult to differentiate in unstained
smears. Pus cells are normally 0 - 5 / HPF.

PYOSPERMIA: >5-10 pus cells / HPF

R.B.Cs. Usually absent

HEMATOSPERMIA: RBCs in semen; frequently idiopathic; exclude bleeding disorders
& genital infections (e.g. T.B. & Bilharzial prostatovesiculitis) & tumors.

OTHER SEMINAL FACTORS

Sperm Agglutination & fluid Viscosity shouldn't be excessive.

Coagulation immediately, Liquefaction within 5 - 30 minutes.

B- URINE & PROSTATE

Smear for pus cells & bacteriological cultures.

C- HORMONES

Assays for FSH, LH, (T), Prl.

D- CHROMOSOMES

Buccal smear for bar body (extra X chromosome); Karyotyping.

E- IMMUNOLOGIC

Most important are the antisperm antibodies attached to the sperm surface.These
are detected using antihuman globulin labeled with either:

Beads: Immunobead test

Enzyme: ELIZA

Radioisotope: Radioimmunassay

Flourescin: Immunoflourescence

RBC: Mixed agglutination reaction (MAR) test

F- ANDROGEN RECEPTORS

Quantitation of receptors from genital skin fibroblasts.

G- TESTICULAR BIOPSY

Differentiates functional from obstructive azoospermia (sperm present) & assess
the degree of testicular pathology.

H- RADIOLOGY & ULTRASONOGRAPHY

e.g. Spermatic vein venography or ultrasonography to confirm mild varicoceles;
Vasography & transrectal ultrasonography for suspected male genital tract
obstruction.

جميع حقوق الطبع والنشر محفوظة للدكتور حسين غانم لعام 1999

discussion group for Patients

Page written & discussion moderated by:

Dr. Hussein Ghanem

Professor of Andrology, Cairo University
Formerly: Fellow in Male Reproductive Medicine and Surgery,
Baylor College of Medicine, Houston, Texas, USA
Formerly: Fellow in Male Sexual Function, Reproduction, and Surgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA

Telephone: +(202) 761 3334

E-mail: ghanem@family-clinics.com

Address: 139 (A) Al-Tahrir Street, Dokki, Cairo, Egypt