Examinations of men
Interview before the first examination
Before proceeding to your first examination, that is, the semen examination, we will talk to you to obtain first basic information about your overall health.
We will ask you about your age.
Then we will continue by asking you about your lifestyle, your overall fitness, your height and weight, and any bad habits you might have (smoking, etc.).
You will also be asked about any attempts to conceive a child in the past (regardless of the outcome of the pregnancy and the partner).
Furthermore, it is important for us to learn about your general health condition and to be informed about any chronic diseases you may have, so that we can help you ensure and maintain good urological health.
Finally, we will ask you about the period of unprotected sexual intercourses.
The reason for us collecting all this information is to be able to provide you with optimal treatment.
Basic urological examination of a man
The basic examination of a man includes a semen analysis (SA), also called a seminogram or a spermiogram. This test is used to evaluate if the ejaculated sperm cells are of sufficient quality, are of adequate motility and are morphologically appropriate.
We recommend that men have no sexual intercourse 2 to 7 days prior to their first examination.
Seminal fluid (sperm) analysis is done twice within 6 to 8 weeks. If a spermiogram results show any abnormality, a clinical examination of the genital tract and an ultrasound examination of the testicles are recommended. We also recommend taking dietary supplements that may affect sperm development.
Semen collection for examination
Semen analysis is one of the first steps to detect any fertility issues in a couple. There are many factors that influence the quality of semen. Expert guidelines recommend a sexual abstinence of at least 2 and no more than 7 days before the examination.
Genetic tests for men
A genetic test of a man is often recommended:
- If there are no spermatozoa in the sexual ejaculate (azoospermia);
- If there are fewer than 1,000,000/ml of spermatozoa in the sexual ejaculate;
- In case of recurrent miscarriages of the female partner;
- When there is a risk of hereditary disorders.
Roughly 5-15% of men who are diagnosed with a severe defect in the number or quality of their sperm also have abnormalities in their chromosomes, which can be diagnosed through blood tests, and in particular through chromosome analysis called karyotyping.
Y-Chromosome Microdeletions (YCMD)
10-20% of men with severe sperm count abnormalities (under 1,000,000/ml) but with a normal number of chromosomes (karyotype) have a mutation of the Y chromosome. This is referred to as a microdeletion, where the Y chromosome does not contain some very important genes that are necessary for the production and development of the seminal fluid. The affected men may also pass this disorder on to their sons.
Cystic fibrosis and congenital absence of the vas deferens (CAVD)
This disorder only occurs in men presenting with a complete absence of sperm in the ejaculate. Men with CAVD are often also carriers of the mutation of the cystic fibrosis (CF) gene. Therefore, genetic testing for cystic fibrosis should be performed in men with azoospermia.
Hormone testing
A hormone test of a man is usually only done in the case of a very abnormal spermiogram.
The levels of FSH, LH and testosterone are checked.
Testicular biopsy (TESE)
Testicular biopsy is performed under local anesthesia. The procedure is performed by your urologist, who collects a small piece of tissue from your testicles. This small piece of tissue is examined under a microscope by an embryologist. If necessary, the tissue is then frozen. If there are sperm cells present in the tissue, they can be used to fertilize the eggs in the ICSI procedure.
If there are no sperm cells in the tissue or the testicular tissue is severely depleted, the tissue is then referred for histopathological examination (HPE). The outcome of the HPE is essential in deciding whether donated sperm is an option for the Intracytoplasmic Sperm Injection (ICSI) procedure.
