Pregnancy is achieved in 85% of couples within 1 year with unprotected sexual intercourse. However, 15% of patients apply to physicians due to difficulties in conceiving. Male-related factors are found in 20% of couples who have trouble conceiving.
While some of the problems detected in men are correctable (hormonal disorders, obstruction in sperm ducts, etc.), they are mostly uncorrectable (for example, atrophy in testicular functions due to previous mumps infection).
During the evaluation of the man, it is aimed to:
—Identification of fixable conditions
—Using in vitro fertilization techniques in the presence of uncorrectable conditions and in case of severe sperm problem
—To ensure that the patient’s sperm are frozen and stored for the continuation of reproductive function in the future, before treatment methods that are life-threatening and that will adversely affect sperm production such as radiation therapy or chemotherapy
—To ensure the application of microinjection (ICSI) and preimplantation genetic diagnosis (PGD) methods in order to screen the children to be born in terms of chromosomal anomalies in those with genetic anomalies.
When evaluating the male, the first thing to do is to take the detailed history of the patient and to perform semen analysis 2 times with an interval of 1 month. In the history, especially the frequency and timing of sexual intercourse, diseases in childhood or later years, systemic diseases (diabetes, lung disease, etc.), previous surgeries, history of sexually transmitted diseases and toxic drug use should be questioned. Semen analysis is done by examining a semen sample taken after 2 or 3 days of sexual abstinence. During this evaluation, the amount of semen, sperm motility and number should be recorded. The semen sample taken is centrifuged at 3000 rpm for 15 minutes and then examined under the microscope. Normal values are as follows within the 1992 The World Health Organization (WHO) recommendation:
Quantity: 1.5 – 5 ml
Sperm count: > 20 million/ml
Mobility : > 50% Fast forward
mobility: > 50%
pH : > 7.2
In addition to these evaluations and sperm analysis, in men who were found to be abnormal;
-Detailed physical examination; The size of the testicles, the presence of obstruction or enlargement in the sperm ducts, the presence of redness or mass in the testicles
-Hormonal evaluation; Sperm anomalies due to hormonal deficiency are not common. Therefore, hormonal evaluation may be considered, especially in those with sperm count <10 million/ml, those with sexual dysfunction and in the presence of findings pointing to some special endocrinological disorders. The primary hormonal evaluation is serum FSH and testosterone measurement. If testosterone is low, free and total testosterone, LH and prolactin levels should be checked.
a) Patients with deficiency in hormone secretion in the brain have low FSH and LH levels and low testosterone levels.
b) FSH and LH are normal or high, and testosterone level is normal in patients who have problems with sperm production in the testicles.
-Post Ejaculation Urine Examination: In patients with little or no ejaculate (semen) amount, there may be a backflow of semen (semen) into the urinary bladder. It can be seen especially with duct obstruction, diabetes or the effect of some drugs. In this case, a urine sample can be taken after ejaculation and evaluated for the presence of sperm.
-Ultrasoundography: In the presence of suspicious findings in the physical examination (in terms of the presence of palpable vasa deferens in azoospermic patients, with normal testicular size and low ejaculate (semen) volume, in terms of obstruction in the sperm ducts), ultrasonography can be performed on the transrectal or genital region.
-Genetic Screening: In the presence of severe oligospermia or azoospermia in men, genetic testing should be performed. Three genetic factors are associated with male infertility.
1- Cystic fibrosis gene mutation; It is associated with bilateral absence of the vas deferens.
2- Chromosomal Anomalies Causing Impairment in Testicular Function; 7% of infertile men have chromosomal anomaly. This rate is 10-15% in those with azoospermia and 5% in those with low sperm count.