Guidelines for the diagnosis and treatment of male infertility – part 1

These guidelines reviewed appropriate testing for men in couples with infertility. 

Male infertility contributes to half of all cases of infertility. Identifying the cause of infertility is the first step towards managing it. There is ongoing research on the best methods of diagnosing infertility in men. Professional organizations regularly release guidelines on the current best practices.

These guidelines reviewed available studies on the evaluation of male infertility. When there was not enough research, it also included expert opinion.

A couple’s infertility may be contributed to by either the male or female partner or both. A man’s complete medical history is important for evaluating fertility. Some health conditions, such as obesity or low testosterone, are related to infertility. Additionally, there is some evidence that a healthy diet and avoiding smoking are linked to better fertility.

All men of infertile couples should have tests of sperm concentration and quality. Semen can vary between samples, so at least two semen samples should be tested, ideally a month apart. One unusual value does not necessarily mean there is a problem. However, if there is an abnormal semen analysis the man should undergo a full evaluation. This typically includes a physical exam.

For men with no or few sperm, there are several possibilities. There could be no sperm produced in the testes. Alternately, there could be a blockage of the tubes which carry the sperm. Hormone tests can suggest whether sperm are not being produced. If the hormone results are normal and there is low semen volume, an ultrasound can test for blockages. Additionally, genetic tests may be used. Extremely few sperm can be caused by extra X chromosomes (a piece of genetic material).

A pregnancy where the embryo has abnormal genetics often ends in miscarriage. For couples with multiple miscarriages, some evidence supports testing for DNA fragmentation in the sperm. This test measures the number of abnormal breaks in the genetic material of the sperm.

These guidelines found that male fertility should be evaluated for all couples with infertility. If there is abnormal semen quality, additional tests may be needed.

Treatment is individual to each patient and depends on both the general guidelines and his individual health history.