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Checking Your Swimmers: What Does a Male Fertility Evaluation Involve?

Nannan Thirumavalavan MD

Some men hate going to the doctor. Whether it’s for a cold that we can’t seem to kick or just our annual physical — we often avoid seeing a physician for as long as we can. The same holds true when we’re trying to start our families. With most couples who are trying to get pregnant, it’s the woman who sees her doctor first and gets poked and prodded long before the man is recommended for a thorough evaluation. For example, one study showed in about 85% of couples, our wives and partners are getting evaluated first[1]! Even if we are told to get checked out, men may avoid going in because they don’t know what exactly is going to happen. Our goal is to give you a general idea, as a man, of what to expect when getting evaluated for fertility.

When picking a men’s fertility doctor, try to see a urologist who has done specialty training in fertility — if you’re reading this blog post, you’re already off to a great start! These are doctors who took one to two years after their urology training to learn specialized care of men with infertility. Here’s a list of providers throughout the USA that fit these criteria.

Your first visit with a male infertility doctor may be a long one, so be prepared! The doctor will start by taking a detailed medical history [2]. This history will go back to your childhood, asking about surgeries or conditions you may have had as a child or even when you were a baby. Many men have had surgeries as a baby that their parents never told them about, so it may be worth talking to your parents to find out if you had anything done. In addition, it is worth asking your parents if there was a family history of fertility problems, as some of these issues could be passed down from generation to generation. Your doctor will ask you about all of your medications, and your habits regarding smoking, alcohol, and drug use. Be sure to tell your doctor if you are currently or have previously taken any sort of testosterone products or anabolic steroids (other than “corticosteroid” rash creams, tablets like prednisone, or joint injections), as these can affect fertility. We also recommend that your wife or partner comes with you — pregnancy is a team sport and this is an important process for the both of you!

After a thorough history, your doctor will perform a physical exam. The exam will look at you overall, but place an emphasis on the genitals to look for any abnormalities. It is usually quick and painless. In addition to a physical exam, there are a few tests that most doctors may do at the first visit. First, doctors will request a semen analysis — a test to look at your sperm. You ejaculate into a cup, and your sperm will be analyzed under a microscope. To get the best results, do not ejaculate for 2-5 days prior to your visit. Some providers will do two semen analyses on different days to get a better picture of your sperm production.

Other tests that may be performed at your initial visit include blood tests, specifically some hormones to see how well your body is producing the hormones necessary for fertility or occasionally genetic testing. Some doctors may also do an ultrasound of your testicles — this is a noninvasive, painless way to take pictures of the testicles and the structures around them. The results of all these tests, coupled with your history and physical exam, will then allow the doctor to tell you where you stand with regards to fertility. Sometimes the recommendations will come at the initial visit, and other times it will be after the results come back from your blood tests. Your doctor will also discuss with you what lifestyle modifications, medications, or procedures may improve your chances of having a baby.

To summarize, getting your fertility checked out as a man is not as scary as it seems. When scheduling your visit, please be sure to use the checklist below to get the most out of your visit. Also take a look at the links below for more information. Don’t hesitate to ask questions! We as fertility specialists enjoy helping couples have children and welcome the opportunity to discuss your treatment plan.

How to prepare for your male infertility visit:

  • Do not ejaculate for 2-5 days prior to your visit in case your doctor would like to check your sperm on the same day as the visit (not always). This includes masturbation!
  • Bring all your medical records, including previous surgeries and a current medication list
  • Bring your wife/partner’s medical records, especially her workup or treatments for infertility
  • Bring your wife/partner with you!

Quick Facts about Infertility

Male Infertility

References

[1] Balasubramanian A, Thirumavalavan N, Scovell J, Lo J, Ji B, Godfrey EL, et al. An Infertile Couple’s Long and Expensive Path to Varicocele Repairs. Urology 2018. doi:10.1016/j.urology.2018.10.021.

[2] Committee of the American Society for Reproductive Medicine P. Diagnostic evaluation of the infertile male: a committee opinion 2014. doi:10.1016/j.fertnstert.2014.12.103.