Andrological evaluation of male infertility

According to the WHO, infertility is defined as the inability of a sexually active couple who does not use contraception to conceive after one year. Approximately 15% of couples are infertile, and about 40% of these cases are attributable to male causes.

Basic study

The initial assessment includes:

Complete medical history: personal (general, reproductive and sexual), partner and family history.
Physical examination: general, neurological and genital.
Analytical and hormonal assessment: general biochemical and complete hormonal assessment (LH, FSH, total and free testosterone, TSH, Prolactin, GH and ACTH).
Lower risk of complications: Minimally invasive technique with rapid recovery and fewer side effects.
Repeated seminogram: at least 2 seminograms are necessary in an interval of 2-4 weeks after 3-5 days of sexual abstinence. The 2 seminograms are interpreted according to the values of the WHO 2010

Advanced study

La evaluación inicial incluye:

Urine culture or fractional culture: if infection is suspected.
Post-orgasm urine study:in cases of absence of ejaculate to rule out retrograde ejaculation.
Sexually transmitted disease serologies: when considering assisted reproductive techniques.
Genetic studies: Blood karyotype, Y chromosome microdeletions, CTFR gene mutations, FISH techniques, DNA fragmentation.
Imaging studies: Scrotal ultrasound, transrectal ultrasound, pituitary MRI, Deferento-vesiculography.

Scrotal ultrasound: if scrotal pathologies are suspected (testicular tumors, clinical varicocele)
Transrectal ultrasound: to rule out an agenesis of vas deferens or obstruction of the ejaculatory ductus.
MRI Turkish chair (pituitary): if pituitary pathology (hormonal alterations) is suspected.
Deferentovesiculography: to check the permeability and morphology of the distal seminal tract.
Testicular biopsy (TESE or micro-TESE): indicated in patients with azoospermia of doubtful cause to differentiate between obstructive and secretory. In addition, in these patients, the gametes extracted from the testicular biopsy can be used for assisted reproduction techniques (IVF-ICSI).

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