Andrological evaluation of male infertility

According to World Health Organization (WHO), infertility is defined as the inability of a sexually active couple that does not use contraceptive methods to conceive after a year. Approximately 15% of couples are unable to conceive and about 40% of these cases are attributable to male factors.

Basic study

The initial evaluation components:

Complete medical record: personal (general, reproductive and sexual), partner and family medical history.
Physical examination: general, neurological and genital examination.
Plasma hormone analysis: general and complete hormone evaluation (LH, FSH, total and free testosterone, TSH, Prolactin, GH and ACTH)
Seminogram: At least 2 semen analyses should be repeated at 2-4 weekly intervals after 3-5 days of sexual abstinence. The two seminograms are interpreted according to WHO 2010 values.

Advanced study

Depending on the findings in the basic study, a personalized advanced study is carried out:

Uricult: if there is suspicion of infection.
Post-ejaculatory urinalysis: Low-volume or absent ejaculate suggests retrograde ejaculation. 
Serologic testing for sexually transmitted diseases: when assisted reproduction techniques are contemplated.
Genetic studies: Blood karyotype, Y chromosome microdeletions, CTFR gene mutations, FISH techniques, DNA fragmentation.
Imaging studies:
Scrotal ultrasonography: if scrotal disorders are suspected (testicular tumors, clinical varicocele).
Transrectal ultrasonography: to rule out an agenesis of deferential ducts or obstruction of the ejaculatory ducts.
NMR Turkish saddle (pituitary): if pituitary pathology is suspected (hormonal alterations).
Vesiculography: to check the permeability and the morphology of the distal seminal pathway.
Testicular biopsy (TESE or micro-TESE): indicated in azoospermia patients with a doubtful cause to differentiate between obstructive and secretory (non-obstructive) types. In addition, in these patients, the gametes extracted from the testicular biopsy can be used for assisted reproduction techniques (IVF-ICSI).