Male Partner Examination
- Evaluation of male partner also plays a significant role in evaluation of infertility.
- Male partner contributes to about 30% as a sole reason for infertility and another 20% as combined factor.
- More often than not infertility specialists ignore this part, and the only evaluation done for the male partner is a semen analysis.
Male partner evaluation is done in a very systematic manner at Sunflower Women’s Hospital
- Detailed history
- Physical examination
- Semen analysis & blood tests
- Scrotal doppler sonography when indicated
- Sperm DNA fragmentation index
A detailed history includes age of male partner, married life duration, addictions like smoking, alcohol consumption, frequency of intercourse, history of coital dysfunction if any ( erectile or ejaculatory dysfunction), history of any major medical surgical illness ( like diabetes mellitus, hypertension, inguinal hernia, hydrocele, surgery for undescended testes), any significant family history
- Height, weight, BMI of male partner is noted as obesity also is known to impact fertility. His vital signs ( temperature, pulse rate, B.P.) examination is performed and if necessary a detailed systemic examination is done.
- Genital examination is done to determine size of testes, presence of varicocele, epididymal cysts or any other pathologies.
Semen analysis and blood tests
Most centres do only a semen analysis of the male partner and if it is normal don’t do any further investigations for the male partner. But this is where we beg to differ, as a few blood investigations are important even for the male partner, like complete blood count to rule out any anemia , random blood sugar ( to screen for diabetes) Hb electrophoresis, Serum FSH and a total testosterone level may help uncover certain trends even though semen analysis is normal, viral diseases like Hepatitis B and HIV which can have parent to child transmission.
Scrotal doppler sonography when indicated
- In case of low sperm count and motility, a scrotal sonography may uncover certain pathologies which may be missed on physical examination.
- A scrotal sonography helps in determining testicular size, position especially in cases of undescended testis, presence or absence of vas, epididymal cyst, spermatocele, presence of varicose veins and grading
- Small testicular size is suggestive of testicular failure
- Absent vas deferens with dilated epididymal head and normal size testicular failure is a classical finding in cases of azoospermia with congenital bilateral absent vas deferens.
The genetic material of the sperm is tightly packaged into a small nucleus in the head of the sperm, this basically assists in giving the sperm a form which can help it to swim, but this tight packaging /also puts the sperm at risk of DNA damage.
The following image shows the causes of DNA Fragmentation the sperm.
- Indications for doing sperm DNA Fragmentation index
- Not only does high sperm DFI lead to increased incidence of infertility and unexplained infertility, but also poses his female partner at risk of miscarriage.
- Unexplained infertility
- Multiple unexplained IUI failure
- Multiple IVF failure
Evaluation of oxidative stress in sperm nucleus can be done with the help of sperm DNA fragmentation index.