Male Partner Examination

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
Detailed history

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

Physical examination
  • 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.
DNA Fragmentation index

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.

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