Kevin McEleny
Kevin McEleny
Ph.D FRCS FRCS (Urol), Newcastle Hospitals

Male fertility check – What happens at the clinic?

Attending for a fertility check at a clinic is an important part of your journey towards parenthood. Nowadays, men should expect to be assessed, especially if a male fertility problem has been identified, or is suspected. This article explains what you might expect to happen when you visit the clinic.

While a lot of the focus during a fertility evaluation is on assessment of the female partner, male assessment is equally important, particularly if a problem has been found with sperm quality.

The doctor or nurse that sees you will ask questions and while some of these may seem personal or embarrassing, they are important as they offer clues as to what the problem might be and that will be helpful in determining the best way to help you. This step is sometimes called ‘Taking the History’.

Male fertility history

 
Time to Conceive and Previous Pregnancies (including in Previous Relationships): You will be asked how long you have been trying to conceive for and also if you have been involved in any pregnancies previously. The longer that you have been trying for, the more likely (assuming that there aren’t any medical issues that you are already aware of) that there is a problem. The clinic asks about previous pregnancies to see if the problem is Primary (i.e. you have never had a partner become pregnant) or Secondary (i.e. you have had a partner who has been pregnant, either from this relationship, or a previous one). This can be helpful as it may suggest where the issue may lie. However it is important to bear in mind that both men and women become less fertile as they get older.
 
Injury: You will be asked if you can recall experiencing anything that may have damaged your testicles. Examples of these sorts of things can include infections of the testicles (including sexually transmitted infections), which can harm sperm production or cause a blockage that prevents sperm from getting out at ejaculation. While most men will have had minor injuries to the testicles, more significant injuries such as ones requiring a hospital visit to treat will be important to share with the fertility team. This can include a testicle that has twisted and needed to be untwisted surgically (testicular torsion) or a testicle that has been ruptured by a sports injury or an accident.
 
Man waiting for at fertility check with a cup of coffe

Previous Surgery: It is important for the fertility team to be aware of operations on the testicles or groin. For example: if you had one or more undescended testes at birth that required a surgeon to bring them down into the scrotum, there may be sperm production problems. Some operations like hernia repair can result in damage to the testicles or to the vas deferens (the tubes that carry the sperm away from the testicles). Sometimes people aren’t always aware of the precise nature of operations that are performed in childhood. That is why examination can be helpful, as the pattern of scars can explain what went on.

Previous/Current Illness: Male fertility can reflect general health, so if you have a history of a significant chronic health problem, this may be relevant, especially if the condition is not well managed. Some drugs or other treatments can affect fertility, including some cancer treatments. Others can affect sexual functioning and if this is the case, the fertility clinic may contact other specialists to see if the medicines can be altered to ones that don’t cause problems. It is important though that if you think that a prescribed medicine is affecting your fertility, that you discuss it with your family doctor or fertility specialist first, rather than just stop taking it yourself.

Herbals/Supplements/Recreational Drugs: Some non-prescribed health supplements, herbal preparations and over the counter medicines can be harmful to semen production. That is why it is important to be honest about what you take. Some recreational drugs can harm male fertility and should be avoided. Perhaps one of the more common problems that clinics see is the use of anabolic steroids for body building, which can wipe out sperm production all together. Studies have also suggested that some protein supplements can be contaminated with steroids and cause the same problems.  Most of the time when these substances are stopped, sperm production eventually restarts; but in a small minority of men who take steroids long term, male fertility can be permanently affected. Furthermore, the use of these drugs can cause other health problems, such as liver problems, mood problems, problems with the blood becoming too thick (increased risk for clots) and acne. If you are using these products, we would recommend that you stop taking them and discuss the situation with your family doctor.

Puberty/Sexuality: You may be asked about how old you were when you went through puberty, or how often you shave. You will also be asked if you have problems with erections or with ejaculating. You may be asked if you feel that your libido (sex drive) is normal. These questions may seem a little strange, but are asked to see if you might have symptoms of a hormone problem or a genetic issue that may be linked to your fertility concerns.

Examination

 

This is an important aspect of the assessment. Men often have less contact with doctors than women and for many men this may be the first time that they have been examined by a doctor. Many people are a bit embarrassed, but just remember, it is all done for a purpose. If you would like your partner (or another staff member) present when you are being examined, just ask. Sometimes there may be Trainees present. It is important that the next generation of doctors and nurses learns how to look after men affected by fertility problems, but if you are uncomfortable with this you can tell the team that you would prefer not to have any one else in the room. Some men may prefer to be examined by a male doctor and if this is important to you, please make the clinic aware and they will then try and accommodate you when possible.

The doctor will examine your genital area. They will assess the volume of the testicles and look to see if the other parts of the male genital anatomy are normal also. This will include checking to see if the vas deferens (the tubes that carry the sperm away from the testicles) are present. They will also see if the caps at the top of the testicles are normal and look to see if you have a varicocele (varicose veins in the scrotum).

Further tests

 

Once this has been completed the doctor or nurse will sit down with you to discuss what they think is happening and plan some tests. In terms of the male partner, this may include blood tests to check hormone levels and genetic tests, to make sure that there are no major abnormalities in the chromosomes (the structures in the cell that contain DNA) or that the sperm-making genes are missing. They may also check to see if you have any abnormalities in the genes that are involved in cystic fibrosis, as changes here can sometimes be linked to sperm blockage problems in men.

The key test is the semen analysis and this is usually repeated at least once. Sometimes the clinic may suggest other tests, such as those that look to see if the sperm’s DNA is damaged. On other occasions the clinic may suggest arranging an ultrasound scan of the testicles.

Discussion

 

Once these results are available, the clinic will usually see you back to discuss them in detail and explain what your options are. If you or your partner have any questions, remember to ask them (some people write them down before they come in, so they don’t forget to ask them them). Most clinics send copies of the clinic letters to the patients, if they don’t write to the patient directly, but if you think that you aren’t getting the letters and would like to, please contact the clinic.

When you come back to the clinic you will have a chance to discuss the pros and cons of the treatments that are suitable for you. If no problems have been identified, the clinic may advise you to continue trying to conceive naturally for a bit longer.

If you feel that your male fertility concerns have not been properly investigated, it is important that you discuss this with the clinic staff. They may suggest asking you to see a male fertility specialist, who may be a urologist.

Infertility problems are stressful and if you find the process difficult to cope with, ask to see the clinic counsellor, or try the peer the support platform on this site, to find out from other men, what the process is all about.