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It is very important that when a couple first sees the doctor for infertility that a semen analysis is scheduled. Forty percent of cases of infertility are due to problems in the male, particularly in the sperm morphology, motility, or concentration.
A semen analysis will evaluate those factors and look at the volume of the semen produced, look at the possibility of having any infection in the semen, looking for motility abnormalities, that is in the movement of the sperm, in the shape of the sperm, and in the concentration of the sperm. The shape of the sperm is very important because that is perhaps the best prognosticator for the ability of the sperm to actually enter the egg when it reaches it.
Causes for male infertility are numerous. They include trauma to the testicles in early life. They include infectious causes, hormonal causes, genetic causes, and perhaps most commonly we see what are called varicocele. Now, a varicocele is the abnormality in the drainage of the blood from the testicles back up into the main vein blood supply of the body. Varioceles are associated with poor sperm numbers, poor motility, and poor morphology, all which can contribute to diminished chances of conceiving in any one cycle.
A male must be evaluated first with a semen analysis and then with the help of a urologist who specializes in reproductive urology. In some cases, specifically if there is a varicocele, surgery can be done to repair the varicocele and improve sperm parameters. In other cases, hormone treatments can be used to enhance sperm counts and enhance sperm motility.
So reproductive endocrinologists work very closely with urologists in order to help the couple achieve pregnancy. These are the most common causes of male infertility.