Childlessness is defined as the couple’s inability to achieve pregnancy after one year of sexual intercourse without contraception.
During the first consultation, the evaluation of male fertility requires:
An interrogation with a search for risk factors for male infertility.
A physical examination with evaluation of the androgenic impregnation and examination of the external genital organs. You can check this website for a perfect understanding of the helps you can get.
The complementary examination of first intention is the spermogram:
If the first spermogram is normal, it is not necessary to request a second.
In the event of an anomaly, always prescribe a second spermogram, if possible 3 months apart (duration of a spermatogenesis cycle = 74 days).
Two other tests will be prescribed for the vast majority of hypofertile men:
Scrotal ultrasound.
The hormonal balance including at least: FSH and testosterone.
Two genetic exams are prescribed before starting AMP in men with azoospermia or OATS of secretory origin:
- The karyotype.
- Looking for Y chromosome microdeletions.
The main tables observed in men consulting for infertility are:
Oligo-astheno-teratospermia (OATS): corresponding to almost 90% of cases. We must in particular look for a varicocele, a history of infection, cryptorchidism, consumption of tobacco / cannabis / alcohol, exposure to toxic substances but also a possible genetic cause. Finally 40% remain idiopathic.
Excretoryazoospermia: of obstructive origin, testicular volumes and FSH are normal, need for scrotal and prostatic ultrasound: ABCD (mutation ABCC7), infections.
central secretory azoospermia: collapsed FSH: hypothalamic-pituitary origin: Kallmann-De Morsier syndrome, pituitary tumors.
peripheral secretory azoospermia: lowered testicular volumes (sometimes normal) and high FSH (sometimes normal), testicular origin, need for a karyotype (Klinefelter syndrome) and a search for microdeletions of chromosome Y: 15–20% of Secretory azoospermias are of genetic origin. :
To Understand
Infertility is the loss of the ability to procreate (concept of aptitude). Infertility is defined by the inability of a sexually active couple without contraception to obtain a pregnancy in one year (concept of result). Infertility can be primary (never a previous pregnancy) or secondary (already one or more pregnancies before the consultation).
About 15% of couples face infertility (i.e. around 60,000 new cases / year), including 20% of strict male origin and 40% of mixed origin, in which there is a male factor.
Hold back
Infertility is the loss of the ability to procreate. Infertility is defined by the inability of a sexually active couple without contraception to obtain a pregnancy in one year. It can be primary (never a previous pregnancy) or secondary.
Each partner of the couple with infertility must be explored clinically (with full questioning, and clinical examination) and benefit from a complementary assessment.
In general, the evaluation of the male partner is essential in the etiological and therapeutic approach of the couple with infertility, and in men with a risk factor for hypofertility. It must follow a systematic and structured approach, the initial stages of which we will recall (initial assessment of the infertile man).
The main objectives of the evaluation of the infertile man are to identify:
- the conditions that can be corrected in order to induce the couple to conceive naturally.
- irreversible conditions which lead to the use of techniques of medically assisted procreation (MPA).
- conditions that pose a serious risk to the patient (infertility revealing pathology) or that may affect the health of the conceptus (genetic or other).
