Male infertility: The sperm analysis and tests that men dread but that change everything (2/2)

Breaking the taboo surrounding andrology in the face of a medical and marital vacuum. In this second installment of our series on infertility, we shed light on men's medical examinations, too often neglected out of fear or pride. From essential sperm analysis to varicocele screenings and hormonal assessments, specialists remind us that infertility is a shared reality that requires a joint approach from the couple.

A semen analysis is an essential test for investigating potential male infertility, yet many men still hesitate to undergo it. Furthermore, varicocele, testicular abnormalities, hormonal imbalances, infections, and lifestyle habits can all compromise male fertility. Infertility is not solely a women's issue. This was the message emphasized by a doctor during a presentation on the care of childless couples. While women are often the first to undergo consultations, tests, and face family pressure, men sometimes remain uninvolved, convinced that their ability to conceive is beyond question. However, male factors are far from negligible. For the specialist, a comprehensive evaluation of the man is a crucial step, with one essential test: the semen analysis.

Semen analysis : the test men should no longer avoid

“The only test we’ll ask the man to undergo is a sperm analysis,” explains the doctor, while acknowledging the difficulties encountered in convincing some patients to submit to this examination. He particularly deplores the behavior of husbands who, having never had children, continue to consider their wives solely responsible for the difficulties in conceiving. A sperm analysis examines semen, specifically sperm concentration, motility, and morphology. It helps to identify abnormalities that could reduce the chances of fertilization. In some cases, it can also reveal an absence of sperm in the ejaculate.

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For this test, the doctor recommends a period of sexual abstinence of two to five days. The sample is generally collected by masturbation, according to the laboratory's instructions. A medical condom specifically designed for this purpose can also be used when permitted by the laboratory. For the specialist, this test is the starting point for a comprehensive male health assessment. A scrotal ultrasound or hormonal testing cannot replace it. These additional investigations must be interpreted in light of the semen analysis results and the clinical examination.

Varicocele , undescended testicles: warning signs

Beyond a sperm analysis, certain medical conditions should prompt men to consult a doctor promptly, especially if they wish to have a child. The doctor specifically mentions varicocele, a dilation of the veins surrounding the testicles, which can affect sperm quality. An ultrasound of the scrotum may be prescribed to look for this abnormality or to investigate other testicular problems. However, a varicocele does not always lead to surgery. Surgery is considered, in particular, when it is accompanied by abnormal sperm quality or other medical indications.

A history of undescended testicles, known as cryptorchidism, is also a risk factor. The specialist emphasizes that any man with only one palpable testicle, or in whom a testicle appears to be missing, should undergo a medical evaluation. An undescended (or undescended) testicle requires special attention due to the risks to fertility and the increased risk of cancer. Men who have had surgery on their testicles or pelvis during childhood, adolescence, or adulthood should also inform their doctor of this history. Some procedures can affect reproductive function. A family history of infertility and cancer treatments, including chemotherapy and radiation therapy, which can damage reproductive cells, are also risk factors.

A hormonal assessment and a clinical examination as needed

A male health assessment is not limited to semen analysis. The doctor must also ask the patient about their medical history, sexuality, any erectile or ejaculatory difficulties, lifestyle habits, and occupational or environmental exposures. Hormonal testing may be necessary when a sperm production disorder is suspected. The dosages are determined based on the clinical context and initial results. An ultrasound of the scrotum, meanwhile, allows for the investigation of certain anatomical abnormalities.

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These tests are not routinely performed on all men, but their indication can be crucial in guiding diagnosis and treatment. The specialist also warns against several factors that can affect male fertility: tobacco, alcohol, drugs, obesity, certain infections, stress, and exposure to endocrine disruptors. These disruptors can be present in various everyday products and environments. Their potential role should be considered, but they should not be automatically assumed to be the cause of conception difficulties.

Too few sperm or sperm unable to reach the egg

Among the main male causes cited are a decrease in sperm count, abnormalities in sperm motility or morphology, hormonal disorders, and obstructions of the reproductive tract. For fertilization to occur, sperm must reach the egg. An insufficient number of sperm, reduced motility, or an obstruction along their path can compromise this encounter.

Some infections can also lead to complications affecting reproductive function. The doctor therefore emphasizes the importance of consulting a doctor for any suspected infection and following appropriate treatment, rather than resorting to self-medication. Age is another factor to consider. While the decline in fertility is more pronounced in women, the specialist reminds us that men are not immune. Male reproductive quality can also decline over time, particularly from the age of 40, although this decline varies from one individual to another.

Treatment : care tailored to each cause

Once a diagnosis is established, treatment depends on the identified abnormality. Drug treatments may be offered in certain hormonal situations. Surgery may be considered for a varicocele that meets medical criteria or for certain obstructions of the genital tract.

When difficulties persist, assisted reproductive technology (ART) can be discussed with the couple. In intrauterine insemination (IUI), sperm is collected and prepared in a laboratory before being placed in the uterus at the appropriate time. In in vitro fertilization (IVF), sperm is used to fertilize eggs retrieved from the woman. The choice of technique depends, in particular, on the fertility outcomes of both partners. The doctor emphasizes, however, that these treatments do not guarantee pregnancy. IVF, in particular, represents a significant expense for households, and its success rate varies depending on several factors.

" Infertility is a couple's issue."

Beyond the examinations, the specialist denounces the accusations systematically levelled against women. According to the data he presented, a study conducted in Kaolack between 2021 and 2023 found that 43% of cases were female infertility, 31% male infertility, and 26% mixed forms. These figures refer to the study cited during his presentation and should not be interpreted as national prevalence rates. Globally, the doctor also points out that the World Health Organization estimates that approximately 15% of couples are affected by infertility, with a significant male contribution.

For him, this situation demands a change in behavior. A man who has never had children cannot assume his fertility without evaluation, just as a woman should not be held responsible by default. Infertility is generally defined as the absence of pregnancy after twelve months of regular, unprotected intercourse. However, earlier consultation is recommended in the presence of risk factors or known problems. When a woman is over 35, it is also advised not to wait a full year before seeking medical advice.

The specialist's message is unequivocal: in a childless couple, the evaluation must involve both partners. For the man, the sperm analysis remains a key test. Having it done early, identifying risk factors, and agreeing to a joint approach to treatment are essential steps to increase the chances of conception and prevent the woman from bearing the burden of blame alone.