How is male sterility diagnosed?
The first step in diagnosing male sterility is an andrological examination during which the doctor collects a complete anamnesis and performs an accurate examination of male genitalia. The examination includes scrotal palpation, an estimate of testicular volume and an analysis of the rectal canal to examine the prostate. The examination of testicular volume is particularly important in male sterility diagnosis because it is an expression of the quantity of active seminiferous tubules; a reduction of active seminiferous tubules (<15 ml) may indicate testicular damage.
What are the most common diagnostic exams?
Among the most important diagnostic exams, the first one is semen analysis or spermiogram, that is the examination of seminal fluid to assess qualitative and quantitative characteristics of spermatozoids and fecundation potential. It is important to consider the high variability of results that depends on external factors that may alter the spermiogram like for example the intake of antibiotics, high temperature before the examination or the incorrect transportation of the fluid to the lab. In addition, scrotal or testicular echocolordoppler is often performed to identify possible pathologies that could be responsible of sterility like for example varicocele and possible testicular lesions. This is performed using specific ultrasound equipment with a linear probe that allows the observation of the blood flow as coloured images. If the alleged causes of sterility are genetic, the andrologist may recommend karyotype examination that allows to identify chromosomal abnormalities through a blood test. As an alternative, it is also possible to perform microdeletion analysis that identifies deletion events that have deleted the normal Y chromosome sequences that are involved in spermatogenesis in men. Last but not least, treatment through dosages of certain hormones like FSH, LH, total testosterone, or prolactin (PRL) and the evaluation of the thyroid function (TSH and fT4) can also be recommended because alterations in such hormones may affect spermatogenesis leading to impotency.