Urologists calculate that up to 40% of cases of sterility are due to ‘male factor’ sterility. Some of the conditions that the man may be affected by are low sperm production, poor quality sperm, spermatozoa with low motility (or incorrect morphology); or obstructions of the reproductive tract.
What is the role of the urologist in an Assisted Reproduction Unit?
An assessment of male infertility needs to begin with anappointment with the urologist, who will conduct an interview and a basic examination, including a look at medical and reproductive history. A consideration of any surgery that the patient may have had, and of any medication that he may be taking. Questions about medical history, lifestyle, exercise habits, diet, consumption of tobacco, alcohol or drugs will help to determine the possible cause of male reproductive problems.
Subsequently, the urologist will perform a testicular ultrasound scan in order to assess size and particularly, the possible presence of testicular varicocele, an abnormality where there is an enlargement of the veins in the spermatic cord, and which is the cause of approximately 16% of cases of male infertility.
The urologist will request and carry out a semen analysis, known as a seminogram, which analyses the volume of semen, the number of spermatozoa, their morphology, motility and other variables. In some cases this analysis should include a blood test to check the levels of testosterone and prolactin and also other hormones related with sperm production, such as follicle stimulating hormone (FSH) and inhibin B. Genetic screening may also be carried out, when medical history makes this advisable.
What types of treatment are carried out?
After diagnosis, the urologist will be responsible for any medical or surgical treatment of the underlying cause (varicocelectomy, vasovasostomy…). In those cases where there are no spermatozoa in the semen (azoospermia), a testicular biopsy will be performed with two aims: on the one hand to obtain spermatozoa for reproductive purposes, and on the other the anatomopathological analysis of the testicular parenchyma, which will give a possible etiological diagnosis of the problem.
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