Physical examination for the man

1. Height, weight, and hair distribution, gynecomastia, palpable lymph nodes or thyromegaly should be sought.

2. The consistency, size, and position of both testicles and the presence of varicocele or abnormal location of the urethral meatus on the penis should be noted. Testing for Chlamydia, Ureaplasma, and Mycoplasma should be completed.

D. The cornerstone of any infertility evaluation relies on the assessment of six basic elements: (1) semen analysis, (2) sperm-cervical mucus interaction, (3) ovulation, (4) tubal patency, and (5) uterine and (6) peritoneal abnormalities. Couples of reproductive age who have intercourse regularly without contraception have approximately a 25-30% chance of conceiving in a given menstrual cycle and an 85% chance of conceiving within 1 year.

E. Semen analysis. The specimen is routinely obtained by masturbation and collected in a clean glass or plastic container. It is customary to have the man abstain from ejaculation for at least 2 days before producing the specimen. Criteria for a normal semen analysis include a sperm count greater than 20 million sperm/mL with at least 50% motility and 30% normal morphology.

Semen Analysis Interpretation

Semen Parameter

Normal Values

Poor Prognosis

Sperm concentration

>20 x 106/mL

<5 million/ mL

Sperm motility

>50% progressive motility

<10% motility

Sperm morphology

>50% normal

<4% normal

Ejaculate volume

>2 cc

<2 cc

F. The postcoital test (PCT) is used to assess sperm-cervical mucus interaction after intercourse. The PCT provides information regarding cervical mucus quality and survivability of sperm after intercourse. The PCT should be performed 8 hours after intercourse and 1 to 2 days before the predicted time of ovulation, when there is maximum estrogen secretion unopposed by progesterone.

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