What to Expect for Your Appointment
Diagnostic Testing or Male Infertility Consultation
When scheduling an appointment, the patient will be advised to have two – five days of sexual abstinence prior to providing a semen sample. Plan on approximately 20-45 minutes for the appointment.
- Bring your photo ID with you to your appointment
- Bring or fax in advance a Requisition Order for the lab signed by your physician.
- Sign-in at the front desk and wait to be called to the Andrology check-in desk. Payment is due at the time of service, a copy of your photo ID will be taken and demographics will be verified. A technician will review sample collection procedures, study patient consents and long-term storage agreements as needed.
- Receive an insurance billing form receipt. (It is the patient’s responsibility to submit this form to the insurance company.)
- Collect sample in a private collection room. (Sample Collection Instructions)
Please arrive a few minutes before the scheduled appointment, check in at the front desk and take a seat. Patients will be called to the Andrology office for service, which may include a short consultation, paperwork to process the sample, a review of semen collection instructions and payment (Fee Schedule & Policy). Note All services must be paid for in full at the time they are provided. Upon completion of paperwork, with an opportunity for the patient to ask any questions or clarify information, the patient will be escorted to a private collection room. The technician will verify proper labeling of the container prior to collection and lock the door at his/her departure. The patient collects the sample and once complete, is free to leave, unless otherwise instructed.
Male Infertility Consultations
What to expect at your appointment with Dr. Hotaling:
A male infertility evaluation will involve an office visit to a male infertility specialist. To prepare for the appointment, we ask you to fill out a fertility questionnaire and complete some laboratory tests ahead of time, so we can take better care of you.
Your male fertility evaluation will begin with two semen analyses and a male endocrine profile (blood work) at one of the Andrology Laboratory locations prior to or at your clinic visit. Before the semen analyses, we ask that you abstain from ejaculation for two to three days (no less than two; no more than three).
The endocrine profile/blood work consists of six labs that need to be drawn before 10:30 am in order to be accurate; these can be done at an andrology laboratory or another lab that is convenient for you, and we are happy to provide an order/script for this blood work. The labs are a total testosterone, follicular stimulating hormone, luteinizing hormone, sex hormone binding globulin, albumin, and estradiol.
2. Office Visit
At your office visit, you will meet Jim Hotaling, MD, and undergo a thorough male infertility evaluation, including the following:
- Physical exam*
- Review of your semen analyses and endocrine results
- Review of male infertility risk factors
- Plan development about lifestyle changes, medicines, treatment options, and, if necessary, surgery in order to increase the chances of pregnancy
Updates will be sent to your referring urologist, reproductive endocrinologist, or primary care physician.
The physical exam will consist of your doctor determining the longitudinal testis axis and palpating the spermatic cord (see anatomy) structures to help detect any underlying issues. In large series of patients undergoing a male infertility evaluation by a qualified andrologist (fellowship-trained male infertility expert), serious medical pathology was discovered in 1–6% of patients screened (Hotaling et al, Nat Rev Urol 2009). Thus, the vast majority of men do NOT have a serious underlying cause of their infertility.
While andrologists focus on treating the male, we will often ask a few questions about your partner and whether you have talked to a reproductive endocrinologist. We ask this only so that we can better understand your reproductive goals as a couple as we do not have expertise in female infertility.
Figure 1: Semen analysis reference ranges from WHO 2010 criteria
|Ejaculate volume||≤ 1.5 mL|
|Sperm concentration||≤ 15 million sperm/mL|
|Progressive Motility||≤ 32%|
|Morphology||≤ 4% normal|
Morphology or percent normal sperm are typically recorded by the Kruger Strict Criteria. This criteria was developed by a pathologist to classify the shape or morphology of sperm. What many find surprising is that most men have 96% abnormally shaped sperm. Thus, if a man has at least 4% of his sperm that are not abnormally shaped, this is considered to be normal. Data remains very conflicting on the impact of abnormal morphology (called teratozoospermia). A previous meta analysis by our group demonstrated that teratozoospermia did not have an impact on either fertilization or pregnancy outcomes. (Hotaling et al, Fert & Steril, 2011.)
Perhaps the most important aspect of a semen analysis is the total motile count or TMC. The total motile count is the number of sperm that are motile in the ejaculate. A total motile count of over 20 million is considered normal. Above 20 million sperm, increasing numbers of motile sperm do not result in significantly increased pregnancy rates. From 20 million down to one sperm, there is a linear decrease in the chances of a successful pregnancy. Typically, a total motile count of over five million will allow a man’s sperm to be used for intrauterine insemination (IUI) of sperm or in-vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI). More details of artificial reproductive techniques will be provided by a thorough discussion with a reproductive endocrinology and infertility specialist.
Terms of Semen Analysis
A brief description of the semen analysis terms are something many patients find helpful:
- Azoo means an absence of any sperm.
- Oligo means fewer than normal sperm.
- Asthenospermia means that the sperm have poor motility or do not swim well.
- Teratozoospermia refers to abnormally shaped sperm.
- Pyospermia refers to a condition where numerous white blood cells are present in the sperm, typically from the prostate. Thus, azoospermia means no sperm and oligospermia means a total motile count of <20 million. Severe oligospermia is defined as <1 million motile sperm. To make all of these conditions even more complicated, any of these prefixes can be used in combination with each other.