Subfertility is defined as the inability of a sexually active couple to achieve a spontaneous pregnancy for 1 year. It is therefore important to stress that it should not be considered the existence of a problem below this time limit, counting from the moment the decision to attempt pregnancy has been made (from the time contraceptive methods were abandoned). Taking into account these precepts, it is considered that about 15% of the couples that actively attempt pregnancy will not achieve it during the first year. It is important to point out that it is considered a problem of the couple, since alterations in one member may be compensated by the other and, therefore, it is necessary to study both partners at the same time. In our case, we will study the subfertile men, usually in collaboration with the HM Group Fertility Centre.
There are numerous conditions that can affect male fertility, such as congenital and genetic abnormalities, lower urinary tract infections, history of malignant diseases, increased scrotal temperature (varicocele), hormonal disorders, or immunologic factors. However, in up to 30-40% of cases no clear cause is found, so it is defined as idiopathic subfertility. It is considered primary subfertility if no previous pregnancies have been achieved with the current partner (or previous ones), and secondary if otherwise.
Clinical interview with a super-specialised andrologist.
In addition to collecting personal background, important aspects such as the duration of the subfertility, whether primary or secondary, and the age and fertile status of the partner will be evaluated. A focused physical exam will be performed, with special attention to the presence of signs of hypogonadism, testicular volume and consistency, and the presence of varicocele (dilation of the veins that drain blood from the testicles).
- The first step is to order a seminogram or spermiogram since, if the result is normal, no further studies are needed. If alterations are observed, it is necessary to obtain a second confirmatory seminogram. For this purpose, all the semen from the ejaculate must be obtained after a period of abstinence of 3 to 5 days. It is important to collect all the sample without losses, and deliver it to the laboratory that will perform the analysis no later than 1 hour after it is obtained. The most frequently observed alterations are those related to the concentration of spermatozoa, their morphology and their motility. A combination of these alterations may also occur. If there is a complete absence of spermatozoa, it is called azoospermia, and it is not necessary to collect a second sample.
- If alterations have been observed in the first seminogram, in addition to the confirmatory one, it will be necessary to perform a general analysis with a hormone profile that includes testosterone, LH, FSH, and prolactin, which will contribute to establishing a possible diagnosis and evaluate the severity of the problem, if applicable.
- Genetic studies: Depending on the findings, it may be necessary to study genetic factors to confirm the diagnosis (karyotype, microdeletions of the Y chromosome, cystic fibrosis gene). In any case, this test is performed with a simple blood test.
Testicular Doppler ultrasonography:
It is necessary to evaluate morphological imbalances of the testicles, such as size, presence of nodes and/or calcifications. The Doppler ultrasonography allows us to determine the presence and, if necessary, the degree of a varicocele.