Andrological testing

We talk about a couple being infertile if pregnancy does not occur within one year despite regular unprotected intercourse.

In such couples, 50-70% of the men have limited reproductive capacity and should thus be examined in detail by a specialist in male health, called an andrologist.

For some of these fertility disorders, we have already been able to establish a characteristic molecular genetic profile (Feig et al., 2007), (Chalmel et al., 2012).

At the start of treatment, the patient is asked detailed questions about previous events that could have had a negative effect on reproductive capacity. Common causes for male fertility disorders that can be determined from the first consultation include:

• Congenital abnormal position of testis (“undescended testicle”),
• Inflammation of the genital area (epididymitis or orchitis, sexually transmitted diseases),
• Injuries to the genital area,
• Tumours,
• Chemotherapy and radiation,
• Metabolic disorders (type 1 diabetes mellitus)

This includes:

• Measuring height and weight,
• Determining hair growth pattern,
• Determining testicular volume,
• Palpation and ultrasound of scrotal contents

• Determination of sex hormones
• For specific indication: serology (testing blood serum for infections, particularly chlamydia, HIV and hepatitis B/C)
• For specific indication: genetic testing  
• Semen analysis:
  • Semen analysis in accordance with the current guidelines from the World Health Organisation (WHO Laboratory Manual 2010, 5th edition) and the German Federal Medical Association (RiliBÄK). The semen sample should be taken after an abstinence period of 3-5 days.
  • The main parameters to be determined are: sperm concentration and total count, motility, and morphology (shape, appearance).
  • If there is a specific indication, the analysis can be expanded to include microbiological, biochemical and immunological parameters, and a sperm DNA integrity (SDI) test. Occasionally, a test for chromosome maldistributions in the sperm (FISH semen analysis) may be advisable.

  It is important to note that the reference values listed in the current WHO laboratory manual for the main semen parameters are not normal values, but lower limit values. They were established from a large group of men who had brought about a pregnancy within one year.

Scientifically validated, “rational” drug-based therapy only exists for certain forms of hormone deficiency. In other cases, therapeutic efforts must focus on taking into account or eliminating disruptive factors, for example:

• treating an infection,
• potentially long-term anti-inflammatory treatment (Spiess et al., 2007),
• potentially correcting a varicose vein in the scrotum (varicocele).

If reproductive capacity is severely impaired, assisted reproduction methods (ICSI,TESE) are often the only options to offer a realistic chance of fatherhood.

Even in the case of very low semen quality and after freezing/thawing of sperm, the possibility of promising artificial reproduction procedures now exists. This is why we offer all patients requiring surgical or drug-based treatments that may have a damaging effect on fertility the opportunity to freeze semen or testicular tissue (cryopreservation) as a fertilisation reserve.

This is particularly suited to patients who are scheduled to have chemotherapy or surgical interventions in the genital and abdominal regions (colon, bladder, prostate). However, the patient must cover the cost of this. The storage duration can be freely determined by the patient.