Diagnosis
General diagnostics: For many couples it is initially a problem to be able to admit that the reason for the childlessness could possibly be one of both partners. The way to get help and counselling is often a burden for both spouses, not only for the relationship, but also for their own psyche. It is therefore important to take the matter to a competent doctor in whom you have confidence.
Since the causes of infertility can be equally important for both sexes, it makes sense for both partners to have themselves examined. First, the doctor will take a medical history, asking questions about lifestyle, sexual intercourse, medication and diseases. This will give him a complete overview and enable him to make an initial assessment as to whether the causes may be psychological or organic in nature.
This is followed by the clinical examination, which in men includes several tests. Genital examination: The doctor examines the male sexual organs and pays attention to external or noticeable changes. Changes in the penis, such as a curvature or hardening and swelling of the testicles, can give a first indication of a disorder.
The examination also includes a digital-rectal examination of the prostate. The testicles and prostate can also be visualized more precisely by means of an ultrasound. This enables the doctor to detect possible tissue changes.
Furthermore, the doctor can take a smear of the skin on the penis to determine whether there is an infectious disease or whether the patient has already been through an infection such as Chlamydia. Sperm examination (spermiogram) The spermiogram is the most important examination to determine how fertile the man is. The examination usually takes place after a break of three to four days from sexual intercourse.
The patient gives a sperm sample obtained through masturbation. Most practices have separate rooms for this, because the sperm should not be older than two hours for a good, meaningful examination.The sample is then examined under a microscope and recorded in a spermiogram. The quantity of the sample, the appearance of the sperm, i.e. whether they have a normal shape and motility, and finally the number of normal sperm is determined.
The result is compared with the normal values. For example, it is considered normal if there are at least 20 million sperm cells in one millilitre of ejaculate. Furthermore, more than 50 percent should have normal mobility and at least 20 percent should be able to move forward quickly.
However, since the quality of the sperm can vary greatly, the examination is usually repeated after one month. If both results are present and deviate from the guideline values and if the sperm cells in the ejaculate are completely absent, one can speak of an inability to conceive. Although fertilization is still possible even with abnormal values, the probability of fertilization is greatly reduced.
Hormone tests: The examination of male hormones is carried out when the spermiogram shows a reduced number of sperm cells. Especially the hormones FSH (follicle stimulating hormone) and LH (luteinizing hormone) are important for the production and maturation of the individual sperm. Their values are therefore determined.
Furthermore, the level of testosterone in the blood is also determined, as this is crucial for the production of FSH. Hormone disorders can usually be treated well. For example, testosterone injections are administered when the body’s own testosterone levels are too low.