If the sperm tests come back with normal results, there are several further tests that can be carried out to assess a man’s fertility.
Some men, particularly those whose testes are no longer capable of producing sperm properly, may have abnormal hormone levels. The most important test for men who are producing very few or no sperm at all, is the blood test to measure the levels of follicle stimulating hormone (FSH). This is produced by the pituitary gland and stimulates the testes to produce sperm. If the testes are unable to produce sperm, then the brain sends a message to the pituitary to produce increasing amounts of FSH. So if the testes are unresponsive, FSH is produced in increasing amounts. Consequently, a very high level of FSH suggests that the testicle is no longer able to react to the brain’s message. It generally indicates that sperm manufacture in the testes (so-called spermatogenesis) is failing or has stopped completely.
On rare occasions, a man may be producing insufficient FSH. This is usually because the pituitary gland has been damaged in some way. On rare occasions, part of the brain which regulates the pituitary gland may be damaged. In many such cases, administration of pituitary hormones (gonadotropin treatment) may be helpful to get a man to produce normal sperm. However, deficiency of FSH is a rare cause of male infertility.
A testicular biopsy is a small piece of tissue taken from one or both of the testes. This is called a ‘minor surgical’ procedure as it can usually be done as a day-case in hospital under anaesthesia. Once collected, pieces of testes are prepared, usually by staining, and examined under a microscope. This evaluation can determine whether the testes are producing sperm in a normal way. It may also be used to see if there are any viable sperm which might be used for one of the more advanced IVF procedures.
Whilst testicular biopsy can be quite painful, tenderness afterwards can be helped using tight-fitting underwear or a jock strap to support the scrotum and testicles for a few days afterwards. Stitches are generally removed about one week later. It is best to avoid sexual activity for some two weeks or so after a biopsy.
From time to time, a doctor may order an ultrasound examination of the testes, which is completely painless and can be done on an outpatient basis. Small cysts or very occasionally tumours in the testes may be identified. Sometimes the presence of such abnormalities indicates that the tubes from the testes are blocked.
Chromosome testing involves a blood test. Some men who are not producing enough normal sperm, or who are hardly producing any sperm at all, have a chromosomal abnormality affecting the Y chromosome (the male chromosome). Sometimes certain genes on the Y chromosome are missing or changed. Other chromosomal abnormalities include ‘translocations’ when parts of two individual chromosomes are stuck together. These abnormalities are commonly associated with infertility, usually because the sperm are incapable of fertilisation or because normal cell division of an embryo cannot take place. Translocations in either parent are also associated with miscarriage.
Despite countless breakthroughs in medical science, we still do not understand why some pregnancies will end in tragedy. For most of us, having a child of our own is the most fulfilling experience of our lives. All of us can imagine the desperation and sadness of parents who lose a baby, and the life-shattering impact that a disabled or seriously ill child has on a family.
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