AboutArthur Goldstein, M.D. Expertise Any problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, impotency, etc.
Experience I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in male impotence and endourology.
Organizations American Medical Association, American Urological Association, American College of Surgeons
Question Hello, Me and my husband have been trying to conceive for two years, after getting me all checked out, and finding nothing wrong, my doctor sent him to get a sperm count, finding he does have a low sperm count. He is now having to go see our primary care and get referred to a urologist. I was just wandering if they are going to be able to fix this and what to expect in the following visits. Thank You for all your help. sincerely, victoria
Answer Victoria, infertility is the general term applied to those conditions that make it difficult for a couple to conceive. Usually, if a couple has tried for a pregnancy for one year by having intercourse at the proper time each month without success, an infertility problem may exist. At that point in time, fertility evaluation of the couple is suggested. In the female, this necessitates test to ensure that she is ovulating, that her fallopian tubes are patent, that the uterus is conducive to implantation of a fertilized egg and that the vaginal environment is favorable for the sperm. These studies are done by the woman’s gynecologist. The initial test in the male is a semen analysis. The most significant factors checked in the semen are the sperm concentration and sperm motility. The normal sperm concentration is greater the 40 million per ml and 70% of the sperm should be mobile with a very active forward progression (3-4 plus). Also checked are the volume, viscosity, pH, and total sperm count. If abnormal, the semen analysis is best repeated. To get an accurate analysis, the pre-collection period should include a 3-5 day period of abstinence, The specimen should be collected in a clean, dry container, as much of the specimen as possible should be ejaculated into the jar (including the first and last portion) and it should be kept warm (ie inside coat pocket in the winter) and examined within 1 hour of collection. If the repeat specimen is abnormal, the man is generally referred to a urologist for consultation. A history, physical examination, and specialized tests may be ordered at that time to learn more about the infertility.
If a man has an abnormal semen analysis, it is even more important for his wife to be checked thoroughly as outlined above. Infertility is a couples problem and the finger of guilt should not be pointed at one of them. Trying for a pregnancy is stressful enough without this added pressure.
The options for treatment of the male with an abnormal semen analysis depend on the results of examination and testing. They may include the use of medication (such as clomiphene), surgery (such as to repair a varicocele), sperm pooling, or various insemination techniques. Good luck.
