What Happens During a Fertility Consult?
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During a male fertility consult, you will see a urologist or an andrologist (a urologist who has had special training in male reproductive medicine and surgery). They will start by taking a history about your fertility journey and your medical history (be ready for some intimate questions about your sex life!), as well as questions about any potential exposures to things that could contribute to issues with fertility. You will also have a genital exam (penis and testicles - no rectal exam, don’t worry!). The exam is to assess the penis for any abnormalities that may relate to issues with erections or with ejaculation, and assess the testicles for their size (as sperm production contributes greatly to testicle size), any masses/nodules, and signs of a varicocele (dilated veins that sit above the testicle which can decrease sperm number and quality due to increased pressure and/or temperature on the testicle). Please see the question below about varicoceles for more details.
You will also have some labs (a blood draw) done to take a look at your sex hormones (which include testosterone, as well as some hormones that the brain produces to communicate with the testicles to produce sperm (FSH) and testosterone (LH)).
If you have not yet had one, you will also likely be told to give a semen sample for analysis (and possibly multiple). Make sure that you do no ejaculate/have sex on the day of your visit just in case they want you to leave a sample that day - but also don’t avoid ejaculation for longer than 3-5 days (as this can skew the results).
This is overall the extent of the initial work up. Depending on the history/physical exam, results of the labs, and results of the semen analyses, the next steps will be determined. These steps can include things like more testing (including potentially genetic testing or DNA fragmentation testing), prescribing a medication, recommending a procedure to repair a varicocele to improve sperm parameters, or recommending a testis biopsy to assess the tissue for sperm, or even recommending a sperm harvesting procedure. It is important to note that all patients are candidates for fertility supplementation regardless of the work up to attempt to improve the sperm.
*This post is for educational purposes only, and should not be taken as medical advice. If you have personal medical questions, consult with your personal physician*