Initial evaluation of male infertility
The cornerstone of a cost-effective male infertility evaluation is a thorough history and physical. We use a standardized questionnaire that is built into an electronic database, populated by patients through a web portal prior to their arrival (visit http://healthcare.utah.edu/andrology/fees.php and click “Male Infertility Questionnaire”). This form, which is an adaptation of an intake form developed by Craig Niederberger and another by Keith Jarvi, is part of an ongoing project to develop a cloud-based male infertility web portal by our group, Pravin Rao, Mike Eisenberg, Keith Jarvi, and others. This intake form covers all aspects of male infertility and provides a baseline analysis of female infertility as well. It auto-populates a clinic note prior to the visit.
Due to the limited ability of electronic medical record systems such as EPIC to support the care of infertile patients, this system has saved us a significant amount of time and allows us to ensure a comprehensive evaluation of male infertility in a timely fashion. This system also allows us to identify simple lifestyle changes that can improve fertility, such as weight loss, reducing exposure to wet heat or spermatotoxic chemicals or medications, quitting smoking, and discontinuing use of cocaine or marijuana. As part of this form, we also obtain an androgen deficiency of the aging male (ADAM) form as well as a Sexual Health Inventory for Men (SHIM) form to assess for hypogonadal symptoms and erectile dysfunction.
Of course, a comprehensive evaluation also includes treating sexual dysfunction, assessing coital technique and frequency, time of vasectomy (if performed), identifying and treating any medical conditions that are contributing to male infertility, and ensuring that a man has a primary care provider. Additionally, we typically refer the female partners of our patients to a reproductive endocrinologist if they have not already seen one. Pyospermia, if present, is treated with a 4-week course of a quinolone and resolution is confirmed with a semen analysis.