Retrograde Ejaculation

Retrograde ejaculation occurs when the muscles of the urethra do not pump properly during orgasm and sperm are forced backward into the bladder instead of forwarding out of the urethra. This condition is a common consequence of bladder neck or prostate surgery and may also be caused by diabetes, multiple sclerosis, and spinal cord injury. It can also be a temporary side effect of certain drugs such as tranquilizers or hypertension medication.

Tests used to Diagnose Male Infertility

Physical Exam

A urologist will usually perform a physical examination to detect any abnormalities, such as a varicocele in the testes and prostate problems. Checking the size of the testicles is also helpful. Smaller–sized and softer testicles along with tests that show low sperm count are strongly associated with essential problems in sperm production, a low–sperm count in men whose testicles have normal size and consistency indicate possible obstruction. The temperature of the scrotum can be determined with a test called scrotal thermography. The physician may also take a urine sample to detect sperm in the urine (indicating retrograde ejaculation).

Semen Analysis

The basic test to evaluate a man’s fertility is a semen analysis. To perform this test, a man collects a sample of his semen in a collection jar during masturbation either at home or at the physician’s office. For those for whom religion or culture prohibits masturbation, a silicon semen collection device (stockiest–Rocket) may be available that will enable collection of a sample during sexual intercourse. A man should abstain from ejaculation for several days before the test, because each ejaculation can reduce the number of sperm by as much as a third. (The maximum number of sperm is usually obtained by abstaining for about four days.)
Proper collection procedure is important, since the highest concentration of sperm is contained in the initial portion of the ejaculate. The sample should be kept at body temperature and delivered promptly, because if the sperm are not analyzed within two hours or kept reasonably warm, a large proportion may die or lose motility. A semen analysis should be repeated at least three times over several months. Both the man and the woman should be present when the physician discusses the result of this analysis so that both partners will understand the implications. The analysis should report any abnormalities in sperm count, motility, and morphology as well as any problem in the semen.

Sperm Count

A low sperm count should not be viewed as a definitive diagnosis of infertility but rather as one indicator of a fertility problem. Counts of less than 20 million per milliliter are currently considered strong indicators of infertility, although pregnancy is sometimes possible even with such low counts.

Sperm Motility

Motility (the speed and quality of movement) is graded on a 1 to 4 ranking system. Grade 1 sperm wriggle sluggishly and make little forward progress. Grade 2 sperm move forward, but they are either very slow or do not move in a straight line. Grade 3 sperm move in a straight line at a reasonable speed and can home on an egg accurately. Grade 4 sperm are as accurate as Grade 3 sperm, but move at terrific speed. Sperm that clump together may indicate that antibodies to the sperm are present. This test may be particularly valuable for predicting the success of artificial insemination although less useful for those are candidates of the ICSI fertilization technique, in which the sperm is inserted directly into the egg and motility plays almost no role.

Sperm Morphology

Morphology is the structure of the sperm. About 60% of the sperm should be normal in size and shape for adequate fertility. Determining the morphology of the sperm is particularly important for the success of the fertility treatments in vitro fertilization (ART) and intracytoplasmic sperm injection (ICSI).