Infertility Evaluation

Individual differences (such as a woman’s age, social preferences, or the presence of known risk factors) make it possible to conduct an infertility evaluation at an earlier stage. Infertility treatment—which is often misunderstood by many families—does not consist solely of in vitro fertilization (IVF) procedures. Identifying the underlying cause of infertility is the first step in treatment. Furthermore, the fact that life-threatening conditions are detected in approximately 1% of patients during the evaluation of male infertility alone underscores the importance of this evaluation once again.

The first step in infertility evaluation is to identify and correct any potential issues in the couple’s sexual life. Sperm cells can remain viable inside the woman’s uterus for 2 to 5 days. For this reason, it is recommended that couples have intercourse every other day during the woman’s ovulation period. 

While having sex more frequently can reduce the number of sperm transferred, having sex less frequently can result in missing the ovulation window. Lubricants used during sex may have a harmful effect on sperm quality. For this reason, it is recommended that couples trying to conceive avoid using them.

Many illnesses experienced during childhood and adulthood can contribute to male infertility. While testicular torsion, groin surgeries, or mumps contracted after puberty may be associated with infertility, diabetes, thyroid disorders, nervous system disorders, and cancers can also cause male infertility. In addition, medications, environmental factors, and exposure to chemicals can impair sperm quality and lead to infertility. Another factor that is often overlooked is smoking. Scientific studies have shown that in men who smoke regularly, sperm count, motility, and quality are impaired. For this reason, smoking should be discontinued not only to reduce the risk of infertility but also to improve the success rates of assisted reproductive technologies.

Sperm analysis (spermiogram) is crucial in the evaluation of male infertility. While a properly collected sperm sample can provide vital information about infertility, an improperly collected sample may lead to unnecessary further testing. For this reason, patients must understand the collection procedure and follow the guidelines. Sexual abstinence is required for 2–7 days (on average 3–4 days) prior to providing the sample for a semen analysis. Masturbation is the most commonly used method for ejaculation, and chemical lubricants should not be used during this process.

Some patients’ attempts to collect a sample using the withdrawal method may lead to inaccurate results due to insufficient material. Sperm must be ejaculated into a sterile container suitable for sampling, which will be provided by the laboratory. The collected sample must be delivered to the laboratory without delay. Under normal conditions, the maximum waiting time is 1 hour; test results may vary if this time is exceeded. Sperm analysis is evaluated according to the criteria established by the World Health Organization. However, values above the specified thresholds do not definitively indicate fertility, nor do values below them definitively indicate infertility. Patients with abnormal results should have their semen analysis re-evaluated at least 3 weeks later. Further evaluation may be conducted based on risk assessment and test results, and this process must be carried out entirely under the supervision of urologists.

Only 3% of male infertility cases are caused by hormonal disorders. For this reason, the role of hormonal medications—which are often used indiscriminately by many people—in infertility treatment is quite limited, and they should be administered only to patients who truly need them. The goal of infertility treatment is to help families have healthy children. However, during this process, it is essential to select cost-effective, appropriate treatment methods and to ensure that family members are not harmed during treatment. To achieve all of this, the correct evaluation must be performed by qualified professionals.

The absence of sperm cells in the ejaculate is referred to as “azoospermia” and can result from hormonal causes, testicular tissue-related issues, or damage to the sperm transport pathways. Another condition is “oligospermia,” defined as having fewer than 20 million sperm cells per milliliter of ejaculate. Identifying the cause in these patients is more difficult, and in some cases, the cause may not be fully determined. While a decrease in sperm count can cause male infertility, impaired sperm motility and structure can also lead to infertility in men. On the other hand, there are also couples who are unable to conceive even though their sperm parameters are normal. Ultimately, every identified characteristic must be carefully evaluated, as it could be a sign of a medical condition.