The workup for male infertility is an important for couples seeking assisted reproductive technology, especially if a cause for female infertility cannot be established. Although there may be a wide variety of tests, including imaging tests such as ultrasound examinations of the scrotal and transrectal area, urinalysis, semen analysis, and even testicular biopsy.
Blood examinations are key factors in diagnosing male infertility. These examinations screen not only for infections, congenital abnormalities or hereditary illnesses, but also for hormones. These examinations are highly vital for assisted reproductive technology in the Philippines, and prolactin and androgen tests are of particularly high screening and diagnostic value in this regard.
Prolactin is a hormone that has several hundred known effects. Its relevance to fertility issues is based on its effects during the human sexual response. Since prolactin counteracts dopamine, a neurotransmitter associated with arousal, it is closely related to the sexual refractory period. Unusually high levels of prolactin in both men and women are highly correlated with impotence and loss of libido. With this in mind, high levels of prolactin decrease androgen and estrogen hormone levels in both men and women respectively.
High levels of prolactin are also seen in the following disorders:
- Anorexia nervosa
- Drugs (estrogen, tricyclic antidepressants, opiates, amphetamines, anti-hypertension medications)
- Hypothyroidism
- Prolactinomas
Low levels of prolactin are usually indicative of hypopituitarism or the use of drugs such as dopamine and levodopa.
Androgens in adult men are responsible for facilitating spermatogenesis by working cooperatively with follicle-stimulating hormone (FSH) to act on Sertoli cells in the testes. However, excessive levels of androgens due to the intake of supplements may inhibit luteinizing hormone (LH), and this process prevents Leydig cells in the testes from producing androgens themselves. This absence of endogenous androgens leads to infertility.
Blood tests for androgens, therefore, are of particular value for male patients dealing with infertility, and complain of symptoms of impotence or have a laboratory finding of low sperm count. It can be used to diagnose causes of erectile dysfunction, as well as evaluate abnormal sex characteristics such as gynecomastia, which is the abnormal development of breast tissue in males. Once a blood sample is drawn, the test for androgens measures testosterone that is not bound by carrier proteins, as well as those bound to them. Carrier proteins include albumin and sex hormone binding globulins.
High levels of testosterone in adult men may be due to any of the following conditions:
- Testicular or adrenal tumors
- Use of anabolic steroids
- Hyperthyroidism
In turn, low testosterone levels may be due to the following scenarios:
- Hypothalamic disorders
- Pituitary diseases
- Klinefelter syndrome
- Alcoholism, physical injury to the testes
Once blood tests results for both prolactin and androgen have been correlated with clinical findings, further diagnosis can follow, or the IVF or assisted reproductive therapy specialist can initiate the appropriate course of treatment.