Editing Infertility: Diagnosis and Evaluation (section)

=== Serum ===

==== FSH and Morning Total Testosterone ====
*'''<span style="color:#ff0000">Not recommended as a primary first-line test in the evaluation of male infertility[https://pubmed.ncbi.nlm.nih.gov/33295257/ ★]</span>'''
*'''<span style="color:#ff0000">Indications (6):[https://pubmed.ncbi.nlm.nih.gov/33295257/ ★]</span>'''
*#'''<span style="color:#ff0000">Azoospermia</span>'''
*#'''<span style="color:#ff0000">Oligozoospermic (particularly if sperm concentration <10 million/mL)</span>'''
*#'''<span style="color:#ff0000">Impaired libido</span>'''
*#'''<span style="color:#ff0000">Erectile dysfunction</span>'''
*#'''<span style="color:#ff0000">Atrophic testes</span>'''
*#'''<span style="color:#ff0000">Evidence of hormonal abnormality on physical evaluation</span>'''

===== FSH =====
* '''<span style="color:#ff0000">Indirect assessment of germ cell mass</span>'''
** '''<span style="color:#ff0000">If testicle long axis < 4.6 cm and FSH >7.6 IU/L --> consider spermatogenic dysfunction</span>'''
**'''<span style="color:#ff0000">If testicle long axis > 4.6 cm and FSH < 7.6 IU/L --> consider obstructive azoospermia'''

===== Morning Total Testosterone =====
*'''Should be defined based upon a morning blood sample,''' since levels drop during the day
*'''≥300 ng/dL considered adequate (164 ng/dL bioavailable)'''
*'''<span style="color:#ff0000">If fasting morning total testosterone level is low (<300 ng/dL), obtain</span>'''
*#'''<span style="color:#ff0000">Repeat measurement of total testosterone (or bioavailable testosterone)</span>'''
*#'''<span style="color:#ff0000">Free (or bioavailable) testosterone</span>'''
*#'''<span style="color:#ff0000">LH</span>'''
*#'''<span style="color:#ff0000">Estradiol</span>'''
*#'''<span style="color:#ff0000">Prolactin</span>'''  
*#*The relationship of testosterone, LH, FSH, and prolactin helps to identify the clinical condition.

==== Other ====

*'''LH'''
** '''Determine if hypoandrogenism testicular (primary) or pituitary (secondary) in nature'''
* '''Estradiol'''
** '''Ratio of total T:E < 10:1 indicates reproductive dysfunction'''
*'''Prolactin'''
** '''Abolishes GnRH pulsatility, suppresses testosterone production'''
** '''Pituitary disease (hyperplasia, adenoma, tumours), including prolactinoma, is associated with visual field changes, headache, and erectile dysfunction'''
** '''Obtain prolactin if clinically indicated. Consider MRI if very elevated.'''
*** '''Prolactin is a labile assay. Before continuing with further diagnostic assessment or therapy, moderately elevated assay results should first be confirmed with a second test.'''
{| class="wikitable"
|+
!
!Severely impaired spermatogenesis
!Obstructive azoospermia
!Hypogonadotropic hypogonadism
|-
|LH
|Increased or no change
|No change
|Decreased
|-
|FSH
|Increased
|No change
|Decreased
|-
|Testosterone
|Decreased or no change
|No change
|Decreased
|}