Editing Infertility: Diagnosis and Evaluation (section)

=== 2020 AUA Guidelines'''<span style="color:#ff0000">[https://pubmed.ncbi.nlm.nih.gov/33295257/ ★]</span>''' ===
*'''<span style="color:#ff0000">History and physical exam</span>'''
* '''<span style="color:#ff0000">Labs</span>'''
** '''<span style="color:#ff0000">Semen analysis</span>'''
*** '''<span style="color:#ff0000">At least two SAs obtained a month apart are important to consider, especially if the first SA has abnormal parameters[https://pubmed.ncbi.nlm.nih.gov/33295257/ ★]</span>'''
****'''Semen parameters are highly variable biological measures and may vary substantially from test to test'''
****'''Up to 35% of men with non-obstructive azoospermia will have sperm detected on subsequent SA without medical intervention[https://pubmed.ncbi.nlm.nih.gov/9222005/]'''
**'''<span style="color:#ff0000">Serum</span>'''
***'''<span style="color:#ff0000">FSH and morning total testosterone, if</span>''' '''<span style="color:#ff0000">(6):</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>'''
****'''<span style="color:#ff0000">If testosterone low (<300ng/mL), get (5)</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 levels</span>'''
**'''<span style="color:#ff0000">Genetic testing, if indicated (see below)</span>'''
***'''<span style="color:#ff0000">Karyotype and Y</span><span style="color:#ff0000">-microsome deletion</span><span style="color:#ff0000">, if</span>''' 
****'''<span style="color:#ff0000">Primary infertility and (</span><span style="color:#ff0000">3</span><span style="color:#ff0000">):</span>'''
****#'''<span style="color:#ff0000">Azoospermia or severe oligozoospermia (<5 million sperm/mL) with elevated FSH OR</span>'''
****#'''<span style="color:#ff0000">Testicular atrophy OR</span>'''
****#'''<span style="color:#ff0000">Presumed diagnosis of impaired sperm production as the cause of azoospermia</span>'''
***'''<span style="color:#ff0000">Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) mutation carrier testing (including assessment of the 5T allele), if (3):</span>'''
***#'''<span style="color:#ff0000">Vasal agenesis (unilateral or bilateral)</span>'''
***#'''<span style="color:#ff0000">Idiopathic obstructive azoospermia</span>''' 
***#'''<span style="color:#ff0000">If the female partner is a carrier (to consider for preimplantation diagnosis)</span>''' 
*'''<span style="color:#ff0000">Imaging</span>'''
**'''<span style="color:#ff0000">Renal ultrasound, if (1):</span>'''
**#'''<span style="color:#ff0000">Vasal agenesis</span>''' 
**'''<span style="color:#ff0000">Trans-rectal ultrasound, if (3):</span>''' 
**#'''<span style="color:#ff0000">Low semen volume with azoospermia and palpable vasa OR</span>'''
**#'''<span style="color:#ff0000">Low semen volume and significant asthenospermia (total motility <40% or progressive motility <32%) OR</span>'''
**#'''<span style="color:#ff0000">Symptoms (e.g. painful ejaculation)</span>'''