In the microscopic examination of sperm one looks, for example, at the number of sperm cells, their mobility and their shape. The volume of the sperm sample and the degree of acidity are also recorded. It is important that there should have been no ejaculation for three days: research has shown that that is when sperm quality is at its highest, and in addition different sperm samples can in that way be compared over time. We find that it is difficult for many men to produce sperm in the laboratory. However, if the sperm sample is obtained in more familiar surroundings, it is important that the sperm is delivered to the laboratory within the hour. The sperm must be collected directly into a jar provided for the purpose – the use of a patient’s own jars is not to be recommended. The same applies to catching the sperm in a condom: rubber and latex are harmful to sperm cells. Of course it is crucial that all the sperm ejaculated is collected. If something gets lost, there is no point in taking the rest of the sperm to the laboratory. It is much better to arrange a new date with the lab.

Echography is a painless form of examination using sound waves, with which organs and blood vessels can be examined. Echography in the case of a subfertile man concerns mainly the contents of the scrotum, the groin, the prostate and the seminal glands. An echo can give indications of abnormalities in the testicle (inflammation, tumours), the epididymsis (engorgement, inflammation) and in the membranes surrounding the testicle (hydrocele). In combination with a measurement of the flow speed (colour Doppler echography), exam­ination of the seminal cord can help locate a varicose vein quickly. Echography of the prostate and seminal glands is called for if there is a suspicion of inflammation or if the volume of sperm is repeatedly too low. This examination is performed by the rectal insertion of an echo sensor, which is placed against the prostate. This is not painful and can be carried out in an outpatient department. In this way abnormalities of the prostate (inflammation, calcification, enlargement, cancer) and the seminal glands (engorgement, or absence) can be brought to light.

The level of hormones like lh, fsh, inhibine and testosterone in the blood can be measured. With the passage of time there is a clear reduction in inhibine concentration and an increase in fsh. Both phenomena point to reduced sperm production. This loss begins shortly after the age of 21. This is not, though, the first sign of aging: that has to be the loss of one’s milk teeth.