your husband may appear impotent to you mainly due to lack of interest /attraction but may appear potent to another female :-) wherein studies have shown .
Urinalysis. Analysis of urine can provide information about protein and sugar in the urine. If present, these substances could indicate diabetes or kidney disease, which can cause erectile dysfunction.
Kruger Strict Morphology
A routine semen analysis typically assesses the volume, concentration, percent motility and progression of the sample. While these components are essential for understanding a possible male factor source of infertility, sperm morphology determined by the "Kruger strict morphology" method has the greatest correlation to successful in-vitro fertilization (IVF). In fact, the Kruger method is the only morphology scoring system shown to have a clinical predictive value for the sperm being able to actually fertilize an egg in-vitro.
The Reproductive Care Center is the only IVF center in Utah that routinely performs this test as part of the initial semen analysis evaluation. Kruger strict morphology testing can also be completed at the time of intrauterine insemination (IUI) (for an additional cost) if desired. This is often done if an initial semen analysis was completed in an outside lab.
For this test, freshly ejaculated sperm are smeared on a slide and stained using a morphology staining product for human sperm. Sperm are judged as normal based on the following criteria:
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Head must be oval in shape with smooth contours, 5-6 µm in length and 2.5 to 3.5 µm wide with the acrosome taking up 40-70% of the head.
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Neck and mid-piece must have no abnormalities and a cytoplasmic droplet (a remnant from sperm production) if present must not be larger than half the size of the head.
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Tail must not be coiled or bent and should not have a droplet at the end.
After 200 individual sperm are counted at a magnification of 1,000 times, the percent normal forms is calculated. The prognosis is based on the following scale:
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>=15% normal: |
Normal range - Good prognosis |
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5-14% normal: |
Sub optimal range - Prognosis is fair to good, however, the lower the percent normal, the lower the chance of successful fertilization |
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0-4% normal: |
Poor prognosis - Will usually need IVF with intracytoplasmic sperm injection (ICSI) |
The Kruger strict morphology test can be highly subjective, therefore choosing a lab with extensive daily experience that can also correlate the results with fertilization in vitro is extremely important.
Based on our experience we currently recommend a couple consider IVF with ICSI if the Kruger strict morphology is 5% or lower. Intrauterine insemination is often recommended for couples with Kruger results in the sub optimal but good prognosis range if there are no other factors that would prevent pregnancy.
When a couple is undergoing IVF we usually recommend ICSI if the Kruger strict morphology is 8% of less in order to minimize the likelihood of no fertilization and to maximize the number of eggs that fertilize. Each individual is different and your physician will review the complete semen analysis results in order to make a specific recommendation.
Physcial Examination
The evaluation of the male with erectile dysfunction consists of three distinct parts, namely, a structured interview, physical examination, and adjunctive testing. While the role of the latter is debated for the general erectile dysfunction population, there are some patients who benefit from identifying a cause of the ED. All patients presenting for the evaluation of impotence should undergo a comprehensive history and a focused physical examination. The purpose of this approach is to define (1) that the patient suffers from s*xual dysfunction and to determine the nature of this, (2) that the patient has adequate exercise tolerance to resume s*xual relations, (3) that the patient does not have any conditions in his medical or surgical history that represent contraindications to specific therapies and (4) to seek out factors in the patient's medical surgical and s*xual history that may indicate an etiology of his s*xual dysfunction.
