Male Fertility Testing: How To Check Fertility In Men

Man giving semen sample to doctor for a male fertility test.

Comprehensive male fertility testing involves checking several factors to determine whether or not you’re infertile. Additionally, these tests are useful in ascertaining which treatment options may be available to you should there be a problem.

If you’re a man and you haven’t been able to conceive a child, it’s important to make an appointment with your doctor.

Why Take A Male Fertility Test?

The most common reason for male fertility testing is to help couples conceive or who are having difficulty getting pregnant. Other reasons to undergo fertility testing include:

  • ​Before freezing your sperm to ensure that you have provided a good sample.​​​​
  • After a vasectomy to make sure it was successful.
  • After a vasectomy reversal to verify that healthy sperm are present in the semen.
  • Simply to get additional information about your overall health.

When To Have Testing Done

Doctors have traditionally recommended fertility testing after attempting to conceive unsuccessfully for 12 months. If the woman is older than 35, testing is recommended after 6 months of unsuccessfully conceiving.

However, some experts believe that having basic male fertility testing done earlier while trying to conceive may prove to be helpful.

One reason for this is that a semen analysis is not invasive and isn’t overly expensive. In-office testing will typically cost around $250, while an at home sperm test costs less than $150.

Another reason is that because men can improve their fertility by making lifestyle changes, it’s possible to save both time and money by testing male fertility earlier in the process and taking steps that will improve it.

Initial Fertility Evaluation

Your first step should be a visit to a urologist. This doctor will perform a physical examination on you and ask questions about your health and past medical history, including:

  • Any previous surgeries you may have had.
  • Any medications you are currently taking.
  • Diet and exercise habits.
  • Other lifestyle habits, such as smoking, drinking, and recreational drug use.

The doctor might also ask you questions about your sexual history. This could include any past or present problems such as erectile dysfunction (ED), delayed ejaculation or retrograde ejaculation, and whether or not you’ve ever been diagnosed a sexually-transmitted disease (STD).

You will also likely be asked to take a semen analysis as well.

Types of Testing for Male Fertility

It can be difficult determining what exactly is causing your infertility. While the diagnostic methods used by male infertility specialists may vary, the following are some or the more common tests that are performed.

Semen Analysis

After submitting a semen sample for analysis, a qualified professional examines your sperm count and other factors, including morphology (shape) and motility (movement). If you have an ample amount of normal-shaped sperm, it is generally a sign that you have greater fertility.

However, there are many exceptions. A number of men with abnormal semen or low sperm counts are still fertile. Additionally, some men have normal sperm counts and semen, but are still infertile nonetheless.

Your doctor may order another test if the first semen analysis results are normal.  A second test is often given in order to confirm the results.

If both of these tests are normal, it’s usually a sign that you don’t have significant problems with fertility. If your results indicate something out of the ordinary, your doctor might need you to take additional tests to help determine the source of the problem.

If there is no sperm or semen at all, it could very well be caused by some type of blockage in the reproductive system. In many cases this is something that can be repaired by surgery.

Ultrasound

Your doctor might request ultrasound imaging in certain circumstances to ensure that your anatomy is clear and free from obstructions. There are two forms of ultrasound that may be used: Scrotal and transrectal.

Scrotal Ultrasound

This test uses a handheld probe that emits high-frequency sound waves. The device is passed across the scrotum to look for:

Although present in a number of adult men, varicoceles are usually not bothersome. However, it may be recommended by your doctor if you are having problems with infertility.

Transrectal Ultrasound

This test uses a small wand that is lubricated and inserted into the rectum. Your doctor can use the imaging to examine your prostate and verify that there aren’t any blockages in your vas deferens.

Surgery can usually be used to correct any blockages.

Urinalysis

Sometimes you may still experience difficulties conceiving even though your sperm cells pass all of the medical tests required for fertility. A urinalysis is used to detect a condition called normozoospermic infertility. This is when testing shows that the sperm cells are otherwise healthy, but are nevertheless infertile.

After providing a small sample of your urine at the doctor’s office, it will be tested by urinalysis to detect certain molecules called “biomarkers”. These biomarkers can indicate the physiological issues behind the normozoospermic infertility.

Assessing Hormone Levels

When it comes to the production of sperm, the pituitary, hypothalamus and testicles functioning together is crucial.

Follicle stimulating hormone, FSH (follicle stimulating hormone) and LH (luteinizing hormone), working together with testosterone, are key components in this process. These three key hormones are easily detected by a simple blood test.

FSH (Follicle-Stimulating Hormone)

This hormone assists in sperm production.

Low levels could indicate that you have low or no sperm production. High levels could show that your testicles are not working properly, or could be damaged due to disease, chemotherapy or X-rays.

LH (Luteinizing Hormone)

Produced by the pituitary gland, LH attaches to receptors in the Leydig cells in the testes to release testosterone. Testosterone is necessary for the sperm production process.

By testing your LH levels, your doctor can determine if the problem is in your pituitary gland or elsewhere in the body.

Testosterone

Healthy testosterone levels are crucial for sperm production. Men should have testosterone levels between 300-1,000 nanograms per deciliter (ng/dL). Remember that testosterone levels drop by around 1 % each year after age 40.

Testing For Antisperm Antibodies

If the cause of infertility remains unclear, your doctor may request testing for antisperm antibodies.

Using a sample of your semen, this test looks for sperm antibodies that fight against your sperm cells. This condition can be caused by things like injury, surgery, or infection of the prostate gland.

The greater the number of sperm impacted by antibodies, the less likely they are to fertilize an egg. Additionally, women can have these types of antibodies as well, so your doctor might ask that your partner be tested also.

Testicular Biopsy

If the results of any other tests aren’t conclusive, a testicular biopsy may be the last option.

This test involves retrieving a tissue sample directly from the testicle with either a needle or through a small incision. If normal sperm production results are obtained through a testicular biopsy, it could indicate that the infertility is due to a blockage or other issue involving the transport of sperm.

Genetic Testing

Research on genetic causes of infertility has increased since the introduction of in vitro fertilization treatments (IVF). 10-20% of men with severe disorders in sperm production have genetic abnormalities.

It is possible for the DNA carried by the sperm to be damaged, making it difficult for them to fertilize an egg properly. This is referred to as DNA Fragmentation and it’s linked with a decrease in pregnancy rates and increased instances of abnormal embryos.

DNA fragmentation is usually associated with aging. However, there are other causes such as infection, high fever, exposure to toxins, smoking, and drug use.

Genetic testing of sperm DNA can be used to identify chromosomal abnormalities. This is particularly true for men who have either a low sperm count (oligozoospermi, or an absence of sperm in the semen (azoospermia).

DNA testing is not a standard method for measuring male fertility. However, this type of testing may be an option for men who have certain risk factors known to be associated with sperm fragmentation.

When Testing Doesn’t Identify The Problem

If all your tests have all come back with normal results, your doctor may diagnose you as having idiopathic infertility. This simply means there is currently no way to determine the cause of your infertility.

Although it won’t make your pain or frustration go away, it may help in knowing that others are also experiencing the same thing. Both men and women are often diagnosed with idiopathic infertility, and it is actually quite common.

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