Basic Workup for Male Infertility
Approximately 90% of male infertility cases are related to poor sperm quality, low sperm counts, or both. Other causes of male infertility are related to hormone imbalances, genetic defects, and anatomical problems. Infertility testing may not be covered by your insurance, so be sure to ask the fertility specialist which tests are right for you.
The doctor will ask questions about certain inherited conditions, illnesses, chronic health problems, injuries, and surgeries that could affect fertility. The doctor will also inquire about sexual development during puberty, as well as past and present sexual habits.
The fertility specialist will do a thorough physical examination, which focuses on the male reproductive system.
The fertility specialist will ask you to provide a semen sample by masturbating and ejaculating into a specimen container at the fertility clinic. The semen is evaluated in the laboratory to assess movement (motility), abnormalities in shape (morphology), and number of sperm (sperm count). The count usually fluctuates from one specimen to the next, so the doctor may have you provide several semen specimens to ensure accurate results.
This test is done using high-frequency sound waves. Images are provided of the testicles and supporting structures so the fertility specialist can look for problems. The test is also used to evaluate for a varicocele (mass of vessels), which is one of the main causes of male infertility.
Male hormones are produced by the hypothalamus and pituitary gland (in the brain), as well as from the testicles. These hormones are key substances for sexual development and sperm production. Any abnormalities in these hormones can contribute to infertility. Hormone testing is done using a simple blood test.
Sperm in the urine after ejaculation indicates that the sperm is traveling into the bladder instead of out of the penis. This is known as retrograde ejaculation, which can contribute to male infertility.
The testicular biopsy is done to assess sperm production. The fertility specialist removes samples from the testicle using a small needle. When sperm production is normal, this indicates that the problem is related to a block or other problem with transport of sperm.
If the sperm concentration is found to be extremely low, the fertility specialist will want to assess for a genetic cause. A simple blood test is done to see if there are subtle changes in the Y chromosome, which indicates genetic abnormality. Genetic testing is also done when there is a risk for certain inherited or congenital syndromes.
When blockages are suspected in either the seminal vesicles or ejaculatory ducts, the fertility specialist will conduct a transrectal ultrasound. This test involves inserting a small wand into the rectum to check the prostate, as well as look for blockages.
Specialized Sperm Function Tests
These tests are used to check how well the sperm survive following ejaculation, as well as how they penetrate an egg. Sperm function studies can also assess if there is a problem attaching to the egg. These tests are not usually performed, as they do not change treatment.