Male Infertility Diagnosis: Complete Testing Guide

When a couple struggles with infertility, it’s assumed that the problem lies within the female reproductive system. But did you know infertility in men is just as common as it is in women? 

According to the National Center for Biotechnology Information, 20% of infertility cases are due to male-factor infertility alone, while 30-40% of infertility cases have male factor as a contributing factor. This means roughly 50% of all infertility cases are linked to male-factor infertility. 

If partners were more open about male infertility diagnosis, more people would receive timely treatment, thus improving their chances of conception. So, what exactly is male infertility? And why does diagnosis matter? Let’s find out.

What Is Male Infertility?

Male infertility refers to a man’s inability to impregnate their female partners after having regular sexual intercourse for over a year or more. A man’s contribution to conception involves producing adequate amounts of healthy sperm cells and transporting them effectively to the female reproductive tract. 

There could be many things that can go wrong at different points. For example, the hormones that control sperm production can be disrupted, thus leading to low sperm count. Or, sperm could be abnormally shaped or not move properly. In some men, sperm production and quality are normal, but the obstructions in paths that transport sperm can cause infertility. 

Sometimes, injuries, chronic illnesses, and lifestyle choices can contribute to male-factor infertility. That’s why a comprehensive male reproductive health checkup includes much more than a basic semen analysis test. You may have a normal sperm count, but still have other fertility problems.

Common Causes of Male Infertility

Male infertility can have one or many causes, and sometimes no identifiable cause. Here’s a look at some common factors that might contribute to male-factor infertility.

Sperm-related Issues

Sperm-related issues are considered the most common infertility causes in men. Your body might produce fewer sperm cells than what’s considered normal to impregnate a female partner. This is called oligospermia. Or worse, no sperm cells might be detected in a semen sample, a condition called azoospermia. 

A sperm test for infertility might show low motility, i.e., reduced movement. For successful fertilization, sperm must move in the forward direction, toward the egg, and at a speed of 25 micrometers per second. Poor motility can prevent sperm from reaching the egg, thus making fertilization difficult.

Another vital factor is morphology. For a sperm cell to be considered normal, it must feature a long, uncoiled tail, a smooth, oval head, and a slim midpiece. A male partner must have at least 4% of normal-shaped sperm.

Hormonal Problems

Follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone are the key male reproductive hormones that play a big part in sperm production. Hormonal imbalance can disrupt the signal from your brain to the testicles, thus affecting testosterone production and consequently sperm production. 

Higher levels of estrogen and prolactin can also interfere with testosterone production and reduce sperm quality. However, low testosterone doesn’t necessarily mean poor sperm production in all men. It’s important that you have proper male infertility testing and discuss the results with a fertility expert rather than starting self-treatment with testosterone medication.

Structural Problems

Structural problems are the blockage in the male reproductive tract or obstructions in the pathway that carry sperm to the ejaculate. It’s different from sperm production. 

Let’s see how it works. 

Your sperm is produced in the testicles. It travels through the tubes, mixes with semen, and is released out of the penis during ejaculation. You may have healthy and normal-shaped sperm, but something along this transportation path can prevent sperm from mixing with the semen and getting released. 

Blockage in the transportation tubes can occur due to previous surgery, infection, injury, or congenital defects, such as being born without one or both vas deferens

Testicular Conditions

Testicles are where sperm is produced. So, any problem in the testes can directly affect sperm production. For example, injuries, undescended testes, genetic conditions, cancer treatment, or an infection can all affect testicular function, which in turn reduces sperm count and affects its quality.

Lifestyle Factors

Certain lifestyle factors are also linked to increased risk of male infertility. For example, prolonged use of Anabolic steroids to build muscles can shrink the testes and reduce sperm count. 

Likewise, alcohol consumption is linked to low testosterone levels, while smoking can affect a male’s fertility in many ways. It can reduce sperm count, affect motility, and damage genetic DNA. 

Environmental Factors

Repeated exposure to industrial chemicals, such as pesticides, herbicides, and organic solvents, as well as heavy metals, such as lead, can affect sperm production. Excessive and regular exposure to heat can also affect sperm production. 

Normally, for sperm production, testes function in temperatures below core body temperature. So, using saunas, sitting in hot tubs, or having radiation therapies near the testes can all contribute to male-factor infertility.

How Is Male Infertility Diagnosed?

Fertility assessment for men includes many tests that check hormonal levels, sperm parameters, and physical health of the testes. Here’s what helps identify male-factor infertility and relevant causes.

Medical History Evaluation

During your first consultation, you will be asked questions about your sexual life, previous pregnancies, surgeries, known fertility problems, and how long you have been trying to impregnate your partner. 

The doctor will also want to know your medical history, such as undescended testicles, injuries, infections, or illnesses that might affect your fertility. For example, long-term exposure to radiation therapy and chemotherapy can affect sperm production. 

Expect questions related to your lifestyle, such as whether you smoke, drink alcohol, or consume drugs. They may assess your weight, as that too influences your fertility.

Physical Examination

A physical examination involves checking the testes for size and overall structure. Smaller testes can sometimes indicate impaired sperm production. Additionally, the fertility doctor may check the epididymis, vas deferens, penis, and scrotum.

Semen Analysis

The first and most crucial infertility test for men is semen analysis. It gives important clues about a man’s semen and sperm health. The important parameters examined in the test include sperm concentration, motility, and morphology. Based on the laboratory and clinic, additional parameters might be included in the reports. 

Note that a single abnormal semen analysis result doesn’t necessarily mean you are infertile. Oftentimes, a repeated test is ordered, as sperm production may vary and might change from one test to another. 

Another crucial thing to know is that semen analysis is a part of a man’s fertility evaluation, not a confirmed diagnosis. Those with an abnormal semen analysis can father a child, while many with normal results might still face difficulty in conception.

Hormone Testing

A hormone test is advised when your semen analysis or medical history suggests a hormonal issue. Your doctor may check testosterone, LH, and FSH, and in selected cases, prolactin and estrogen. Hormone tests are mainly advised for men with oligospermia or azoospermia.

Scrotal Ultrasound

A scrotal ultrasound can be a reasonable diagnostic option in selected patients. The test uses high-frequency sound waves to produce images of the inside of the testicles and surrounding structures, providing important clues about structural changes in a man’s reproductive tract. 

However, scrotal ultrasound isn’t routinely performed for all infertile men. It’s advised when other tests strongly indicate a structural defect that could be contributing to infertility.

Sperm DNA Fragmentation Test

While semen analysis can detect basic sperm parameters, a more advanced test, such as sperm DNA fragmentation, may sometimes be necessary. The test provides insights into damage in the sperm’s DNA. 

Higher DNA fragmentation means a larger number of sperm cells are damaged, which might also explain recurring pregnancy losses or poor embryo growth. Again, sperm DNA fragmentation isn’t part of routine male infertility tests. Even though it creates a detailed picture of your sperm health, it is only recommended when other routine fertility tests do not identify major underlying fertility issues, or you have a history of multiple pregnancy losses.

Genetic Testing

For severely low sperm count or repeated miscarriages without an identifiable cause, a fertility expert may order genetic testing. 

A karyotype test is one such genetic screening that tells the size, shape, and number of chromosomes in the collected sample of cells, thus identifying chromosomal or genetic abnormalities. The test helps your doctor look at the 23 pairs of human chromosomes, which further helps them investigate the cause of recurring miscarriages.

Y Chromosome Microdeletion, a leading cause of male infertility, is a genetic disorder that suggests missing DNA pieces on the Y chromosome. Men with this condition often appear normal and have no noticeable symptoms, apart from difficulty impregnating their female partners. Y chromosome microdeletion test is a blood test that detects the missing DNA on the male chromosome. It’s advised for men with low or no sperm count.

Testicular Biopsy

Testicular biopsy is an advanced fertility test recommended for men with azoospermia or complex reproductive health issues. The procedure involves taking a small tissue sample from the testicles for biopsy. 

Standard diagnostic protocols include less-invasive diagnostic procedures, such as semen analysis. Scrotal ultrasound and physical examination often help doctors assess the root cause of male-factor infertility. 

These tests can also tell whether it’s obstructive or non-obstructive azoospermia, which is why testicular biopsy is recommended as part of broader assessment for male-factor infertility rather than as a routine procedure.

Micro-TESE Evaluation

Severe non-obstructive azoospermia is when no sperm is found in the semen sample. Micro-TESE isn’t a routine male infertility assessment test, but a carefully planned advanced fertility procedure that involves extracting sperm directly from the testicular tissue. The sperm is then used for IVF fertilization, most likely through ICSI. 

When Should Men Get Fertility Testing?

The most common reason for couples to undergo fertility assessment is when they have been continuously trying sex without protection for over 12 months without success. Both partners must get fertility evaluation at this point. 

Some men are advised to undergo fertility assessment earlier if they have a medical history of surgeries, injuries to the testicles, illnesses, or prolonged exposure to chemotherapy or radiation. 

Besides, advancing maternal age is another major concern. Pregnancy depends on both partners’ fertility status, so a female partner must be assessed sooner if they are above 35, as advancing age can reduce fertility.

Male Infertility Treatment Options

Male infertility treatment is planned based on the male infertility diagnosis. Here’s what the doctor may recommend:

• Lifestyle Changes: Sometimes, simple lifestyle modifications, such as quitting alcohol, anabolic steroids, and recreational drugs, can address the underlying infertility. 
• Medicines: For hormone-related infertility, the fertility expert may prescribe medication that encourages your brain to produce hormones that boost testosterone and other reproductive hormone production. This may include clomiphene citrate, human chorionic gonadotropin (hCG), and aromatase inhibitors (e.g., anastrozole).
• Surgery: When there’s a clear physical issue that’s blocking sperm transportation, such as a varicocele, surgery can be an appropriate treatment choice.
• IUI: IUI prepares the sperm by removing dead cells, seminal fluid, and debris from the sample and transferring healthy, fast-moving sperm directly into the uterus. It’s an assisted reproductive procedure that’s relatively less invasive than IVF, but can help couples achieve pregnancy.
• IVF: IVF is an advanced fertility procedure that involves placing sperm and egg in a specialized incubator for fertilization outside the uterus.
• ICSI: In ICSI, a single sperm cell is injected into the egg to maximize the chances of fertilization in couples with repeated IVF failures or severe male-factor infertility.
• Surgical Sperm Retrieval: If sperm is produced in the testicles or is found in the epididymis, a small surgical procedure that retrieves sperm directly through the testes can be considered.

FAQs

Can male infertility be diagnosed with one test?

No, it requires a comprehensive fertility assessment that includes physical examination, medical history assessment, semen analysis, and, in selected cases, testicular biopsy or micro-TESE evaluation.

Is semen analysis enough to diagnose infertility?

While it matters the most, the test isn’t always enough to diagnose the root cause of infertility in men.

Can men with low sperm count have children?

Absolutely. Low sperm count alone doesn’t mean you can’t father a child. Many are able to conceive despite low sperm count.

Is male infertility treatable?

Yes, most cases of male infertility, such as varicocele, low sperm count, poor motility, and hormonal imbalance, are treatable.

How long does male fertility testing take?

There’s no standard timeframe. Some tests are quick, with results often being handed the same day as the test. 

Conclusion

Male-factor infertility is treatable. The bigger challenge isn’t the treatment, but diagnosis. Early diagnosis can help couples identify the cause of infertility and seek appropriate treatment. Ideally, every couple who’s struggling to get pregnant for a long time should see a fertility expert rather than believing the infertility-affects-women-only myth. The sooner treatment starts, the better your chances of getting pregnant.