Male Fertility Testing – How Do You Know if You Are Infertile?

By (embryologist) and (babygest staff).
Last Update: 02/21/2019

After a year of having unprotected sexual intercourse, there may be a fertility problem in either the man, the woman, or both. To find out, it is necessary to do some tests on both. In the masculine case, they are the seminogram, the physical exam and the hormonal test.

In addition to these basic studies of male fertility, there are other more specific ones. In this article we will explain all these tests that men who want to be fathers and don’t get it naturally undergo.

Physical Exam

One of the first steps in case of suspicion of male infertility is to make an anamnesis of the patient. It consists of an interview with the specialist in order to analyse the general health of the patient, his medical history, the quality of sexual relations, etc.

Next, the male reproductive system is analysed to study the presence of any physical defect that may be preventing conception.

Usually, the specialist (urologist) performs the following:

  • Male Height and Weight
  • Abdominal, groin, penis, testicles and prostate exams and palpation. In the case of the testicles, aspects such as their volume or consistency will be carefully studied.
  • Ultrasound of the genital area (not always done)

With this scan, the aim is to discover if there is any problem in the genital anatomy that complicates the deposition of semen in the vagina. In addition, testicular palpation may lead the specialist to suspect an error in spermatogenesis (production of spermatozoa) or some alteration that prevents the spermatozoa from leaving when ejaculating.

In any case, in order to confirm it, it will be necessary to carry out other tests such as those described below.

Seminogram

After checking that there are no anatomical problems that hinder intercourse, a seminogram, also known as a spermiogram or spermogram, is performed.

This is a detailed analysis of a semen sample obtained by masturbation after a period of abstinence of between 3 and 5 days. In this sperm examination, we analyze the sample, both with the naked eye and under the microscope. We study different parameters of seminal quality, which allows us to estimate the fertilization capacity of the spermatozoa.

These are the most common aspects that are analysed:

  • Volume of ejaculated semen
  • Viscosity
  • pH
  • Sperm Motility
  • Morphology
  • Sperm concentration
  • Presence of foreign cells
  • Vitality

Based on the results obtained and their comparison with the reference values established by WHO, the quality of the semen analysed will be determined.

If an anomaly is detected, the corresponding pathology should be diagnosed. The most common are:

  • Azoospermia: when there are no spermatozoa in the analyzed ejaculate.
  • Asthenospermia or asthenozoospermia: when the sperm present motility problems.
  • Oligospermia or oligozoospermia: when the sperm concentration is low (less than 15 million spermatozoa/ml).
  • Teratospermia or teratozoospermia: when more than 96% of the spermatozoa have an abnormal morphology.

Assisted procreation, as any other medical treatment, requires that you rely on the professionalism of the doctors and staff of the clinic you choose. Obviously, each clinic is different. This tool selects clinics and agencies for you out of the ones that meet our strict quality criteria. Moreover, it will offer you a comparison between the fees and conditions each one offers in order for you to make a well informed choice.

Il you want to know more about this exam, you should read this post: What Is a Semen Analysis Report? – Purpose, Preparation & Cost.

Male Hormones Analysis

Sperm production takes place in the testicle thanks to the action of sexual hormones such as testosterone, FSH (follicle stimulating hormone), LH (luteinizing hormone) or prolactin.

An alteration of the hormonal system can complicate or prevent spermatogenesis and, as a result, lead to low seminal quality and infertility.

The most commonly analyzed hormones are the following:

Testosterone

Normal values for the hormone testosterone in adulthood are between 300 and 1000 ng/dl. Altered testosterone levels, synthesized mainly in the testicle, can cause problems:

  • Low levels: may indicate delayed puberty, benign tumor in the pituitary gland, testicular trauma, infection, immune alterations…
  • High levels: related to testicular cancer, congenital adrenal hyperplasia, resistance to androgens, consumption of drugs or specific medications…

If testosterone values lead to suspicion of an abnormality, FSH (follicle stimulating hormone) and LH (luteinizing hormone) analyses are also requested.

FSH and LH

Both LH and FSH are synthesized and released by the cerebral pituitary gland.

  • FSH stimulates the action of Sertoli cells, which favors testosterone synthesis and sperm production. Its normal values are between 1 and 12 mUI/mL.
  • For its part, LH stimulates the action of Leydig cells, related to the production of testosterone. Its levels are between 2 and 12 mUI/mL.

Prolactin

Finally, prolactin, related to LH hormone activity and testosterone synthesis, should be between 2.5 and 17 ng/mL.

Higher values are associated with low levels of testosterone, male impotence, gynecomastia, infertility, hypothyroidism and suspected pituitary tumor.

Additional Tests

Sperm analysis, genital exams and hormone analysis are the basic tests that are performed to determine the fertility status of the male and try to discover the causes why pregnancy does not occur.

When these tests do not help to diagnose the reason for infertility or when it is necessary to confirm the diagnosis obtained, additional tests such as those mentioned below may be requested:

DNA Fragmentation Study

One of the fragmentation tests consists of identifying the presence of spermatozoa with halo (normal) from those without halo (fragmented). By placing the sperm in an acidic medium, the structure of the DNA strand is broken and a halo appears around the head of the spermatozoa. If the DNA strand is fragmented, the acidic medium does not cause the strand to unwind and therefore we do not observe the halo.

When the degree of DNA damage is high, the ability of the sperm to fertilize may be reduced. In addition, alterations in the DNA of the spermatozoa can also cause early failures in the embryo’s development.

Karyotyping

This refers to the analysis of the karyotype, which is the set of chromosomes of a cell. It makes it possible to discover the existence of genetic abnormalities that may cause infertility.

Semen Culture

Also known as sperm culture, this is a bacteriological study. It is usually requested when, in the seminogram, a concentration of leukocytes greater than 1 million/ml of semen is observed. This is usually indicative of infection and, therefore, culture is very useful, as it can help us to determine which is the infectious agent.

Testicular pain, inflammation of the testicles, blood in the sperm, or any change in colour or smell in the semen are also indications of seminal culture.

Testicular Biopsy

It consists of extracting, by surgery, a small fraction of the testicle and then analysing it in the laboratory in search of viable sperm. Indeed, sperm are obtained directly from the testicle.

This test is useful in cases of azoospermia, as it permits to distinguish whether it is a problem of sperm production (secretory azoospermia) or blocking the passage of the same (obstructive azoospermia).

On the other hand, in addition to a diagnostic test, it is also a treatment to achieve pregnancy because, in the event of viable sperm being found, it allows the ICSI technique (intracytoplasmic sperm injection) to be carried out.

If you are interested by this technique, we recommend you to read the following post: What Is a Testicular Biopsy? – Purpose & Procedure.

Hypo-osmotic Test

In order for the sperm to penetrate the egg and allow fertilization, it is necessary that its membrane is undamaged and functions correctly. To check this, we can perform the hypo-osmotic test.

It consists of introducing the spermatozoa into a low salt medium (hypotonic medium), so that, if the membrane is intact, the medium will pass into the spermatozoa by osmolarity and it will swell in the tail.

FAQs from users

Are there any symptoms that might indicate whether or not I am a sterile man?

By Andrea Rodrigo (embryologist).

Generally, most male fertility disorders do not result in specific symptoms. However, there are some of them that can lead to inflammation and redness of the genital area, changes in the color, smell or texture of semen, pain, etc..

For example, a man may have no symptoms of azoospermia and only discover this seminal pathology by performing the seminogram. On the contrary, a hormonal imbalance can give rise, for example, to mood swings, loss of libido or other symptoms that mean that there may be a problem.

Are there any male fertility tests that can be done at home?

By Andrea Rodrigo (embryologist).

There are home tests that can be purchased at the pharmacy and that allow you to measure some parameters of semen quality such as concentration. Many people know them as male predictors.

However, these fertility tests measure only one or two seminal parameters and are not very reliable. That is why it is always recommended to carry out the complete seminogram in a specialised centre.

Suggested for you

In this post, we mentioned the main seminal alterations that can be discovered through the sperm analysis. If you want to learn more about sperm quality, please read our article: Semen Quality : What Is Measured And What Can Be Done To Improve It?

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Authors and contributors

 Andrea Rodrigo
Andrea Rodrigo
Embryologist
Bachelor's Degree in Biotechnology from the Polytechnic University of Valencia. Master's Degree in Biotechnology of Human Assisted Reproduction from the University of Valencia along with the Valencian Infertility Institute (IVI). Postgraduate course in Medical Genetics. More information about Andrea Rodrigo
Adapted into english by:
 Marie Tusseau
Marie Tusseau
Babygest Staff
Editorial Director of Babygest magazine in French and English. More information about Marie Tusseau

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