Although many people still think of infertility as a "woman's problem," in about 40% of infertile couples, the man is the sole cause or a contributing cause of the inability to conceive. One-third of infertility cases can be attributed to male problems, including low sperm count.
So it's crucial that men get tested for fertility as well as women. Yes, it can be embarrassing, but discovering male fertility problems early can mean earlier treatment and a successful pregnancy. Male infertility testing can also spare women unnecessary discomfort and expense.
1. Could lifestyle factors such as smoking, alcohol, or stress be affecting my fertility?
2. Could my job or my partner's job be contributing to our problems?
3. Are there any non-medical approaches, such as relaxation or meditation techniques, that could improve my chances of becoming pregnant?
4. Is it important to proceed with an infertility evaluation now, or should we wait a while longer?
5. What specific tests would you recommend to diagnose our infertility, and what do they cost?
A frank discussion about your sexual life, including any problems with sex or previous sexually transmitted diseases
In any evaluation for male infertility, the man will need to provide a sample of semen for analysis, typically at the doctor's office or nearby. It's important that the analysis take place quickly.
Male Infertility Tests
Identifying the cause of a man's infertility is as much an art as a science. Male infertility specialists differ in their approach, but here are some of the tests a man can expect:
Sperm and Semen Analysis
A trained expert assesses the man's sperm count, their shape, movement, and other variables. Generally, a higher number of normal-shaped sperm means higher fertility. But exceptions are common. Many men with low sperm counts or abnormal semen are still fertile. And about 15% of infertile men have normal semen and plenty of normal sperm.
If the first semen analysis is normal, the doctor may order a second test to confirm the results. Two normal tests are usually interpreted to mean that the man doesn't have any significant infertility problems. If something in the results looks irregular, the doctor might order further tests to pinpoint the problem.
Surprisingly, if no semen or sperm at all are present (azoospermia), this can be a good thing. It might suggest a blockage in the "plumbing" that can be corrected with surgery.
A good physical exam can detect varicoceles -- described below -- and give clues to hormone problems. Testicular size can be measured. The physical exam should ideally be performed by a urologist.
Testosterone, and multiple hormones made in the brain, control sperm production. However, hormones are not the main problem in 97% of infertile men. Experts disagree as to how big a search should be done for hormonal causes of infertility.
Genetic tests can identify specific obstacles to fertility, and problems with sperm. Experts differ as to when genetic tests should be done.