Fertility Tests for Men

Although many people still think of fertility as a "woman's problem," up to half of all cases of infertility involve problems with the man. In fact, about 20% to 30% of the time, a man's low fertility is the main obstacle to conception.

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.

Initial Male Infertility Evaluation

Doctors arbitrarily diagnose infertility when a couple hasn't conceived a child after 12 months of unprotected and frequent sex. Impaired fertility may be a better description; many couples who keep trying will get pregnant in the second year or later.

A visit to a urologist should start the evaluation for male infertility. The urologist will likely begin with a basic interview and examination:

• A full medical and reproductive history, along with any surgeries you've had and medications you're taking.
• Lifestyle questions, including exercise, smoking, and drug use.
• Physical examination.
• 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. The doctor will want the man to give the sample there, or at least someplace nearby, since it's important that the analysis take place quickly.

Male Infertility Tests

Identifying the cause of a man's infertility is as much art as 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 usually means 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.

Physical Examination

A good physical exam can detect varicocoeles and give clues to hormone problems. Testicular size can be measured. The physical examination should ideally be performed by a urologist.

Hormone Evaluation

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 Testing

Genetic tests can identify specific obstacles to fertility, and problems with sperm. Experts differ as to when genetic tests should be done.