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Infertility & Reproduction Health Center

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Fertility Tests for Men

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Male Infertility Tests continued...

Physical Exam

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.

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.

Anti-Sperm Antibodies

Some men make abnormal antibodies against their own sperm. The antibodies attack the sperm on the way to the egg, preventing fertilization.

In other men, making sperm isn't the problem; it's getting the sperm where they need to go. Men with these conditions have normal sperm in their testicles. The sperm in semen, though, are missing, very low, or abnormal. There are several reasons for low sperm in semen when a man is making enough sperm:

  • Retrograde ejaculation. In this condition, sperm ejaculate backwards, into the bladder. Usually retrograde ejaculation is caused by a previous surgery.
  • Absence of the main sperm pipeline (the vas deferens ). A genetic problem, some men are born without a main pipeline for sperm.
  • Obstruction anywhere between the testicles and the penis.
  • Anti-sperm antibodies, abnormally attacking a man's own sperm on their way to the egg.

Varicoceles are the most common cause of correctable male infertility -- up to 38% of cases. These abnormal formations of veins above the testicle can be fixed with surgery.

Up to 25% of infertile men have abnormal or low sperm counts causing their infertility, for no identifiable reason. This is called idiopathic infertility.

About 15% to 30% of cases of infertility are unexplained. That means fertility tests have come back normal but the couple has been unable to conceive. In most cases, through thorough testing of both the man and woman, couples discover the cause of their infertility and go on to become pregnant after the first year with continued attempts and treatment.


WebMD Medical Reference

Reviewed by Traci C. Johnson, MD, FACOG on November 19, 2015
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