Male Infertility Workup

Fertility in men requires normal function of the testes, hypothalamus, and pituitary gland. In addition, the structures of the male reproductive tract must function appropriately. One recent population-based study found that male infertility contributes to 23% of infertility cases, and 90% of male infertility is related to sperm problems (low count or poor sperm quality). Male infertility must be evaluated to detect and treat the underlying cause.


Medical History

A man’s past health status and medical history are evaluated to assess for causes of infertility. The fertility specialist must inquire about:

  • Childhood growth and development
  • Sexual development during puberty
  • Sexual history
  • Surgeries
  • Current and past medication use
  • Exposure to environmental agents (steroids, radiation, chemotherapy, alcohol, and toxic chemicals)
  • Illnesses and infections
  • Previous fertility tests


Physical Examination

The fertility specialist conducts a physical examination to assess weight and height, evaluate muscle distribution and body fat, inspect the genitals, skin, and hair pattern. Testosterone deficiency is associated with small testicle size, as well as lost facial and body hair. In addition, a bundle of varicose veins in the testicles (varicocele) can contribute to infertility.


Semen Analysis

The sperm evaluation (semen analysis) is the main part of a male infertility evaluation. This analysis checks for sperm number, amount of ejaculate, sperm movement (motility), and shape of the sperm. A many must avoid masturbation and sex for 2-7 days prior to providing the semen sample. The sample can be given in the office setting following masturbation, or it can be collected at home using a chemical-free condom or sterile container.


Laboratory Testing

Blood tests are done to assess hormone levels. The hormones that play a role in male fertility include total testosterone, follicle-stimulating hormone (FSH), and prolactin (pituitary hormone).


Genetic Testing

When chromosomal or genetic abnormalities are suspected, special laboratory tests are used to check for abnormal or absent regions of the Y chromosome. Men who have genes associated with cystic fibrosis often have a low sperm count. Genetic counseling is offered to inform a couple of various parent-to-child transmitted conditions.


Diagnostic Testing

Certain tests are used to assess for issues with fertility. These include:

  • Transrectal ultrasound – This test evaluates for blockage in the reproductive tract (vas deferens or epididymis).
  • Post-ejaculation urine sample – This is used to assess for retrograde ejaculation (movement of semen back into the bladder).
  • Testicular biopsy – This involves collection of a small tissue sample, which is done by surgically opening the testis, or by inserting a small needle (fine-needle aspiration). This biopsy allows the doctor to examine the testes tissue under the microscope to see if sperm are present. Presence of sperm in testicular tissue indicates a blockage in the reproductive tract.


Antisperm Antibodies Test

Some men (or their female partners) possess antibodies against sperm. These antibodies immobilize or kill the sperm, preventing them from moving toward the egg. The presence of antisperm antibodies can be tested using semen or the woman’s cervical mucus.