How is male infertility diagnosed?

Male infertility, or subfertility, as it's often called, affects about one in 20 men. It can result from numerous causes, ranging from the mechanical -- undescended testicles, dilated veins and blocked tubes -- to the hormonal, as well as problems with sperm production.

The first step is a complete evaluation. Doctors generally prefer to see men with their partners. Not only are men more comfortable with their partner in the examining room, but the woman often knows more about his health history than he does.

During that evaluation, your doctor will play detective, searching for clues as to what might be wrong. Sometimes the answer is obvious, such as anabolic steroid use.

Your doctor will also search for physical clues for the infertility, including abdominal, scrotal or perineal scars. Such surgeries can affect a man's ability to have an erection and/or orgasm -- both of which affect fertility. 

Another common cause of male infertility is varicocele, in which the veins wrapped around the spermatic cord are numerous and dilate too much, increasing temperature in the scrotum and reducing fertility. Minor surgery can transect the vessels with dramatic results.

Your doctor will also ask if you or your partner has ever had a sexually transmitted disease. Chlamydia, for instance, can cause blockages and other reproductive problems.

One possible cause of sperm-related problems is oxidation, which may damage the membrane of the sperm cell. Your doctor may start you on a multivitamin that contains powerful antioxidants like selenium, folic acid and zinc, and recommend that you eat foods with more lycopene, a phytonutrient (and antioxidant) found in cooked tomato products.

About 25% of male infertility cases are deemed idiopathic (no apparent cause). Sometimes things improve on their own; sometimes the only option is assisted reproduction. Today, specialists can isolate quality sperm to use in procedures like artificial insemination or intracytoplasmic sperm injection (ICSI), in which a single sperm is injected into the egg as part of in vitro fertilization (IVF).
Male infertility may also be diagnosed with these additional tests:
Sperm Antibodies - If the sperm agglutinate (do not move well) the physician may order tests that can localize and quantify specific antibodies in the blood and on the sperm's surface. Antibody attachment can affect the following:
  • If they stick to the head of the sperm, the sperm may not be able to penetrate
  • If they cover the tail of the sperm, the sperm may not be able to swim fast enough or in the right direction
Sperm Penetration - This sperm penetration assay (SPA) is commonly referred to as the hamster egg test. It is designed to evaluate the sperm's ability to break through the outer membrane of an egg and fuse with the egg cytoplasm.
Hemizona Assay Test - Evaluates the sperm's ability to fuse with a previously frozen but no longer viable human egg. (This test is rarely performed now due to the increased technology of ART procedures)
Cervical Mucus Penetration Test (Pentrak) - A lab test that uses cow mucus to simulate the sperm's ability to move through the woman's cervical mucus.
Male factors contribute to infertility in about 40 percent of couples. A semen analysis may be performed to evaluate several semen parameters including sperm count, motility (movement), and morphology (shape). Semen parameters can vary over time, so additional semen analyses may be recommended to more thoroughly evaluate a male's infertility. A consultation with a urologist for additional evaluation may be recommended. A history and examination will be performed to determine if infection, obstruction of the ducts, varicoceles (varicose veins in the scrotum), and/or hormonal disorders exist. Treatments will be directed at the cause of the abnormality, although in some instances, it may remain unexplained.

Male infertility, the inability to impregnate a female partner within six to twelve months, is a common reason that couples seek medical help to conceive. About 20% of infertility in the U.S. can be attributed to male factor problems, and an additional 20-40% are partially attributable to male factors.

Male infertility occurs when a man's body has difficulties:

  • making healthy sperm,
  • making sufficient quantities of sperm, and/or
  • transporting the sperm and semen out of the penis.

There are three basic components a doctor will look at when diagnosing male infertility:

  • your full medical and sexual history,
  • a physical exam, and
  • a semen analysis.

Sometimes, these three pieces of information are all that is needed to get an accurate diagnosis. Other times, a doctor will order more specialized tests to identify the cause.

  • Imaging. Ultrasound imaging of the scrotum and rectum allow the doctor to view the internal structure of the testicles.
  • Blood tests. Your doctor may draw several vials of your blood to analyze your hormones, whether your immune system is affecting the sperm and whether there may be an inherited chromosome abnormality.
  • Urinalysis. If your doctor suspects that the sperm are traveling into the bladder rather than out of the body, a post-ejaculation urinalysis can be done.
  • Additional testing. If everything else is ruled out, there are additional specialized tests that can be ordered.

Once the testing is completed, the doctor will present you with your treatment options and other information that will help you decide what your next steps may be.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.