Male infertility | Diagnosis | At home tests | Treatment
Male infertility is a condition that affects a little over one in every 20 men. It is caused by a variety of factors, including low sperm count, poor sperm quality, and blockages in the reproductive system.
If you are trying to conceive and your partner has been diagnosed with male infertility, you may be wondering about the different fertility tests available.
In this article, we will discuss the different tests used to diagnose male infertility, as well as the treatment options available once a diagnosis is made.
What is male infertility?
Male infertility is when a man has a problem with his reproductive system that prevents him from getting a woman pregnant.
The reasons you may have male infertility can vary and include:
- Trauma to your genitals
- Infection
- Your immune system attacks your own sperm with sperm antibodies
- Radiation therapy on your genitals
- Anatomical abnormalities
- Genetic abnormalities
- Different diseases or medical conditions
Male fertility can also be affected by your lifestyle choices, such as smoking, drinking, or use of recreational drugs.
If you and your partner are having trouble becoming pregnant, it is just as likely male infertility as female infertility and you both need to get evaluated by your doctors to see if there is anything you can do to help the situation.
How do doctors diagnose male infertility?
When you go to get evaluated for male infertility by your doctor (who will most likely see a referred specialist called a urologist) there are several things that can happen.
First, your doctor will most likely want to take a complete medical history and may also question you about lifestyle choices and your sex life which will help give your doctor an idea of any fertility risk factors you may have.
Next, your doctor will do a physical exam to look for any obvious signs of fertility problems in your penis and testicles.
After that, your doctor may order some tests.
The most common tests for male infertility include:
Semen analysis
After your doctor has a complete picture of your medical history, you will be asked to ejaculate for a semen sample.
The semen analysis will help your doctor determine if you have any fertility problems.
You may ejaculate in a private room at your doctor’s office or, due to religious reasons or personal choice, you may ejaculate into a special condom while having sex with your partner that will obtain a sample of semen.
The sample will then be sent to a lab for sperm analysis and will be analyzed for:
- Sperm concentration to ensure there is the presence of sperm in your semen and to determine the percentage of sperm in semen (sperm count)
- Semen volume to make sure the amount of semen you ejaculate is normal or above normal
- The shape of the sperm (morphology)
- How well the sperm move (motility)
- If there are any other abnormal characteristics in your semen such as signs of infection or signs that most of the sperm are dead
The semen analysis test can also give your doctor an idea of how well your reproductive system is working as a whole.
Hormone testing
Hormones from your brain, in particular your hypothalamus and pituitary gland, as well as your testicles all play a role in your fertility.
Low levels of certain hormones may be linked to fertility problems. Your doctor will use a blood test to look for the following three hormones:
Follicle-stimulating hormone (FSH)
The follicle-stimulating hormone is produced in your pituitary gland and signals the testicles to produce sperm.
If levels of follicle-stimulating hormone are low, it may mean that the pituitary gland is not working properly and you are not producing sperm.
If levels of follicle-stimulating hormone are high, it may mean that the testicles are not responding properly to the hormone signal to produce sperm or there is damage to the testicles that is preventing sperm production.
Luteinizing hormone (LH)
The luteinizing hormone is also produced in your pituitary gland and signals the testicles to produce testosterone by binding to your Leydig cells which are the primary cells that produce testosterone.
Having the proper levels of testosterone is important for sperm production as well as sex drive.
Your doctor will most likely give you a shot of gonadotropin-releasing hormone (GnRH) which helps to release the luteinizing hormone and then measure the levels.
Testosterone
Testosterone is produced in your testicles and is important for sperm production and sex drive.
If your testosterone levels are low, it may mean there is damage to your testicles preventing them from producing sperm or that the pituitary gland is not releasing enough luteinizing hormone which signals the testicles to produce testosterone.
Post-ejaculation urinalysis
A post-ejaculation urinalysis may be done to see if there are sperm in your urine.
To perform this test, you will need to ejaculate first and then take a urine sample by peeing into a cup.
The sample is then sent to a laboratory for analysis. Sperm are not supposed to be in your urine because they are supposed to have gone into your semen during ejaculation.
If there are sperm in your urine, it may mean that you have a blockage preventing the sperm from getting into your semen or retrograde ejaculation where your semen goes backward into the bladder instead of out through the penis.
Your urologist may also look for normozoospermic infertility which is when there is a normal sperm count but the sperm are not able to fertilize an egg.
Imaging and physical tests
Transrectal ultrasound
A transrectal ultrasound may be done to get a better look at your prostate and seminal vesicles by inserting a wand into your anus for imaging.
The prostate is a gland that produces some of the fluid in semen and the seminal vesicles are sacs that store sperm until ejaculation.
The transrectal ultrasound can help your doctor look for any blockages in the vas deferens (sperm duct) or other problems in these glands.
Scrotal ultrasound
A scrotal ultrasound can help your doctor look at your testicles and epididymis which is a tube that stores sperm until they mature. The scrotal ultrasound is done by placing a wand on the outside of the scrotum to get images.
The reason why the test may be done is if you have an abnormal semen analysis or if you have a low sperm count.
Your doctor will be checking for any cysts, tumors, infections, or buildup of fluids inside your scrotum or on your testicles.
The scrotal ultrasound will also show if you have scrotal torsion (twisting of the testicles and spermatic cord) or varicoceles (enlarged veins in the scrotum).
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Testicular biopsy
A testicular biopsy is sometimes done to look for signs of damage or abnormal development in the testicles that may be causing fertility problems.
During the procedure, your doctor will remove a small piece of tissue from one or both of your testicles and send it to a laboratory for analysis.
A testicular biopsy is usually done using local anesthesia where you are awake but do not feel any pain in the area being worked on.
If the test results indicate that you have normal sperm production then that typically means you have an anatomical problem blocking the sperm from being released during ejaculation.
Anti-sperm antibodies testing
Antisperm antibodies are proteins that attack and kill sperm and antisperm antibodies testing is done to see if you have these antibodies in your blood, semen, or both.
The test is usually done if you have had a vasectomy reversal or if you have fertility problems even after other fertility treatments.
If the test results show that you have antisperm antibodies, it may mean that the sperm are being attacked and killed before they can fertilize an egg.
Genetic testing
Genetic testing may be done to look for fertility problems that are passed down from parents to children and are usually done if you have a family history of fertility problems or if you and your partner have had multiple miscarriages.
The genetic test looks for changes in genes or chromosomes that may be causing fertility problems.
Treatment options will depend on the results.
Idiopathic infertility
Idiopathic infertility is when fertility problems cannot be attributed to any specific cause even after all of the above tests have been done.
It is possible for your doctor to run all these tests and still be uncertain why you are infertile.
Do at-home fertility tests work for diagnosis?
At-home fertility tests are becoming increasingly popular but it is important to remember that they are not as accurate as tests done by your doctor or urologist.
At-home fertility tests can give you a general idea of your fertility but for a more accurate diagnosis, it is best to see a fertility specialist.
What are the treatment options for male infertility?
Treatment options for male infertility will depend on the underlying cause of fertility problems. If a treatable cause is found, such as an infection, treatment will be aimed at resolving that issue.
If no specific cause can be identified, fertility treatments may be recommended. Fertility treatments for men include:
Surgery
Surgery may be recommended to treat fertility problems such as blockages in the reproductive tract or varicoceles.
You may also get a vasectomy reversed if necessary. Lastly, your doctor may need to perform surgery to obtain healthy samples of sperm if necessary.
Medication
There are a variety of medications that can be used to treat fertility problems in men.
Medications may be used to treat erectile dysfunction or to treat an underlying health condition, such as an infection.
Hormone treatment
Hormone treatment may be recommended if your fertility problem is due to a hormone level imbalance and these treatments can be in the form of injections, pills, or patches.
Assisted reproductive technologies (ART)
ART is a fertility treatment that involves retrieving sperm from the testicles through ejaculation, getting sperm from a sperm donor, or surgically removing sperm and then artificially inseminating an egg.
A single sperm cell may be injected directly into the egg which is known as intracytoplasmic sperm injection (ICSI) or in vitro fertilization (IVF) may be used where the sperm cells and egg are placed on the same culture medium but the sperm is not directly injected into the egg.
ART is typically only recommended if other fertility treatments have failed.
Summary
Male fertility testing is done to diagnose fertility problems in men and to look for underlying causes.
There are a number of different tests your doctor or urologist may utilize to diagnose the cause of infertility and then suggest a treatment option.
At-home fertility tests are not as accurate as tests done by your doctor but can give you a general idea of your fertility.
Treatment options for male fertility issues are listed above and range from surgery to taking medications. If you have any more fertility concerns or questions about male infertility, please talk to your doctor or health care provider.
References, Studies and Sources:
NIH
Healthline
WebMD
Mayo Clinic
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