Male Fertility Testing – How Do You Know if You Are Infertile?

By MD (gynecologist), MD, FACOG, FACS, FACE (reproductive endocrinologist), BSc, MSc (embryologist), BSc, MSc (embryologist), MD (gynecologist) and (invitra staff).
Last Update: 12/24/2020

If you have been trying to conceive for 12 months without achieving pregnancy, perhaps it is time for you to visit a fertility specialist to have your fertility checked.

In the case of men, the main male fertility test to check whether you produce healthy sperm or not is the semen analysis. Through a semen analysis, seminogram or sperm test, we can learn about a man's sperm count and the quality of the sperm produced.

There exist other ways to check if a man is fertile, such as performing a hormone blood test or a semen culture to determine whether a sample is healthy by observing how it looks like in terms of color, texture, and smell.

Provided bellow is an index with the 9 points we are going to expand on in this article.

How do you get tested for infertility?

In order to diagnose infertility, it is necessary for the couple to see a fertility doctor. In general, it is recommended to visit a specialist when the couple has been having regular unprotected sex for at least one year and is unable to achieve a pregnancy.

From this point on, the doctor will ask a series of questions to create a medical history and will request medical tests for both members of the couple. The objective is to determine the cause of infertility and thus decide on the best treatment.

Specifically, the basic tests for a male fertility study are as follows:

  • Physical exploration to see the general health status of the male and his sexual organs.
  • Semen analysis to assess sperm quality.
  • Hormone analysis to determine if there is any alteration in the male sex hormones.

It should be noted that male fertility evaluation should always be personalized. Therefore, the tests that are carried out depend on each individual.

If you have doubts or queries about the results of your fertility tests or the tests you should undergo to have your fertility checked, do not hesitate to ask here: Male infertility and men's fertility forum.

Physical exam

The first test that you will undergo is a physical exam to dismiss the possibility that what is causing you to be infertile are problems of the testes or related with ejaculation.

To this end, the urologist can perform the following exams:

  • Measurement of weight and height
  • Inguinal exploration
  • Genitalia and prostate examination
  • Evaluation of the testis, including testicular size and consistency
  • Testicular ultrasound

The goal is to dismiss the presence of anatomical problems that are causing infertility and evaluate whether the male has some kind of ejaculation problem or disease. If the cause of infertility is not found through this test, the next step is to carry out a semen test.

Semen analysis

A semen analysis, also known as sperm test, seminogram or semenogram, is a study of the sperm parameters that determine the quality of a man's semen sample. For this test to be effective, an abstinence time of between 3 to 5 days is advisable.

The World Health Organization (WHO) establishes minimum values for a normal semen sample. Depending on the results of the seminogram, we can know if there are any pathologies or if the semen is normal (normozoospermia).

In case the semen is altered in any way, we can categorize the condition from which the man suffers according to the affected seminal parameter.

Macroscopic study

When a macroscopic analysis of the semen is performed, basic characteristics of the sperm are analyzed at naked eye without having to resort to a microscope.

The following is a list of seminal parameters that can be analyzed through a macroscopic study:

Volume
the normal amount of semen per ejaculate is between 2 and 4 mL. However, this value can vary according to days of abstinence, stress, etc.
Liquefaction
occurs after allowing the semen sample to rest for approximately 20 minutes.
Color
the semen should have a yellowish-gray color; if it looks different, it may indicate infection.
Viscosity
the presence of threads in the sample is evaluated.
pH
the values for a normal sperm pH are between 7.2 and 8.0, i.e. a basic pH..

Taking into account these semen analyses, it is not complicated for you to interpret the results of the seminogram by yourself.

Microscopic study

The microscopic study of the semen consists of analyzing a small sample under the microscope. Thus, the most important seminal parameters that are examined in the semen analysis are:

Sperm motility
For the sperms to be able to reach the egg and fertilize it, they should move forward rapidly and progressively.
Sperm concentration
It refers to the sperm count per milliliter of ejaculate or in the entire sample.
Sperm morphology
Sperms with abnormal forms will find moving forward more complicated, not to mention the obstacles of the female reproductive tract until they are able to hit the egg.
Sperm vitality
Sometimes, a sperm test shows the presence of dead sperm in the ejaculate, which are obviously incapable of fertilizing an egg. It is important for a high percentage of motile sperm to be available.
Presence of leukocytes
would be indicative of a possible infection.

Do you want to learn more about the seminogram test? Learn about it in detail with the following guide: Semen analysis: procedure, cost and interpretation.

If you need to undergo IVF to become a mother, we recommend that you generate your Fertility Report now. In 3 simple steps, it will show you a list of clinics that fit your preferences and meet our strict quality criteria. Moreover, you will receive a report via email with useful tips to visit a fertility clinic for the first time.

Hormone test

If the seminogram comes back with negative results, your doctor may require you to take a hormone test by means of blood work. This study helps the specialist to determine what is causing the results of the semen analysis to be outside the normal range.

Sperm production occurs in the testis thanks to the action of the male sex hormones, including testosterone, FSH (follicle-stimulating hormone), LH (luteinizing hormone), and prolactin.

So, alterations in the levels of these hormones can affect the sperm production process (spermatogenesis), and therefore the sperm count and quality.

Additional fertility tests for males

When an abnormal result is obtained in the seminogram or there is an alteration in the parameters of concentration, motility, or morphology of the sperm, complementary tests are usually requested to confirm the cause.

Below are details of each of these additional tests that are performed on the man.

Sperm DNA fragmentation test

For the sperms to be able to fertilize the egg properly and give rise to a healthy embryo, capable of attaching to the uterus, it is important for sperm DNA not to be fragmented.

A high degree of sperm DNA fragmentation can translate into fertilization problems, as well as early embryonic development failure.

In recent years, the percentage of men with high levels of sperm DNA fragmentation has increased. The most common causes are exposure to contaminants, pharmacological therapies, smoking or high testicular temperature.

For this reason, those men who present a percentage of sperm fragmentation above 30% should resort to assisted reproduction techniques to achieve a pregnancy.

Semen culture

If the semen analysis reveals the presence of more than 1 million leukocytes/ml, a semen culture would be required. Basically, it is a bacteriological study of the sperm.

A semen culture may be needed also if the man has testicular pain or swelling, blood in the semen or a change in the color or smell of the semen is detected.

If the result of the semen culture is negative, which occurs more often than not, it means that the cause of infertility is not an infection.

Genetic test

The karyotype is the set of chromosomes that has every cell of an individual. Specifically, in the human being, there are 23 pairs of chromosomes and one of them corresponds to the sex chromosomes (XX for the female and XY for the male).

Therefore, the karyotype study consists of analyzing the chromosomes to see if there is any alteration, both numerically and structurally, that could be the cause of infertility. This study is carried out by means of a blood analysis.

The karyotype is a very important diagnostic test and is routinely performed in cases of both male and female infertility. If the parents have a genetic or chromosomal abnormality, it is very possible that this is the cause of their problem in conceiving.

Hypo-osmotic swelling test (HOS)

This test is used to check if the sperm plasma membrane works properly or is damaged. To this end, the sperms are exposed to a hypotonic solution, causing an osmotic imbalance in the cells. This, at the same time, causes the solution to penetrate the sperm and expand the volume of the cell, which becomes "swollen".

If the sperm plasma membrane is neither intact nor functional, fertilization cannot occur, hence the importance of the HOS.

Sperm FISH

Fluorescent in situ hybridization or FISH of sperm is a cytogenetic analysis test in which specific chromosomes of the sperm are marked with fluorescent DNA probes. Its purpose is to check whether the spermatozoa have a normal chromosome make-up. Therefore, the spermatozoon FISH provides great information about the male's seminal quality.

Some situations in which sperm FISH is indicated are the following:

  • Genetic disorders.
  • Abnormal semen analysis results, especially in cases with low concentration or serious morphology problems.
  • Men undergoing chemotherapy or radiotherapy.
  • Couples with unexplained recurrent pregnancy loss.
  • Repeated implantation failure after applying assisted reproduction techniques.
  • Couples who have had a child with a chromosomal disorder.
  • Advanced age.

Usually, the chromosomes that are usually analyzed are chromosomes 13, 18, 21, X, and Y. This is known as the 5-probe FISH. However, this study can be performed on other chromosomes.

In general, an abnormal FISH result is considered when between 100 and 2000 spermatozoa are analyzed and an increased incidence of chromosomal disorders is observed compared to a control group of fertile sperm donors.

Testicular biopsy

It is a surgical intervention whereby small samples of the testicular tissue are removed to check whether sperm production is taking place. It is done when the sperm count is zero, a condition known as azoospermia.

Normally, this technique does not cause complications in the male. However, as in any surgical procedure, wound infection or minor discomfort may occur in the area.

Click the following link to learn more: What is a testis or testicular biopsy?

FAQs from users

Does the man's age affect the quality of his sperm?

By Mark P. Trolice MD, FACOG, FACS, FACE (reproductive endocrinologist).

Advanced paternal age (APA) is usually defined above age 35-40 and is associated with decreasing sperm analysis parameters. Men above age 45 have approximately 5 times as long to achieve a pregnancy compared with men less than 25 years of age. Further, there is evidence for APA increasing risk of miscarriage, birth defects, and autism. Men older than 40-45 have a twice as likely risk of an autistic child and five times higher risk of a child with schizophrenia.

Which values are considered normal in a semen analysis report?

By Dr. Joel G. Brasch MD (gynecologist).

Concentration > 15million/ml
Motility > 40%
Morphology > 4%
Vol > 1.5ml

What is the cost of fertility tests for males?

By Sara Salgado BSc, MSc (embryologist).

The cost of male fertility tests can range from $50-300, although it depends on the clinic chosen. As for blood tests, the price can range from $200-400. In case you require additional tests, an increase of the overall cost should be expected.

Can you check sperm count at home with a microscope?

By Sara Salgado BSc, MSc (embryologist).

Although sperm count plays a major role when determining a man's fertility, there are at-home kits that allow a man to evaluate his sperm count without involving a professional. Some kits contain a microscope that allows couples to examine the count of sperm. Even though this option can be somewhat helpful, we do not recommend this method to evaluate your infertility.

What does healthy sperm look and smell like?

By Sara Salgado BSc, MSc (embryologist).

Indeed, semen color, texture and even smell can provide us with a lot of information about your fertility and health. After ejaculation, we can observe the semen's color, texture, consistency, and smell, and get information on our fertility to some extent.

The color of healthy sperm is normally white or light gray. If it ranges from yellow to even green, you may have a prostate infection and should speak to your medical provider as soon as possible to determine if there is an infection causing your sperm to be non-fertile. In this case, antibiotics may be required.

Yellow can also indicate the presence of urine in the semen. If the color of your semen is pink or reddish-brown, it may be an indication of an inflammation of your prostate and that color is caused by bleeding.

As for the texture/consistency, semen is normally thick after ejaculation. If it changes into a sticky texture, it is likely that a medical condition is present.

How can I know my sperm count?

By Sara Salgado BSc, MSc (embryologist).

As explained above, the best way to find out your sperm count is by visiting a fertility specialist and undergoing a sperm test or seminogram.

However, there's a fertility test available in stores called SpermCheck, which allows you to find out in minutes if your sperm count is within the normal range. It works more or less like a pregnancy test—reading its results is easy, as you get either a positive or a negative result.

Anyway, we always recommend that you visit a doctor to get accurate results.

How can you tell if your sperm is fertile?

By Sara Salgado BSc, MSc (embryologist).

The only way to find out if your sperm is fertile accurately is by means of a semen analysis or seminogram. You can ask your doctor to have your fertility checked whenever you want, although men normally visit a fertility specialist if they have not managed to conceive after one year having unprotected intercourse.

Where can a man go to check his fertility?

By Sara Salgado BSc, MSc (embryologist).

To a fertility clinic or a hospital with an assisted reproduction unit. They should be carried out by a urologist/andrologist that is experienced in the field of infertility.

What can cause a man to be infertile?

By Sara Salgado BSc, MSc (embryologist).

More than 90% of male infertility or sterility cases are caused by sperm abnormalities, including poor sperm quality, low sperm count, abnormal morphology, or a combination between all of them. Other causes that can affect a man's fertility are: anatomical problems, genetic defects, hormonal imbalances, etc.

See also: Male infertility: causes, symptoms, treatment and statistics.

What male fertility test should be done before marriage?

By Sara Salgado BSc, MSc (embryologist).

Actually, there is no compulsory pre-marital male or female fertility test that must be done by default. However, some couples prefer to be tested for HIV and other sexually transmitted diseases, blood group, fertility, possible genetic and/or chronic medical conditions, etc. But, as I said, this is totally optional and varies from couple to couple.

Suggested for you

As explained above, the semen analysis is the most important test to determine whether sperm parameters are altered or not. If you want to learn more about it, visit this post: Semen analysis: procedure, cost and interpretation.

What factors make a man fertile? What is the actual definition of male fertility? Are there any signs or symptoms that prove that a man produces enough sperm? Check this out here: Male fertility: parts and functions of the male reproductive system.

If the results of your semen analysis came back negative and you need to go through infertility treatment, you can learn about the treatments that you have at your disposal here: Treatments for male infertility.

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Authors and contributors

Dr. Joel G. Brasch
Dr. Joel G. Brasch
MD
Gynecologist
Dr. Joel Brasch is the Medical Director of Chicago IVF, founded in 2005. He is board certified by the American Board of Obstetrics and Gynecology, and has over 25 years of direct experience in fertility treatment and reproductive care. He is also the Director of Mount Sinai Medical Center’s Division of Reproductive Endocrinology and Infertility. More information about Dr. Joel G. Brasch
 Mark P. Trolice
Mark P. Trolice
MD, FACOG, FACS, FACE
Reproductive Endocrinologist
Mark P. Trolice is the Director of Fertility CARE – The IVF Center and Clinical Associate Professor in the Department of Obstetrics & Gynecology (OB/GYN) at the University of Central Florida College of Medicine. He is Board-certified in REI and OB/GYN, and maintains annual recertification. His colleagues select him as Top Doctor in America® annually, one among the top 5% of doctors in the U.S. More information about Mark P. Trolice
License: ME 78893
 Marta Barranquero Gómez
Marta Barranquero Gómez
BSc, MSc
Embryologist
Graduated in Biochemistry and Biomedical Sciences by the University of Valencia (UV) and specialized in Assisted Reproduction by the University of Alcalá de Henares (UAH) in collaboration with Ginefiv and in Clinical Genetics by the University of Alcalá de Henares (UAH). More information about Marta Barranquero Gómez
License: 3316-CV
 Sara Salgado
Sara Salgado
BSc, MSc
Embryologist
Degree in Biochemistry and Molecular Biology from the University of the Basque Country (UPV/EHU). Master's Degree in Human Assisted Reproduction from the Complutense University of Madrid (UCM). Certificate of University Expert in Genetic Diagnosis Techniques from the University of Valencia (UV). More information about Sara Salgado
 Sergio Rogel Cayetano
Sergio Rogel Cayetano
MD
Gynecologist
Bachelor's Degree in Medicine from the Miguel Hernández University of Elche. Specialist in Obstetrics & Gynecology via M. I. R. at Hospital General de Alicante. He become an expert in Reproductive Medicine by working at different clinics of Alicante and Murcia, in Spain, until he joined the medical team of IVF Spain back in 2011. More information about Sergio Rogel Cayetano
License: 03-0309100
Adapted into english by:
 Romina Packan
Romina Packan
inviTRA Staff
Editor and translator for the English and German edition of inviTRA. More information about Romina Packan

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