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

By (gynecologist), (embryologist), (embryologist), (embryologist), (gynecologist) and (biochemist).
Last Update: 08/18/2022

If a couple has been trying to conceive for 12 months without achieving pregnancy,  it could be that there are some underlying fertility problems. At this point, the couple should visit a specialist who will order several tests to perform a fertility study.

For men, the male fertility study par excellence consists of the sperm analysis or spermogram, which analyzes the quality of the semen, and a sperm count. However, there are other additional studies, such as hormonal testing, karyotyping or FISH of spermatozoa, among others.

Once the cause of infertility has been discovered, it is possible to choose the most appropriate fertility treatment in order to achieve pregnancy.

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

How do you get tested for infertility?

The first step is for the couple to attend a fertility clinic. In general, it is recommended to visit a specialist when the couple has been having regular unprotected sex for at least one year and are unable to get pregnant.

From here, the doctor will ask a series of questions to create a medical history and will request 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 his general health status that of 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.

Assisted procreation, as any other medical treatment, requires that you rely on the professionalism of the doctors and staff of the clinic you choose. Obviously, each clinic is different. Get now your Fertility Report, which will select several clinics for you out of the pool of clinics that meet our strict quality criteria. Moreover, it will offer you a comparison between the fees and conditions each clinic offers in order for you to make a well informed choice.

Physical examination

The first test that the man undergoes is a physical exam. This is to dismiss the possibility of infertility due to problems of the testes or related with ejaculation.

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

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

The goal is rule out anatomical problems that could be causing infertility and evaluate whether the male has ejaculation problems or diseases. If the cause of infertility is not found through these examinations, 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 to determine its quality. For this test to be accurate 3 to 5 days of abstience is required before providing the sample.

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).

If the results show abnormalities in the sperm, we can then categorize the condition from which the man suffers according to the alterations observed.

Macroscopic study

When a macroscopic analysis of the semen is performed, basic characteristics of the sperm are analyzed with the naked eye without using 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 this simple semen analyses, it is not complicated for the patient to interpret the results of the seminogram by himself.

Microscopic study

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

Sperm motility
For the sperm to reach the egg and fertilize it, they should move forward rapidly and progressively.
Sperm concentration
Refers to the sperm count per milliliter of ejaculate or in the entire sample.
Sperm morphology
Sperms with abnormal forms will find moving forward and the obstacles of the female reproductive tract more complicated to navigate.
Sperm vitality
Sometimes, a sperm test shows the presence of dead sperm in the ejaculate, which are incapable of fertilizing an egg. This parameter is determined when there is a large number of immotile spermatozoa.
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 analysis

If the seminogram comes back with abnormal results, your doctor may order a hormonal analysis 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.

As such, 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 is required. Basically, it is a bacteriological study of the sperm to detect microorganisms.

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 there is no infection. In contrast, if the quantity of microorganisms is greater than the normal values, infection is present.

Genetic test - the karyotype study

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 trying to conceive.

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 (low in salts), causing an osmotic imbalance in the cells. This imbalance would cause the solution to enter the sperm, increasing its cell volume and the sperm cell becomes swollen.

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

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. The purpose is to check if 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 advisable 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, after analysis of between 100 and 2000 spermatozoa, an increased incidence of chromosomal disorders is observed compared to a control group of fertile sperm donors.

You can get more detailed information about this complementary male fertility study in the following article: Fluorescent in situ hybridisation.

Testicular biopsy

A testicular biopsy 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 is absent in the semen sample, 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.

If you would like to learn more about this procedure please click the following link: What is a testis or testicular biopsy?

FAQs from users

What is the male factor study?

By Elena Santiago Romero M.D. (gynecologist).

The male factor as a possible cause of sterility will be studied mainly by performing a semen analysis. This test consists of analyzing a semen sample to evaluate different parameters and thus find out if there is any alteration that may explain or be the cause of sterility. Basically, the pH, volume, concentration and total number of spermatozoa in the sample are evaluated, as well as their motility and morphology. For assisted reproductive techniques, ideally we will also request an EMR (motile sperm count) to know how many motile sperm are actually recovered after processing the sample.

If the semen analysis is altered, it is recommended to repeat it after at least one month to verify that the alterations are still present and have not appeared only occasionally. There are cases in which, if the alterations are important, it will be necessary to complement the study with more tests such as a semen and urine culture to rule out infection; a sperm fragmentation; a genetic study in case this could be the cause of the male factor, etc.

Translated with www.DeepL.com/Translator (free version)

Can I suffer fertility problems because of my advanced age or does it only affect women?

By Patricia Recuerda Tomás B.Sc., M.Sc. (embryologist).

Although in the male there is never a cessation of gamete production, numerous studies have shown that there is a decrease in sperm quality directly related to the age of the male, although it is not as drastic as it would be in the female case.

Between 40 and 70 years of age, a gradual process of decrease in testosterone production begins, which finally affects sperm quality, understood as a decrease in the volume, motility and morphology of spermatozoa, together with damage to sperm DNA.

How can you tell if I am fertile?

By Sara Salgado B.Sc., M.Sc. (embryologist).

If a man has been having unprotected sexual intercourse for a year and has not achieved pregnancy, or if he wants to know if he is fertile, a male fertility study can be performed.

The first thing to do is to take a medical history and a complete physical examination, together with a seminogram, a test that detects the volume, concentration, motility, viability and morphology of the spermatozoa, and which also helps us to prevent, avoid or cure disorders that cause sterility and that usually go unnoticed.

What is the cost of fertility tests for males?

By Sara Salgado B.Sc., M.Sc. (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.

How can you tell if a man is infertile without medical tests? Are there any home fertility tests or tests sold in pharmacies?

By Sara Salgado B.Sc., M.Sc. (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.
Read more

What does healthy sperm look and smell like?

By Sara Salgado B.Sc., M.Sc. (embryologist).

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.

Where can a man go to check his fertility?

By Sara Salgado B.Sc., M.Sc. (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 male fertility test should be done before marriage?

By Sara Salgado B.Sc., M.Sc. (embryologist).

There are no compulsory pre-marital male or female fertility test that must be done by default.

However, some couples choose to be tested for HIV and other sexually transmitted diseases, blood group, fertility, possible genetic and/or chronic medical conditions, etc. However such tests are totally optional and at the couples discretion.

If you want to learn more about the possible causes of male infertility, we recommend you continue reading with the following article: What are the causes of male infertility?

A basic test for the study of maculine fertility is the hormonal analysis. If you wish to obtain more information on this subject, you can visit the following link: Male hormones and fertility.

We make a great effort to provide you with the highest quality information.

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References

Andrade-Rocha FT (2003). Semen analysis in laboratory practice: an overview of routine test. J Clin Lab Anal 2003; 17: 247-258 (View)

Baker DJ (2007). Semen analysis. Clin Lab Sci; 20: 172-187; quiz 188-192 (View)

Cardona-Toro LE (1996). Espermograma: indicaciones e interpretación. Medicina & Laboratorio; 6: 267-275 (View)

G.R. Dohle, T. Diemer, A. Giwercman, A. Jungwirth, Z. Kopa, C. Krausz (2010). Guía clínica sobre la infertilidad masculina. European Association of Urology 2010 (actualización en abril de 2010) (View)

Guzick DS, Overstreet JW, Factor-Litvak P, Brazil CK, Nakajima ST, Coutifaris C, et al. (2001). Sperm morphology, motility, and concentration in fertile and infertile men. N Engl J Med; 345: 1388-1393 (View)

Kvist U, Björndahl L. ESHRE Monographs: Manual on Basic Semen Analysis. Oxford: Oxford University Press, 2002 (View)

Male infertility best practice policy committee of the American Urological Association (AUA) (2010). The optimal evaluation of the infertile male. AUA Best Practice Statement (View)

Weidner W, Colpi GM, Hargreave TB, Papp GK, Pomerol JM, Ghosh C; EAU Working Group on Male Infertility (2002). EAU guidelines on male infertility. Eur Urol;42:313-22 (View)

FAQs from users: 'What is the male factor study?', 'Which values are considered normal in a semen analysis report?', 'Can I suffer fertility problems because of my advanced age or does it only affect women?', 'How can you tell if I am fertile?', 'What is the cost of fertility tests for males?', 'How can you tell if a man is infertile without medical tests? Are there any home fertility tests or tests sold in pharmacies?', 'How can I know my sperm count?', 'What does healthy sperm look and smell like?', 'Where can a man go to check his fertility?', 'What can cause a man to be infertile?' and 'What male fertility test should be done before marriage?'.

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Authors and contributors

 Elena Santiago Romero
Elena Santiago Romero
M.D.
Gynecologist
Bachelor's Degree in Medicine and Surgery from the Autonomous University of Madrid. Master's Degree in Human Reproduction from the King Juan Carlos University and the Valencian Infertility Institute (IVI). Several years of experience as a gynecologist specializing in Reproductive Medicine. More information about Elena Santiago Romero
License: 282864218
 Marta Barranquero Gómez
Marta Barranquero Gómez
B.Sc., M.Sc.
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
 Patricia Recuerda Tomás
Patricia Recuerda Tomás
B.Sc., M.Sc.
Embryologist
Bachelor's Degree in Biology from the University of Alcalá de Henares. Master’s Degree about the Theoretical Basis and Laboratory Procedures in Assisted Reproduction from the University of Valencia (UV). Extensive experience working at several Assisted Reproduction laboratories. More information about Patricia Recuerda Tomás
License: 19882M
 Sara Salgado
Sara Salgado
B.Sc., M.Sc.
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
M.D.
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:
 Michelle Lorraine Embleton
Michelle Lorraine Embleton
B.Sc. Ph.D.
Biochemist
PhD in Biochemistry, University of Bristol, UK, specialising in DNA : protein intereactions. BSc honours degree in Molecular Biology, Univerisity of Bristol. Translation and editing of scientific and medical literature.
More information about Michelle Lorraine Embleton

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