Both partners will be evaluated for fertility problems during the first visit. The male partner will be asked about their symptoms and their personal and family health history. Questions will also be asked about lifestyle habits, such as tobacco and alcohol use. The doctor will also ask about any exposure to toxins, such as those at work or in the environment. A physical exam will also be done to look for health problems that may cause infertility, such as dilation or swelling of the veins of a testicle.
These tests will be done:
A semen analysis is the main tool used to diagnose male infertility. The ideal sample is collected in a lab. It may also be collected at home or at a doctor's office and sent to a lab. The sample must be tested soon after it is collected. The lab will check the sample for:
Total Semen Volume and Thickness
The normal volume of semen is 1.5 to 5 milliliters, which is about a teaspoon. If the volume is low, it could be a sign that tube-shaped glands are not making enough fluid or that the tubes are blocked. The prostate gland also makes fluid that transports sperm. A low volume could point to a problem with the prostate.
Semen should be a thick gel that becomes thin liquid in 15 to 20 minutes. The sperm cannot move well if this does not happen. This may point to problems with the tubes that carry semen.
The total number of sperm and the number of sperm per volume of semen will be counted. The normal number of sperm in a sample is 40 million to 300 million per milliliter. A low sperm count is when a sample is below 15 million per milliliter.
Sperm movement will be tested. The percentage of sperm that are active will be rated (from 0% to 100%). 50% or above is normal. The quality of sperm that move forward will also be checked. It is rated on a 0 to 4 scale. A score of 2 or more is normal.
Size and Shape
The size and shape of sperm will be looked at in a lab. A normal sperm must have an oval head, a mid-piece, and a tail. High numbers of abnormal sperm can make it harder for a sperm to fertilize an egg.
Semen pH is a measure of how acidic a fluid is. Semen should be between 7.2 and 7.8. A high pH may be a sign of infection. A low pH may be a sign the semen has been in contact with urine or that there is a blockage in the tubes that carry semen.
Fructose is a sugar in semen that gives energy to sperm. A sample that is missing this sugar or has low amounts may point to a blockage or problems with the structure of the tubes that carry semen.
White Blood Cells
There should be fewer than 1 million white blood cells per milliliter of semen. High levels may point to an infection.
Sperm that sticks together may point to antisperm antibodies. These are proteins that attack sperm. They can cause problems with how sperm move and their ability to fertilize an egg.
Blood tests will be done to look for:
- Problems with hormone levels, such as follicle-stimulating hormone (FSH), androgens (testosterone), luteinizing hormone (LH), and prolactin
- Faulty genes, such as those found in people with cystic fibrosis
- Abnormal chromosomes
Tests will be done to look for sperm in the urine. This may point to problems with the way sperm is released in the body.
Some people may need more tests.
Images of the body may be taken to look at problems with the reproductive system. This can be done with:
- Ultrasound—sounds waves are used to create images
- MRI scan —magnetic waves and computers are used to create images
A small sample of testicular tissue may be removed for testing. This can be done with a biopsy.
Infertility in men. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/infertility-in-men-23. Accessed November 11, 2021.
Male infertility/andrology. American Society for Reproductive Medicine website. Available at: https://www.reproductivefacts.org/topics/topics-index/male-infertility. Accessed November 11, 2021.
Overview of infertility. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/gynecology-and-obstetrics/infertility/overview-of-infertility. Accessed November 11, 2021.
Reproductive health and the workplace. National Institute for Occupational Safety and Health (NIOSH) website. Available at: https://www.cdc.gov/niosh/topics/repro. Accessed November 11, 2021
Last reviewed November 2021 by EBSCO Medical Review Board Mary-Beth Seymour, RN Last Updated: 11/16/2021