Testing for Male Infertility

Testing for male infertility can be complicated, time consuming and expensive.  Because the end results of the  many disparate problems that cause male infertility are low sperm count, abnormal sperm shape, and poor sperm motility, additional tests besides a semen analysis (described below) are required to pinpoint the cause of the infertility.

The evaluation of the male begins with a history, physical examination, and two semen analyses.

Semen Analysis:

At least two semen samples collected on separate days by masturbation are recommended.  Each sample should be collected after abstaining from ejaculation for at least 48 hours, but not for longer than 3-5 days.  The complete ejaculate should be collected and must be examined within an hour of collection for optimal accuracy.  A general semen evaluation includes a determination of the time it takes for the semen to become liquid and an examination of the semen’s volume, consistency, and pH.  The semen is also microscopically evaluated for sperm count, motility, sperm shape, agglutination (the sperm’s propensity to clump together), and the presence of foreign elements such as bacteria.  According to the World Health Organization, a normal ejaculate should have more than 50 million sperm per milliliter; at least 60 percent of the sperm should have forward motility, and more than 60 percent should have a normal morphology.  Contradictions to these criteria indicate a condition that is causing the male infertility.

To pinpoint the cause of infertility, a variety of other tests may be performed:

• Hormone evaluation--measures blood levels of the hormones involved in sperm production, abnormal hormonal levels are indicative of the hormonal problems described that cause infertility.

• Semen culture--checks for bacteria in the semen which either cause or indicate a genital infection that may cause infertility.

• Biochemical analysis of semen--measures various chemical in semen; a chemical imbalance may impair fertility.

• Post-coital/cervical mucus test--checks the compatibility of a man’s sperm with the mucus of his partner’s cervix.  If the sperm and mucus are incompatible, the sperm is unable to pass through the mucus into the fallopian tubes and fertilize the egg.

• Sperm penetration assay (Hamster test)--measures sperm-egg membrane fusion using hamster eggs a man’s sperm:  tests the capability of the sperm to penetrate the egg during IVF.

• A thorough physical examination and history can diagnose physical problems such as varicocoeles, Klinefelter’s Syndrome, retrograde ejaculation, erectile disfunction, and premature ejaculation.

• An absence of sperm in the semen sample is indicative of ejaculatory incompetence, retrograde ejaculation, or one of the conditions that block the spermatic ducts.