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Male Fertility Testing

Male fertility testing facts

  • Testing for infertility in men uncovers any issues with sperm or the male reproductive system that may interfere with conception.
  • The most common male fertility test is a semen analysis, which checks the quantity and quality of sperm in a man’s semen.
  • Other fertility tests for men include hormone evaluations, genetic testing and imaging.
  • Since male infertility is not always the sole cause of difficulty getting pregnant, a man’s partner should also have infertility testing to get a complete picture of the couple’s fertility.
  • Results of all fertility testing form the baseline from which a fertility specialist can recommend individualized fertility treatment.


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What is male fertility testing?

While many people think that infertility is mostly a female issue, male factor infertility plays a statistically equal role. Male infertility is a major or contributing cause of at least 40% of all cases of infertility, according to the American Society for Reproductive Medicine. That means about 10% of all men in the U.S. who are trying to conceive may experience infertility.

Diagnosing infertility in men

In order to treat male infertility, a fertility doctor needs to conduct tests to pinpoint the underlying cause of infertility. Male fertility testing seeks to identify one or more of the following causes of male infertility:

  • Testicles that are unable to produce any sperm, which is called azoospermia.
  • Sperm of low quantity or poor quality.
  • Abnormally shaped or formed sperm, which means they may not move well or live long enough to fertilize the female’s egg.
  • Sperm with genetic complications that make fertilization difficult or could impact the resulting pregnancy or child.

Though sperm is the primary cause of male infertility, other causes male fertility testing seeks to identify include:

  • Structural problems that can result in poor sperm or sperm production.
  • Erectile dysfunction that prevents delivery of sperm.
  • Diseases and conditions that affect sperm and/or its delivery.

Types of infertility testing for men

To diagnose male infertility, a physician will first conduct a physical examination and assess the man’s overall health. The doctor will also take a medical history that includes questions about medications, sexual habits and environment.

The physical exam and medical history can indicate structural and other causes of male infertility. If these are suspected, the appropriate male fertility tests will determine if the man has any of the following conditions:

  • A blockage in the testicles.
  • Undescended testicles.
  • Not having a vas deferens, the tube that transports sperm from the testicles.
  • Issues such as diabetes and sexual diseases.
  • Varicoceles, which are enlarged veins in the testicles.
  • Poor testosterone levels.
  • Retrograde ejaculation, which causes semen to be expelled back to the bladder and not out of the penis.
  • Damage to reproductive organs.
  • Erectile dysfunction or premature ejaculation.
  • Anabolic steroid or testosterone use.
  • Genetic diseases and hormone issues that affect sperm health.

Some of the above are detected in tests covered in detail below. But the primary issues in male infertility, even if caused by the above conditions, are related to sperm quality. Further testing in this area can include semen analysis, genetic evaluation and endocrine evaluation.

Semen analysis (sperm count test)

A semen analysis is a male fertility test that measures the quality and quantity (amount) of sperm present in the semen, which is the fluid released during a man’s ejaculation.

Semen analysis, also known as a sperm count test, requires a semen sample. There are two common ways a man can collect and provide a sample: masturbating into a sterile container or using a specially designed collection condom during sex.

The keys to an accurate semen analysis are time and temperature. Ideally, a fertility lab would examine the sample within two hours of collection. Per the U.S. National Library of Medicine, the sooner the analysis occurs and the closer to human body temperature the sample is, the more reliable the male fertility testing.

The lab’s semen analysis will measure these factors.

  • Sperm count, or sperm concentration: the number of sperm present in a milliliter of semen. A normal sperm count is 15 million per milliliter or higher.
  • Sperm shape, or sperm morphology: Regularly shaped sperm are more likely to penetrate and fertilize an egg.
  • Sperm movement, or motility: the percentage of sperm with functional forward movement. At least 40% of sperm in a semen sample should be able to swim forward to reach an egg for fertilization.
  • Total motile sperm count, or the number of moving sperm in a semen sample: There should be at least 9 million motile sperm in a semen sample.
  • Semen volume, or the total amount of fluid present in a sample: A normal semen volume is between 1.5 milliliters and 5 milliliters.
  • Thickness of the semen, or viscosity: Low or moderate thickness is considered normal.
  • Number of white blood cells, also called leukocytes: A normal sample should contain up to 1 million leukocytes per milliliter. A higher amount indicates inflammation or infection.

Treatments for an abnormal semen analysis include intrauterine insemination (IUI), in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) and other fertility treatments.

Endocrine evaluation

The hypothalamus, pituitary and testicular glands comprise a man’s reproductive endocrine system and are responsible for the production of testosterone. An endocrine evaluation is a male fertility test that will reveal any hormonal imbalances, such as an inability to produce testosterone, and whether possible hormone therapy could correct male infertility.

Endocrine evaluation can also assess other factors, such as complications from diabetes, cystic fibrosis, erectile dysfunction, or use of anabolic steroids, which may contribute to infertility in men.

Urinalysis (urine test)

A test of a man’s urine can reveal whether any white blood cells are visible, which signal infection or inflammation. A urinalysis can also detect whether any sperm are present in the bladder, which could signal azoospermia or retrograde ejaculation, a condition that is not a health threat but can affect male infertility.

Urological evaluation & imaging

A fertility specialist may enlist a urologist, who specializes in treating the urinary tract and male reproductive system, to administer further male infertility testing. A urologist may assist with ultrasonography, an imaging test that can show damage or blockage in the male reproductive system, or a vasography, a type of X-ray that shows blockage or leakage in the duct that carries sperm.

Genetic testing

Genetic evaluation may be recommended as part of a male infertility diagnosis because men with low sperm counts are predisposed to genetic abnormalities. A fertility specialist may recommend genetic testing for men with urinary tract blockages, low sperm volumes or low testosterone.

Psychological assessment of male infertility

A study reported in the International Journal of Men’s Health notes that male infertility can be humiliating and emasculating for men. The article relates that men can “conflate infertility, virility and sexual potency, which can lead to perceived personal inadequacy.”

Naturally, the stress, pressure and sometimes sadness and grief associated with assisted reproductive therapy can trigger emotions such as anxiety, depression, shame and low self-esteem. Therefore, a psychological assessment may be discussed as part of male infertility testing.