Diagnostic Testing for Male Factor Infertility

Revised 2008


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Male 50-50.pngWhen a couple has trouble having a baby, there's about a 50-50 chance that the man has a problem contributing to the pregnancy. He might:

  • Produce too few sperm to fertilize an egg
  • Make sperm that are not shaped properly or that do not move the way they should
  • Have a blockage in his reproductive tract that keeps sperm from getting out

If you might have a fertility problem, your doctor will want to perform a complete history and physical, as well as several tests to find out what may be causing your infertility.

Semen analysis

Semen analysis is probably the first test you will be asked to perform. Semen is the fluid that is released when a man has an orgasm. Semen carries the sperm in fluids that should nourish and protect it. You will typically be asked to provide a semen sample by masturbating into a sterile glass jar. If masturbation is not culturally acceptable, your doctor can provide you with a special condom in which to collect semen during intercourse.

The semen analysis provides a lot of information about the quantity and quality of both semen and the sperm it contains. Some of the things that are measured are:
  • How much semen a man produces (volume)
  • The total number of sperm in the semen sample (total count)
  • The number of sperm in each milliliter of semen (concentration)
  • The percentage of sperm that are moving (motility)
  • If the sperm are the right shape or not (morphology)

DYK  Sperm Count Testing Male Infertility.pngThe analysis can also suggest if you have an infection in your reproductive system.

The semen sample has to be tested within an hour of collection, which usually takes place in the doctor's office. You'll probably need to make two visits to provide samples on two different days more than two weeks apart because samples from the same man can be different at different times. Collecting two samples makes it easier to tell if something really is wrong. You may be asked not to release sperm (ejaculate) for 2 to 5 days before you provide a sample.

Hormone levels and reproduction

Important chemicals in your body, called hormones, control sperm production. They also affect your interest in sex and your ability to have sex. Too much or too little of these hormones can cause problems with sperm production or trouble having sex. Two important hormones for reproduction are follicle-stimulating hormone (FSH) and testosterone (T). Your doctor may do blood work to check to see if you have the right amount of these hormones. If indicated, your doctor may check other hormone levels, including luteinizing hormone (LH), estradiol, and prolactin.

Other testing (that may not be necessary in most men)

If the semen analysis test results aren't normal, you may need to have more tests that can be performed by your doctor or you may be referred to a urologist. These tests will show:

  • If enough sperm in the semen sample are alive ("vital staining" test)
  • If antibodies have attached to sperm, making it hard for the sperm to move properly ("antisperm antibodies" test)
  • If you have an infection or inflammation that affects your semen ("peroxidase staining" and "semen culture")

Sperm Shape.pngMore tests (but these won't be necessary for most men)

If you've had the tests described above, but your doctor still does not know why you are having problems, additional tests may be necessary. These tests will tell your doctor:

  • If the outer layer of the sperm is broken or intact ("hypo-osmotic swelling" test)
  • If your sperm are moving the way they should ("computer-assisted semen analysis")
  • If too many of your sperm have broken or fragile DNA ("sperm DNA testing")

If you produce very few sperm (or if you produce no sperm), your doctor may want to perform a genetic test to see if there is anything abnormal with your genes that makes it impossible for you to produce sperm. These tests can also tell if there is a problem that you could pass on to a child. These tests will tell your doctor:

  • If your sperm have the correct number of chromosomes (sperm aneuploidy testing)
  • If you have a chromosome defect (chromosome analysis and/or Y-chromosome deletion testing)
  • If no sperm are seen (determine if the sperm tubes are intact or perform a biopsy of the testicles)

No semen test can fully predict fertility. Other than a semen analysis, not all tests discussed are appropriate for every couple.

Fact Sheets/Booklets

View more fact sheets and booklets written by the ASRM Patient Education Committee.
Patient Factsheet teaser

Hormonal Contraception

Hormonal contraceptives contain a progestin (progesterone medicine) with or without an estrogen.
Patient Factsheet teaser

Menopausal Transition (Perimenopause): What Is It?

The menopausal transition (perimenopause) is the period that links a woman’s reproductive (childbearing) years and menopause.
Patient Factsheet teaser

Embryo Donation: What Should I Know?

In the current practice of in vitro fertilization (IVF), some patients may create more embryos (fertilized eggs) than they need. The extra embryos may be cryopreserved (frozen) so that they can be transferred later.
Patient Factsheet teaser

Hypothyroidism and pregnancy: what should I know?

Hypothyroidism (underactive thyroid) is when the thyroid gland produces less  thyroid hormone than it should.

Resources For You

The American Society for Reproductive Medicine (ASRM) is committed to providing patients with the highest quality information about reproductive care.

Male Fertility/Andrology

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SART Fertility Experts - Wellness and Fertility: Diet, Sleep and Exercise

Drs. Timothy Hickman and Rashmi Kudesia discuss the links between lifestyle and fertility. Listen to the Episode
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Male Fertility Journey

About 20% of infertility cases are due to a male factor alone. Another 30% involves both male and female factors.

View the Patient Journey
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SART Fertility Experts - Urology and Male Reproductive Health

Male infertility is less often discussed than female infertility. Dr. Ajay Nangia discusses when a man should seek help with conceiving.
Listen to the Episode
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Male infertility evaluation: what do I need to know?

Infertility is the inability to achieve pregnancy after one year of unprotected sex. View the fact sheet
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SART Fertility Experts - Male Factor

Infertility is not just a female problem. Dan candidly shares his journey with both diagnosis and treatment of male infertility with Dr. Paul Lin.
Listen to the Episode
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SART Fertility Experts - IVF: Cycles of Hope and Heartbreak

Does stress cause infertility or is it the other way round?  Listen to the Episode
Patient Ed Icon

Fertility Options After Vasectomy

Vasectomy is currently one of the most common methods of sterilization in the United States. After your vasectomy, if you change your mind about having children, there are two procedures that can help you have a child with your partner. View the Fact Sheet
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Infertility: an Overview (booklet)

Infertility is typically defined as the inability to achieve pregnancy after one year of unprotected intercourse. View the booklet
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Optimizing Natural Fertility

Before attempting pregnancy, a woman should make sure she is healthy enough for pregnancy by adopting a healthier lifestyle and taking prenatal vitamins. If she has a medical or genetic condition or risk of one, she should seek advice from a medical professional before conceiving (becoming pregnant) View the fact sheet
Patient Ed Icon

Optimizing Male Fertility

About 20% of infertility cases are due to a male factor alone. Another 30% involves both male and female factors. View the fact sheet
Videos Icon

Male Fertility and Infertility - a patient education video

Male Factor Infertility is responsible for about 30% of infertility cases and can contribute infertility to an additional 20% of cases. Watch Video
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Infertility

Infertility is the result of a disease (an interruption, cessation, or disorder of body functions, systems, or organs) of the male or female reproductive tract which prevents the conception of a child or the ability to carry a pregnancy to delivery.  Watch Video
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Basic Infertility Evaluation

Dr. Roger Lobo of the American Society for Reproductive Medicine discusses the various methods to evaluate infertility. Watch Video
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Infertility Treatments

Dr. Roger Lobo of the American Society for Reproductive Medicine discusses the various treatments for infertility. Watch Video
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Understanding Fertility

In this video series, Dr. Roger Lobo explains the basics of infertility, including causes, treatments and coping methods. Watch Video
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Surviving the Roller Coaster Emotions of Infertility Treatment

The experience of infertility is a rollercoaster of hope and disappointment. Treatment presents an opportunity for hope as well as a new set of challenges. Watch Video
Patient Ed Icon

What is intracytoplasmic sperm injection (ICSI)?

A procedure called intracytoplasmic sperm injection (ICSI) can be done along with in vitro fertilization (IVF) if a sperm cannot penetrate the outer layer of an egg. Read the Fact Sheet
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Male cancer, cryopreservation, and fertility

This can be confusing since the terms are often used interchangeably in the media and casual conversation. View the fact sheet
Patient Ed Icon

Surgical techniques for sperm retrieval: what should I know?

As many as 10% to 15% of infertile men have no sperm in their ejaculate (the fluid released from the penis during orgasm). View the fact sheet
Patient Ed Icon

Testosterone use and male infertility

Testosterone (also referred to as “T”) is a hormone produced in men by the testes (testicles). View the fact sheet
Patient Ed Icon

Weight and fertility

One of the easiest ways to determine if you are underweight or overweight is to calculate your body mass index (BMI). View the fact sheet
Patient Ed Icon

Stress and infertility

It is not clear how exactly stress impacts fertility. Read the Fact Sheet
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Sperm morphology (shape): Does it affect fertility?

The most common test of a man’s fertility is a semen analysis. View the fact sheet
Patient Ed Icon

Spinal cord injury sperm retrieval

There are several reasons a man with a spinal cord injury (SCI) might have infertility. View the fact sheet
Patient Ed Icon

Varicocele

A varicocele is a variation of normal anatomy in which veins in the scrotum (the sac that holds the testicles) become enlarged and sometimes even visible. View the fact sheet
Videos Icon

Causes of Male Infertility

Dr. Roger Lobo, of the American Society for Reproductive Medicine explains the causes of male infertility. Watch Video
Patient Ed Icon

Diagnostic Testing for Male Factor Infertility

When a couple has trouble having a baby, there's about a 50-50 chance that the man has a problem contributing to the pregnancy.

  View the Fact Sheet
Info Icon

FAQ About Infertility

Infertility is not an inconvenience; it's a disease of the reproductive system that impairs the body's ability to perform the basic function of reproduction. Learn the facts
Infographic Icon

Male Fertility Infographics

ASRM has prepared infographics to illustrate the subject of  Male Fertility better. View the infographics

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