Male Infertility Testing
Male factor infertility is one of the most common causes of infertility so it is extremely important to evaluate the male early in the investigation of the infertile couple. Generally, the work-up of the male begins with a semen analysis. Depending on the results of a semen analysis, we may recommend bloodwork or an examination by a urologist. Sometimes an actual "cause" for the male infertility can be identified but more commonly no explanation is found. Although the lack of diagnosis can be frustrating, the success with treatment is usually very good.
Male Factor Testing: Patient History
It is extremely important to review the medical history of the male partner of an infertile couple. Some men may have a history of sexual dysfunction or abnormal ejaculation. Alternately others may have had previous surgeries, illness, exposures or injuries that may lead to problems in semen production.
Male Infertility Tests: Semen Analysis
The initial diagnostic study of male infertility is the semen analysis. The analysis is generally performed on a specimen that has been produced by means of masturbation into a sterile specimen container. For those men who are unable or unwilling to masturbate, special semen collection devices, which are used like condoms, can also be used to collect sperm for analysis. Ideally the male should abstain from ejaculation for 2-5 days prior to the analysis. The specimen should be evaluated within one hour from production. The analysis consists of basic measurements of the volume (in milliliters), the concentration of sperm within the ejaculate (usually expressed in number of sperm per milliliter of semen), the percentage of the sperm which are moving (motility), and the quality of the movement described as the “progression” and the shape of the sperm (“morphology.”) Labs may also report other parameters such as the pH, viscosity, agglutination, color of the semen, or the viability (percentage of sperm which are alive and dead).
Male Infertility Tests: Hormonal and Genetic Bloodwork
If the concentration (“count”) of the sperm is low in the semen analysis, hormonal bloodwork will be ordered to determine if a central (brain) or testicular explanation can be found. If the concentration is extremely low (<5 Million/ml), genetic testing may be recommended (karyotype, Y chromosome microdeletion testing.)
Male Infertility Tests: Urology
Some male infertility patients will be referred to an urologist for evaluation. Via exam and sometimes, ultrasound, the urologist will ensure that all pelvic structures are normal and that no blockages, masses or dilated blood vessels (varicocele) are present. A large varicocele may decrease sperm number and/or quality and can be a surgically correctable problem. Unfortunately, in the majority of cases of abnormal sperm parameters, a "cause" is never identified.
Male Infertility: Additional Diagnostics
There are many other diagnostic tests offered to evaluate infertility in males. Some may be useful in very specific situations, such as a DNA integrity testing or testing for Antisperm Antibodies.
Others, such as the Hamster Penetration Assay, Hemizona Assay, Hypoosmotic Swelling Test, and the Acrosome Reaction Test, have limited roles, if any, in the evaluation or treatment of male infertility today.