Infertility and men: Diagnosis

Infertility and men: Diagnosis

So your partner and you have decided to have a baby, you have been trying very hard for more than six months without any success?  This is the first red flag that should alert you that it is time you seek medical help to determine why it’s taking so long. Inability to conceive for more than six months of having unprotected sex can indicate infertility, either due to a male factor or a female factor. There are several tests available to diagnose the underlying causes of infertility. Your doctor will be able to guide you best after evaluating your medical history and other factors.

Here are the steps involved in diagnosing infertility due to a male factor:

Physical examination

This is generally the first step where the doctor asks you about your medical history, injuries, surgeries, family medical history to check for hereditary conditions, and sexual development and habits.

Semen analysis

This step involves the analysis of the semen which is then sent to a laboratory to check sperm count, abnormalities in shape (morphology), movement of sperm (motility), and infections. Since sperm count can vary in different samples, more than one semen analysis will be conducted to get an accurate result. If the semen analysis yields nothing out of ordinary, the doctor will then ask your partner to get tested before conducting further infertility tests to check for a male factor.

Hormone testing

A blood test to measure the levels of testosterone and other hormones produced in the pituitary and hypothalamus is conducted. These hormones are important in sexual development and sperm production.

Genetic testing

Genetic causes can also be responsible for a low sperm count. A genetic test can help discover subtle changes in the Y chromosome which cause genetic abnormalities, and also check for congenital and inherited problems.

Biopsy of the testicles

Samples are extracted from the testicles using a needle. This will determine if sperm production is normal. If this problem is ruled out, further tests to see if there is a blockage or a sperm transport problem will be conducted.

Scrotal ultrasound

In a scrotal ultrasound, the doctor will use high frequency sound waves to produce images inside the body, which will then help him check for obstructions in and around the testicles.

Trans-rectal ultrasound

The doctor will check for blockages of tubes that carry semen, and the prostate by inserting a lubricated wand in the rectum. This will determine if the problem lies in transportation of the semen.


This is conducted to check for retrograde ejaculation, i.e. to check if the sperm is traveling backward into the bladder and not through the penis during ejaculation. A urine sample will be collected after ejaculation to check for this condition.

Other sperm tests

A number of specialized tests are conducted to check how long the sperm survives after ejaculation, how successful it is in penetrating the egg, and if it’s facing problem attaching to the wall of the egg.  Some of these are:

  • Anti-sperm antibody test determines if there are antibodies attached to the sperm which are hindering its movement.
  • Vital staining test checks if there are enough sperms are alive in a sample.
  • Peroxidase staining and semen culture is done to check for infection or inflammation that might be affecting the sperm.
  • Hypo-osmotic swelling test will check if the outer layer of the sperm is damaged
  • Computer assisted semen analysis helps determine if the sperm’s movements are normal
  • Sperm DNA test can detect fragile DNA or if many of the sperm are broken
  • Some blood tests may also be conducted to determine why the sperm is unable to successfully fertilize an egg.

While almost half of the infertility cases can be due to a male factor, it should also be noted that testing might not always yield any answers. In about 10% of infertility cases, no cause can be determined. If however, the doctor is able to determine the cause, there might be a good chance it can be treated or sperm can be retrieved manually for artificial insemination. In either case, it is best to seek medical advice as soon as you face hiccups when you are trying to conceive.