Male Fertility Analysis and Fertility Testing Procedures

An analysis of male fertility should include the following:

Sperm/Semen Analysis

A semen analysis for accurate measurement of sperm motility and count. Sperm morphology is assessed employing “Kruger criteria.” Semen should also be cultured for UreaplasmaUrealyticum, Chlamydia, Gonococcus and for aerobic/anaerobic pathogens.

Male Fertility Physical Exam

A proper physical exam is an important part of a complete male fertility evaluation.  In most cases, the physical exam is performed by a Urologist.  The physician may examine the penis, scrotum, testicles, and prostate for medical problems such as a varicocele (varicose vein) in the scrotum, irregular testicle size, or enlarged/dysfunctional prostate.

Hormone Exam

In a relatively small number of cases of male infertility, the failure to produce an adequate quality of sperm relates to reduced secretion by the pituitary gland of those hormones necessary to stimulate sperm production. The pituitary gland in the man produces two important hormones-identical to those produced by women-that control testicular function. The first is follicle stimulating hormone (FSH) and the second is luteinizing hormone (LH). Luteinizing hormone’s predominant function is to act on a particular variety of cells in the testicles that produces the male hormone testosterone. These cells are referred to as Leydig cells. A sustained reduction in FSH production, therefore, is capable of resulting in male infertility. Usually, if there is a reduction in either one of the components, LH or FSH, the other one will also be low. In other words, if a man produces a normal amount of LH and has normal male hormone levels (testosterone, androstenedione, dehydroepiandrosterone), then it is very unlikely that he will have a reduced FSH production. Accordingly, if his sperm function is reduced, it is unlikely to be the result of reduced FSH production by the pituitary gland.

Genetic Testing

A Sperm DNA Integrity Assay (SDIA). The SDIA, like the Sperm Chromatin Structure Assay (SCSA) is a tool for measuring clinically important properties of sperm chromosomes. The results correlate well with the potential of sperm from a given male to produce embryos that would be sufficiently “competent to produce a live birth.” The SDIA utilizes a specially designed DNA probe and a high tech machine that can then sort out according to properties that are even more integral to their ability to create an embryo than their physical appearance under the microscope. Instead, the SDIA measures DNA damage.

The degree of abnormalities in the genetic material of the sperm is expressed numerically as the DNA Fragmentation Index (DFI). DNA damage may be present in sperm from both fertile and infertile men. Therefore, this sperm DNA damage analysis may reveal a hidden abnormality of sperm DNA in infertile men classified as unexplained based on apparently normal standard sperm parameters. Infertile men with abnormal sperm characteristics exhibit increased levels of DNA damage in their sperm. Sperm from infertile men with normal-appearing sperm may have DNA damage to a degree comparable to that of infertile men with abnormal-appearing sperm. An abnormal SDI assay is more likely to occur in cases of abnormal semen parameters. Since SDIA is independent of conventional semen parameters, results may identify male patients for whom In Vitro Fertilization (IVF) and intracytoplasmic sperm injection (ICSI) will be far less likely to result in a viable pregnancy.

Antisperm Antibodies (ASA)

A blood test for the presence of Antisperm Antibodies (ASA). Immunity to sperm, whether in the male or female, is not an absolute cause of infertility. Sperm antibodies-small proteins that can be produced by immune cells to attach to sperm-reduce fertility, but do not invariably prevent conception. Rather, the effects are graduated; the larger the immunologic response, the less likely it is that a pregnancy will occur.

Postcoital Test (PCT)

Assessment of the cervical mucus after intercourse to evaluate the quality of the mucus and mucus sperm interaction; also known as the Huhner Test.

Causes and Treatments

Though many people assume that infertility is largely a female problem, the truth is that approximately half of infertility cases involve the male to some extent. The good news is that male infertility can be treated effectively in the overwhelming majority of cases.

Know more about Fertility Tests for Men.

Male Infertility Diagnosis

Disorders of sperm quality range from a low count or motility to a complete absence of sperm production. Deformities of the sperm cell shape (morphology) are important because they reflect its ability to fertilize the egg. Mild abnormalities of semen parameters can be effectively treated using techniques that “wash” away the seminal fluid to improve the concentration and selecting/isolating the normally-shaped motile sperm from the abnormal ones. This elite group of sperm can then be transferred to the uterus via an intrauterine insemination (IUI). However, for more severe degrees of male factor infertility, this treatment is inadequate. With a total motile cell concentration of less than 10 million cells per ml or a normal morphology of less than 4% “normal” by strict Kruger criteria, the chance of fertilization failure is very high, even with IVF.

Male Infertility Signs and Symptoms

It is always a good idea to have a fertility evaluation if you are having trouble conceiving, regardless of whether your female partner has already been evaluated. Male infertility accounts for approximately half of all couples’ failure to conceive.  You should seek out a urologist for a complete fertility evaluation if you have experienced any of the following symptoms:

  • Absence of ejaculate
  • Thin, watery ejaculate
  • Problems ejaculating
  • Erection problems
  • Low sex drive
  • Tenderness or pain in testicles
  • Past groin injury or surgery – including scrotum, penis and/or testicles
  • History of prostate or sexual problems

Testicular Sperm Extraction (TESE)

Testicular Sperm Extraction (TESE) is a minor procedure that can be performed on men that produce sperm but are unable to ejaculate it. It involves the introduction of a thin needle directly into the testicle(s), under local anesthesia, without making a skin incision. Hair-thin specimens of testicular tissue are removed in the space of 15 to 30 minutes. Sperm are extracted from the tissue and each egg is injected with a single sperm using the ICSI technique described above. It is most commonly done in cases of spermatic duct (vas deferens) occlusion or absence but can also be performed in cases of ejaculatory dysfunction, such as might occur following spinal cord injuries, after prostatectomy, or in cases of intractable male impotency. TESE is a simple, relatively low-cost, safe, and virtually pain-free procedure. Most men can literally take off a few hours for the procedure and return to normal activity the same day. In addition to the remarkable success rates with TESE/ICSI, the fact is that unlike vasectomy reversal, the procedure allows the man to retain his vasectomy for future contraception.