If you and your partner haven’t been able to conceive after a year of trying (or 6 months if they’re over age 35), both of you may be ready to start exploring your options for fertility testing and treatments. While this responsibility is usually placed on the woman, it really shouldn’t be. According to the Centers for Disease Control (CDC), "35% of couples with infertility, a male factor is identified along with a female factor. In about 8% of couples with infertility, a male factor is the only identifiable cause." The only way to know for sure is to get tested. For male fertility testing, there are several options.
However, one test may not be able to conclusively diagnose infertility because the issue is often multi-faceted. Still, if you want to become a father, it’s important to be proactive about getting tested — your doctor can identify possible issues and recommend a treatment plan. Putting in the time and effort up front can save both you and your partner stress (and money) in the long run.
Below, you'll learn which lifestyle factors can cause infertility in men, how male fertility is evaluated, which male fertility tests are available, and how you can protect and improve your sperm health at home.
Which lifestyle factors cause sperm abnormalities?
Sperm count, sperm shape and size, and the ability of sperm to move in the way it needs to are all critical elements of male fertility. When these things are thrown off, infertility can occur. However, poor sperm health and function typically don't happen on their own. The only exception is when genetic disorders, such as cystic fibrosis, are present.
Most of the time, sperm health is impacted (for better or worse) by your lifestyle and your environment. Here are some of the most common causes of sperm abnormalities.
- Infections — Sexually transmitted infections, especially chlamydia, gonorrhea, and Mycoplasma, can impact the morphology of sperm. If you have a urinary tract infection, your body produces white blood cells (known as leukocytes) to fight off the bacteria. These white blood cells release a toxic substance that can damage sperm. The good news is that all of these infections can be treated with antibiotics, allowing your fertility to return to normal.
- Environmental exposure — Every day, you’re exposed to a variety of different toxins, chemicals, and substances that have the ability to affect sperm count, quality, and motility. These are known as endocrine disruptors and can be found in everything from household cleaning supplies to personal care products to food. Check out our article on male endocrine disruptors to learn more.
- Varicocele — Swelling of the veins that drain the testicles is known as varicocele and it the most common reversible cause of male infertility. It affects both the quality and quantity of sperm and is largely due to abnormal temperature regulation of the testicles.
- Hormone imbalances — Levels of testosterone, androgens, luteinizing hormone, and follicle-stimulating hormone all need to be at the right level. When hormone levels are too high or too low, sperm abnormalities can occur and cause male infertility. Though there are many underlying causes that can cause hormonal imbalances in men, there are usually effective methods for treating them.
- Sexual dysfunction — If you have a hard time getting or maintaining an erection, it can be challenging to get your partner pregnant. Treatments are available for this, so be sure to talk to your healthcare provider when you go in for a fertility test.
- Celiac disease — An allergy to gluten, known as celiacs disease, can cause fertility issues in men and women. Though more research needs to be done, it is thought that men with celiac disease have abnormal hormone levels and sperm.
- Medications — Though some medications may be necessary for your health and well-being, it’s important to discuss their impact on your fertility with your doctor. Chemotherapy medications, testosterone replacement therapy, and antifungal and ulcer medications can impair sperm production.
- Defect sperm transport tubules — The seminiferous tubules, epididymis, vas deferens, ejaculatory ducts, and urethra all play a large role in transporting sperm through and out of the male reproductive tract. If an injury, scarring from a surgery, or abnormal developments affect any of these tubules, sperm may have difficulty (or may not be able to) carry sperm.
- High fever or overheated testicles— In order to create healthy sperm, testicles need to stay slightly cooler than the rest of your body. An illness that results in a high fever can cause abnormal sperm production, as well as spending a lot of time in hot tubs, wearing tight underwear, or holding a laptop. Thankfully, avoiding overheated testicles can actually cause your sperm production to improve.
- Retrograde ejaculation — Normally, semen is released through the urethra. When retrograde ejaculation occurs, semen goes into your bladder instead. This happens when the muscle that helps you hold in urine fails to contract during ejaculation. There are several potential causes of retrograde ejaculation, including diabetes, spinal cord injury, multiple sclerosis, and Parkinson’s disease.
- Other lifestyle factors — There are so many components of male infertility that are not easily controlled. When it comes to your lifestyle, though, you can (usually) take action to help improve your fertility.
- Age — There’s not much you can do about your age but it's important to know that your sperm count and quality decrease over time. The more aware you are of your biological clock, the more proactive you can be about your fertility.
- Stress — Research has found that high levels of stress can negatively impact sperm quality and count.
- Weight — Excess body fat is often accompanied by a higher body temperature and hormonal imbalances. Even losing a small percentage of your body weight could help increase fertility.
- Alcohol, cigarettes, and drug use — Aside from being harmful to your overall health, the excess consumption of alcohol and any level of cigarette and drug use can cause the quality, count, and motility of your sperm to deteriorate.
For a more in-depth look, check out our guide ‘Trying to Conceive with Male Factor Infertility.’
How is male fertility evaluated?
Before we look at how male fertility testing is done, let’s take a high-level look at some of the factors that affect male fertility.
- Abnormal sperm morphology — If the size and shape of your sperm are abnormal, it may have trouble penetrating and fertilizing an egg.
- Low sperm count — It only takes one sperm to fertilize an egg but if your sperm counts are low, your odds of getting your partner pregnant decreases. Low sperm count is when there is less than 15 million sperm per milliliter of semen.
- Poor sperm motility — To fertilize an egg, your sperm first needs to reach it. If your sperm is not fast enough or strong enough to move from the testicles all the way to your partner’s fallopian tubes, you’re considered to have poor sperm motility. Less than 35% sperm per milliliter of semen is considered low.
In order to get your partner pregnant, your sperm needs to be healthy enough to reach her egg and fertilize it. If one or more of the above problems prevent this, it could explain why you're having trouble getting pregnant. These are the three factors a fertility specialist will look for during male fertility testing.
What types of male fertility testing are available?
If you're struggling to get your partner pregnant, having fertility testing done is smart. As soon as you can identify the problem, it will be much easier to find an effective solution. It's important to remember that not all male fertility tests will give you an answer -- in about 10% of couples dealing with infertility, there is no identifiable cause.
No one likes to be thought of as a statistic, yet knowing that millions of other people share the same or similar challenges as you do can be a relief. Here are some common (and not so common) fertility tests available for men.
Semen Analysis: The Most Common Male Fertility Test
When you speak to a doctor or fertility specialist about your male infertility concerns, the first thing they’re likely to recommend, after a basic physical examination of your testes, is a semen analysis. You’ll be asked to provide a semen sample at a lab and a technician will evaluate your semen by checking for the following:
- The presence of sperm in your semen
- How much sperm is present (sperm count)
- The shape of the sperm (sperm morphology)
- The motility of the sperm (how fast and strong it is)
While a sperm analysis done in a lab is the most effective means of testing all of the above factors, there are home options available. These typically only test sperm count but can be a great place to start. If you choose to start with a home test, our friends at Trak offer a sperm count test that has been recommended by doctors.
Hormone Testing for Male Infertility
It’s no secret that hormones — in females and males — play a huge role in reproductive health. For males, there are three main hormones that need to remain balanced in order for optimal fertility — testosterone, luteinizing hormone, and follicle-stimulating hormone. Too much or too little of any or all of these hormones can wreak havoc on sperm production and sperm health.
Luckily, there are tests (and treatments) available for hormonal imbalances that affect male fertility. Typically, if you’ve had a semen analysis done and your sperm count, morphology, or motility is abnormal, your doctor will recommend a hormone test. These tests can help identify the cause of abnormal sperm production but aren’t always a great indicator of infertility because normal hormone levels don’t necessarily mean there is no problem.
A blood test will allow your doctor to check your hormone levels. The normal ranges for each are:
- Testosterone — 270 to 1,100 ng/dL
- Luteinizing hormone — 2 to 18 mIU/mL
- Follicle-stimulating hormone — 2 to 7 mIU/mL
Your hormones are affected by a number of things including lifestyle factors and exposure to hormonal disruptors. The good news is that, by identifying where you may have a hormonal imbalance, you’ll be able to take action to correct it.
Genetic Fertility Testing
According to the Cleveland Clinic, the chances of finding a genetic abnormality through testing are very low. However, if your sperm count is very low (or there is no sperm found in your semen) or if you have physical features that suggest genetic abnormalities like small testicles, a genetic test may still be worthwhile. With these factors present, the likelihood of finding a genetic cause jumps to about 15%.
The Cleveland Clinic outlines the three common genetic tests performed to detect male infertility:
- Karyotype (also known as a chromosome analysis). This test examines the number and “set-up” of the chromosomes and can detect if a person is missing or has extra copies of entire chromosomes or very large pieces of the genetic code.
- Y chromosome microdeletion test. This determines if genetic information is missing from parts of the Y chromosome that are necessary for normal sperm production.
- Cystic fibrosis (CF) gene test. Cystic fibrosis is a genetic (inherited) condition that mainly affects the lungs. Recent research has uncovered “variant” forms of cystic fibrosis that affect male fertility only. Cystic fibrosis gene testing looks for misspellings (mutations) in the cystic fibrosis genes that can cause male infertility.
These tests can help your fertility specialist detect genetic conditions that may be impacting your fertility, as well as devise plans that can help address them.
Other Male Fertility Testing Options
While semen analysis and hormone testing are the most common types of male fertility testing, with genetic testing a close third, there are other options. These are far less common but it’s important not to rule anything out if you’re determined to get to the root of your infertility.
- Sperm agglutination — a test to determine if the sperm are clumping together, making it hard for them to move through cervical mucus
- Testicular biopsy — removal of a small piece of tissue from the tubules in the testes, used to evaluate how well sperm are being produced
- Hemizona assay — a test where a non-usable human egg is cut in half to observe whether your sperm can penetrate the outer layer
- Vasography — an x-ray to see if the vas deferens is blocked or leaking sperm
- Ultrasonography — an exam that allows your doctor to locate damage or blockage in the male reproductive tract
If all other tests are inconclusive, it’s possible that your doctor may recommend one of these less common tests. If you’re unsure why they’re advising these or have any questions, don’t hesitate to ask. These are all more invasive and complicated than hormone, genetic, or semen testing but they are an option.
How to improve sperm health at home before and after male fertility testing
- Talk to a doctor about your health and your medications. While there’s no need to talk to a doctor about infertility issues before you’ve even started to try to conceive, you should still meet with them to discuss your general health before you think about introducing a new family member to your life. This will give your doctor a chance to provide any initial feedback on things to be aware in the near future, and will also give them a chance to address any health issues that could affect children you may conceive. Meeting with a doctor will also allow you to review your current medication list if there is one. This is important, since you may need to ditch any that have a tendency to affect sperm or fertility.
- Add folic acid to your diet. Folic acid doesn’t just help mothers set the way for a healthier pregnancy. Researchers have found a connection between lower levels of folic acid in men’s diets and higher rates of abnormal chromosomes in men’s sperm. Since abnormal chromosomes can lead to birth defects or even increase the chances of a miscarriage, it’s worth trying to prevent future problems by going on a multivitamin or eating more foods that are high in folate.
- Reduce your alcohol intake. Sorry, guys: alcohol doesn’t just affect women. Studies have shown that consuming high amounts of alcohol can reduce your sperm count and even cause sperm abnormalities. The good news is that you don’t need to give up alcohol entirely - limiting yourself to one or two (normal sized!) drinks a day should be enough to keep your sperm healthy enough to conceive.
- Stop smoking. Smoking is a serious risk factor for both genders when you’re trying to conceive. According to the CDC., “a pregnant woman who is exposed to secondhand smoke has a 20% higher chance of giving birth to a baby with low birthweight than women who are not exposed to secondhand smoke during pregnancy.” Add in the fact that smoking damages sperm, and you have a dangerous habit that should be under control before you begin trying for a baby.
- Take a look at your work environment. Safe work environments aren’t just important for pregnant women - they can also affect a man’s fertility and even whether or not he conceives a healthy child. To avoid this potential risk, find out before conceiving if you're regularly exposed to pesticides, chemical fertilizers, lead, nickel, mercury, chromium, ethylene glycol ethers, petrochemicals, benzene, or perchloroethylene at work. These can affect sperm health and even lead to miscarriages.
- Keep your boys cool. You’ve probably heard at some point that overheating your testicles is a bad idea if you want to start a family. We’re here to say that’s true - even the heat we’re exposed to in hot tubs, saunas, and long showers can impact sperm quantity. Heating pads, electric blankets, and overly tight clothing can also have a negative impact on the temperatures within your testicles. Because of this, it’s a good idea to minimize your exposure to heat sources if you want to conceive a baby.
- Ditch your bike. While cycling can be a great form of exercise, it can also cause a lot of friction and may even increase the temperature of your testicles enough to affect your sperm’s health. Because of this, you may want to consider an alternative method of exercise that doesn't hurt your fertility.
Male fertility testing can seem overwhelming but it’s important that you don’t leave it as a last resort. The odds are that, if you and your partner are having trouble conceiving, the issue lies with you in some way. This isn’t anything to be ashamed of and it’s not your fault. Be proactive, get tested, and look forward to coming up with effective solutions so you can become a father.