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. Male infertility contributes to about 50% of all cases of infertility, with it being the main factor in one-third of all cases.
Fertility, in general, is a complex problem. 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 upfront can save both you and your partner stress (and money) in the long run.
Which Factors Contribute to Male Infertility?
Before we look at the different male fertility tests available, 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
- 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.
These three things all play an important part in male fertility. But they don’t just happen on their own. Here’s a quick rundown of the possible causes for abnormal sperm morphology, low sperm count, and poor sperm motility:
- Infections such as sexually transmitted infections and UTI’s
- Environmental exposure to harmful toxins and chemicals
- Genetic disorders like cystic fibrosis
- Hormonal imbalances
- Sexual dysfunction
- Certain medications
- Retrograde ejaculation
- Lifestyle factors like age, weight, and stress
For a more in-depth look, check out our guide ‘Trying to Conceive with Male Factor Infertility.’
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.
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.