Infertility in Men
Diagnosis
An initial male fertility examination includes a medical history, physical examination, general hormone tests and one or more semen analyses, which measure semen volume as well as sperm number, ability to move spontaneously and quality of motion.
Medical history
Initial questions may include:
- A review of past medical history, prior surgeries and medications used
- A discussion of family history of infertility or birth defects
- A careful review of social history and occupational hazards to evaluate potential exposure to hazardous substances that could impact fertility
Physical exam
Next, you will receive a thorough physical examination to evaluate the pelvic organs — the penis, testes, prostate and scrotum.
Laboratory tests
Laboratory tests may include:
- Urinalysis. These can indicate the presence of an infection.
- Semen evaluation. The evaluation assesses sperm motility or movement, the shape and maturity of the sperm, the volume of the ejaculate, the actual sperm count and the liquidity of the ejaculate.
- Hormonal tests. Hormonal tests evaluate levels of testosterone and FSH (follicle-stimulating hormone) to determine the overall balance of the hormonal system and specific state of sperm production. Serum LH and prolactin are other hormonal tests that may be done if initial testing indicates the need for them.
If a diagnosis is not obvious after the initial evaluation, further testing may be required. One or more of the following tests may be recommended:
- Seminal fructose test. To identify if fructose is being added properly to the semen by the seminal vesicles
- Post-ejaculate urinalysis. To determine if obstruction or retrograde ejaculation exists
- Semen leukocyte analysis. To identify if there are white blood cells in the semen
- Kruger and World Health Organization (WHO) morphology. To examine sperm shape and features more closely
- Anti-sperm antibodies test. To identify the presence of antibodies that may contribute to infertility
- Sperm penetration assay (SPA). To confirm the sperm's ability to fertilize
- Ultrasound. To detect varicoceles (varicose veins) or duct obstructions in the prostate, scrotum, seminal vesicles and ejaculatory ducts
- Testicular biopsy. To determine if sperm production is impaired or a blockage exists
- Vasography. To check the structure of the duct system and identify any obstructions
- Genetic testing. To rule out underlying mutations in one or more gene regions of the Y chromosome, or to test for cystic fibrosis in men missing the vas deferens
After the diagnostic evaluation is completed, treatment may involve medical or endocrinologic treatment, surgical correction or a decision to manipulate or process sperm to achieve a pregnancy.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.