How Is Male Infertility Evaluated? What Sperm Analysis Looks for and More

How Is Male Infertility Evaluated? What Sperm Analysis Looks for and More
Find out how fertility tests for men work from a Stanford IVF nurse — what goes on in diagnosing and improving male fertility.
Written by Orchid Team 
Medically reviewed by‍ Cristina Vidal, RN
  • Cristina Vidal, RN, is the IVF-Donor-Surrogate nurse coordinator at Stanford Reproductive Endocrinology and Infertility with over 20 years of experience in the fertility and reproductive clinic.

Who can be impacted by male factor infertility?

The large amount of evidence regarding infertility among couples shows that on average, male factor infertility causes between 20-30% of infertility in couples and also plays a contributing role of 20-30% for infertile couples. This means that in total, male factor infertility plays a critical role in the fertility of a couple around 50% of the time.

This is why it is so important to consider a male factor fertility evaluation when making your initial plan with an endocrinologist or other fertility expert. Infertility in men is also compounded by age, due to the fact that as men reach the age of 40 years old or above, the quality of their sperm begins to gradually diminish and they also tend to produce less sperm.

The most common causes of male infertility are in relation to how the testicles work, along with any blockages in the ducts or the absence of these ducts. It is also possible for hormonal imbalances, sperm disorders, and lifestyle factors such as obesity and substance use to play a role in decreasing fertility in men.

How is male infertility evaluated?

The evaluation of male fertility includes an analysis of a patient’s medical history, their past surgeries, lifestyle factors, medications, tests for infectious diseases, genetic testing, and a semen analysis. If a patient is diagnosed with infertility, or the patient is already aware that he has male infertility from a previous diagnosis, then a referral to a urologist is necessary to get a more thorough evaluation.

A referral to a urologist will also include a focused physical examination to better understand the patient’s anatomy, along with lab assessments of the patient’s reproductive hormones and other tests such as an ultrasound.

Not all urologists are trained in the causes of infertility, so it pays to check that you are going to see a urologist who has the right training and experience with diagnosis and treating male infertility.

What does a sperm analysis look for?

A complete male infertility diagnosis is made by analyzing a patient’s semen through 2 separate tests carried out on separate days. Evaluation also looks at hormone levels and ultrasound studies on the scrotum and blood vessels inside the testicles.

Sperm analysis looks at a couple of things: the volume (in milliliters) of semen produced per sample, the concentration of sperm present within a milliliter of semen in the sample, the total count of individual sperm produced, the percentage of sperm that have healthy motility (sperm that can swim), and the amount of sperm that show the desired shape for fertility, also called sperm morphology.

The results of a semen analysis can vary, so it may be necessary for the physician to repeat the analysis for confirmation of normal or abnormal test results. Men can produce varying results on different days, and with two semen analyses, the physician will have a better interpretation of the sperm quality. So, it can be common if they ask for a second sample.

Problems regarding how a sperm fertilizes an egg, or problems relating to getting and maintaining an erection or ejaculating may indicate male infertility. Some of the most common causes of male infertility include sperm disorders such as immature sperm that are not fully formed, abnormally shaped sperm, a low sperm count, or where sperm are unable to swim. If the semen analysis indicates a low sperm count or not sperm at all, a testicular biopsy of each testicle may be performed.

All of these types of sperm disorders may be caused by infections or inflammatory diseases, hormonal or pituitary gland problems, environmental and lifestyle factors, genetic diseases such as cystic fibrosis, or problems caused by the immune system. Additionally, structural problems that block the tract can affect the flow of sperm whether it is caused by inflammation, scar tissue, or a birth defect. Problems relating to sperm transportation make up between 10 and 20% of male infertility cases.

How do hormones impact fertility?

There are three key areas of hormone production in the body that relate to male fertility, those being the testes, the pituitary gland, and the hypothalamus. Approximately 10% of cases of male infertility are caused by hormonal imbalances.

The hormone called Luteinizing Hormone (LH) is produced in the pituitary gland and it helps the testes to produce testosterone which in turn plays a critical role in male fertility. Imbalances in these hormones may lead to the body not producing enough sperm, however this can be remedied with regular hormone therapy depending on the specific cause for the hormone imbalance.

What are ways to improve fertility?

Perhaps one of the first things that should be considered when trying to improve fertility in men is the use of substances. Things like alcohol, cigarettes, and other recreational drugs like marijuana have been shown to negatively affect the quality of sperm.

Other things like your diet, weight, and whether or not you exercise are going to have an additional impact, all of which will require lifestyle changes to improve fertility. It’s a great idea to regularly visit your healthcare provider to routinely monitor cholesterol and blood pressure for a more targeted approach to improving your health. Stress can also play a larger role in sperm production and male fertility.

There is also a range of medications that your doctor can prescribe when appropriate if you suffer from hormone imbalances to ensure that you have the right balance of testosterone and estrogen for improved fertility.

If you are planning on starting or growing your family, check out our expert guides on all things genetics and fertility. Today, advanced genetic screening is now available to couples who want their child to have the best shot of a healthy life. Explore how Orchid helps you conceive with confidence.
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