Guide To Fertility Testing For Men – Getting The Right Answers

fertility testing men
Male fertility mainly relies on the quality and quantity of a man’s sperm. When the number of sperm a man will ejaculate is considerably low or is of low quality, then it will be difficult or sometimes impossible to cause pregnancy.

Infertility of the male is only diagnosed when both partners have been tested and the reproductive problem has been found to be in the male.

male infertility

How Common Is It?

It may not be known to many, but it is indeed a widespread problem. This is because, in every 5 infertile couples, about 1 of the problems lay only in the male partner [1].

In fact, according to sources, the ratio of a male fertility problem with a low sperm count is 1:20, but only 1 in every 100 male subjects has no sperm when ejaculating.

Symptoms of Male Infertility

There might be no obvious signs of infertility. As a matter of fact, the process of intercourse, erection, and ejaculation happens without any problem at all.

In most cases, the appearance and quantity of the semen ejaculated will generally seem normal to the eyes. Only medical tests can determine if a man is really infertile.

What Does It take to Get a Woman Pregnant?

The male partner must be able to produce healthy sperm.

This will involve the formation and growth of the male reproductive organ when he is going through puberty.

Likewise, he should have at least one functional testicle and his body must be able to produce testosterone, as well as other hormones in order to trigger and maintain the production of sperm.

Sperm must be carried into the semen.

After sperm are created in the testicles, a number of delicate tubes will transport them until the sperm is able to mix with the semen and then ejaculate out from the penis.

Enough sperm is needed to go with the semen.

In the case when the number of sperm in the semen is low, there is a possibility that you will not be able to fertilize the egg of your partner.

Semen is said to have a low count when it has only 15 million sperm per milliliter of semen or less than 39 million every ejaculate [2].

Sperm needs to be able to move and must be functional.

In cases when the mobility or movement of the sperm is not normal, there is a possibility that it may not be able to penetrate or reach the egg of your partner.

Medical Causes of Male Infertility

There may be a number of health issues as well as medical treatments that can cause male fertility problems. Here are some of these issues, according to medical studies.

  • Varicocele. This type of problem is caused when there is swelling of veins draining the testicle. This is a common reversible cause in male infertility. Although it is not fully known if varicocele really causes infertility, it is still related to abnormal testicular temperature regulation. The reduction of sperm quality is mainly caused by varicocele. Treatment for varicocele should improve the sperm count and function and would potentially enhance the outcome via assisted reproductive techniques, which include in vitro fertilization.
  • Ejaculation problem. Retrograde ejaculation will occur when semen enters the bladder during orgasm, instead of emerging at the tip of the penis. It is said that there are different health conditions that will cause retrograde ejaculation, which includes spinal injuries, surgery of the bladder, urethra or prostate, medications, and diabetes. Those with spinal injuries or certain diseases might not be able to ejaculate semen, even if they can still produce sperm. Thus, there are cases where sperm can be retrieved to be utilized in assisted reproductive techniques.
  • Infection. Some types of infections might interfere with the production or health of the sperm. In fact, this can cause scarring that will block the passage of sperm. Such would include inflamed epididymis or testicles and some infections transmitted sexually, such as HIV or gonorrhea [3]. Despite the permanent testicular damage that can be caused by infections, sperm often can still be retrieved.
  • Tumors. Cancers and certain non-malignant tumors can also affect the male reproductive organs. Moreover, in some cases, male fertility can be affected by surgery, chemotherapy, and radiation that treats tumors.
  • Antibodies attacking sperm. There are antibodies that also act as anti-sperm. These are immune system cells identifying sperm as invaders attempting to eliminate them.
  • Undescended testicles. During male fetus development, the testis lies in the abdominal cavity and descend into the scrotum before birth. In rare cases, there is a failure of the testis to descend from the abdominal cavity into the scrotum, a sac normally containing the testicles. The reduction of fertility mostly happens to men having this condition.
  • Tubular defects that transport sperm. Various tubes carry the sperm, but they can be blocked due to some causes, which include surgery, trauma, and prior infections. This may also be caused by abnormal development, which includes cystic fibrosis or some other inherited conditions.
  • Hormonal imbalance. Infertility results from disorders of the testicles or an abnormality that affects other hormonal systems, which include the pituitary, hypothalamus, adrenal, and thyroid glands. Male hypogonadism, or having low testosterone and other hormonal abnormalities, may also have some impact on this case.
  • Chromosomal defects. Males having inherited disorders, including Klinefelter’s syndrome will cause abnormal development of the reproductive organs in the male. This is the case when males are born with 2 X chromosomes and 1 Y chromosome, instead of 1 X and 1 Y chromosome.
  • Sexual intercourse problems. This will include trouble maintaining or keeping an erection enough for sexual intercourse, painful intercourse, premature ejaculation, and anatomical abnormalities.
  • Celiac disease. This is a digestive disorder that might be caused by sensitivity to gluten. Fertility may only be improved after adoption of a gluten-free diet [4].

Environmental Causes of Male Infertility

  • Industrial chemicals. Overexposure to benzenes, xylene, toluene, herbicides, pesticides, organic solvents, lead, and painting materials could lead to low sperm count.
  • Radiation or X-rays. Radiation can definitely reduce sperm count, but it will return to normal eventually. However, high doses of radiation can reduce the production of sperm permanently.
  • Heavy metal exposure. Infertility can be caused by exposure to heavy metal or lead.
  • Overheating of testicles. This can happen when temperatures get elevated. Despite the absence of solid proof, the frequent use of hot tubs or saunas can temporarily impair sperm production. Long hours of sitting and wearing tight clothing can lead to an increase in temperature, which can cause the reduction of sperm count.

Health and Lifestyle Causes of Male Infertility

  • Illicit use of drugs. Muscle strength and growth stimulants, such as anabolic steroids, reportedly cause testicles to shrink. It will also likely reduce the production of sperm. Likewise, the use of marijuana and cocaine can temporarily reduce the quality and number of sperm.
  • Tobacco smoking. Those who smoke heavily can have a lower sperm count than those who do not. Male fertility can also be affected by secondhand smoking [5].
  • Alcohol intake. The consumption of alcohol should be able to lower the levels of testosterone. It can also cause erectile dysfunction and will decrease sperm count. At the same time, fertility problems can be related to liver diseases due to excessive drinking [6].
  • Emotional stress. Certain hormones that produce sperm can be disrupted with stress. In fact, prolonged or severe emotional stress can affect sperm production, which includes fertility problems.
  • Weight problems. There are several ways obesity can impair fertility, which includes directly affecting the sperm and causing hormonal changes that reduce the fertility of the male.

Diagnosis of Male Infertility

infertility diagnosis

There are various ways to test male infertility, which include the following options.

Semen and Sperm Analysis

Experts trained in this area should check your sperm count, movement, shape, and other characteristics of the sperm. Having a higher number of normal-shaped sperm would mean that you have a higher fertility.

However, there are exceptions to this fact, including one that many male patients who have low sperm count are still fertile. On the other hand, 15% of infertile men indeed have normal semen with lots of normal sperm.

When the first semen analysis has been found out to be normal, you would likely undergo another test in order to confirm the results. A couple of normal tests would usually mean that there are no significant problems of infertility.

If the result indicates unusual patterns, then you might undergo another test so that the problem would be pointed out. For those who don’t exhibit sperm at all would undergo surgery to correct the possible blockage in your reproductive organ.

Physical Examination

During this test, the doctor can determine if there are varicoceles. These are vein formations at the top of the testicles with abnormal patterns, which can be corrected surgically.

Hormone Evaluation

The making of sperm is under the control of the testosterone and other hormones of the body. However, it was found out that 97% of men tested with infertility were not due to hormonal problems.

Scrotal Ultrasound

This is the type of test that would use high-frequency sound waves in order to provide images inside the body. This process helps your doctor see varicocele or other problems inside the testicles and other structures.

Post Ejaculation Urinalysis

If there is sperm in your urine, this indicates that your sperm travels backward into the bladder. This is called retrograde ejaculation, which should instead be traveling out to your penis during the ejaculation.

Genetic Tests

When the concentration of sperm is so low, it is an indication that it is genetic in nature. Thus, a blood test is able to show whether there are changes in the Y chromosome, which are signs of genetic abnormality.

Testicular Biopsy

This type of test would involve the removal of samples from the testicle via a needle. In the event when sperm production is normal, it indicates that another problem with sperm transport is causing this condition, such as a blockage.

Transrectal Ultrasound

If you undergo a transrectal ultrasound, a tiny lubricated wand will be inserted into your rectum. This process will enable your doctor to examine your prostate and to be able to determine blockages of the tubes carrying semen.

DNA/Genetic Fertility Testing

Potential male fertility problems can be eliminated via semen analysis. This would also help the doctor get a strong baseline for understanding the condition of the person’s fertility.

The problem with this method is that the results are not conclusive enough. In some cases, the sperm is not functioning properly, but it may be there.

Epigenetic Male Fertility Test

This method would evaluate the problem with each gene in your DNA, which gives you more specific information about is going on with your condition.

It also examines the abnormalities in the genes, which also provides with both poor embryo development and male factor infertility.

DNA Fragmentation

In some tests, sperm DNA has been found to be broken or damaged, which is a marker for infertility. This was observed in 25% of infertile men with abnormal semen and 5% of infertile men with normal semen analyses.

SpermCheck Fertility

There is an alternate method of checking fertility issues for men via SpermCheck Fertility. This serves as a way to take some of the guessings out of the process of conception.

If you are planning a pregnancy in the future or might have been trying hard to get pregnant, this process is inexpensive and unique sperm detection product to help couples to save money, time, and frustration. Moreover, it can eliminate the expensive and unnecessary testing of the female.

It works similarly to the pregnancy test, as it provides easy-to-read results quickly. This uses colored lines to indicate if there is low or normal sperm count.

Likewise, you don’t have to go to your doctor to get a series of physical examinations. This is because you can do this method without leaving the comfort and privacy of your own home.

When you get 2 lines, it indicates that the sperm count is on the 20 million per milliliter mark, which is considered a normal reading for male fertility levels. However, it doesn’t indicate that the male is fertile, due to other factors that can affect the ability of the male to achieve that.

When the reading is negative, it indicates that the sperm count is less than 20 million per milliliter, which would likely create issues with contraception. Nevertheless, there are cases when men with low sperm count are still fertile enough to become a father.

Take note that sperm count might vary daily, depending on your lifestyle. Thus, you can get positive results if you spend some time before you re-take the test. But, you should consult your doctor after a series of negative readings on the SpermCheck Fertility home testing.

Order SpermCheck Fertility Test on Amazon

Increasing Sperm Count Naturally

Identifying and treating the condition can help increase sperm count in some cases. However, some lifestyle and dietary changes, such as those mentioned below, could also help increase a man’s sperm count.

  • Eating Healthy – This includes having a healthy diet that is rich in vegetables, whole grains, and fresh fruits. It can also help to replace animal fats with monounsaturated oils, such as olive oil.
  • Avoid Cigarettes – Cigarette smoking and drug intake would also affect sperm count or might even reduce sexual function.
  • Waist Sizes and Testosterone Levels – The correlation between testosterone and waist size affects male fertility. So if the waist is big, the testosterone levels would lower.Men are advised to avoid being overweight as obesity can be related to infertility. Being so skinny can also be a reason for lower sperm count.

    Men with body mass index (BMI) over 25 have over 20% chance of being infertile. The ideal BMI should not exceed 25 and not lower than 20.

  • Healthy Lifestyle – Exercising regularly and getting enough rest is ideal to achieve the required fertility levels. However, it is not advisable to get too much exercise as it can impair fertility.
  • Avoid Overheating or Sexual Lubricants – It is not advisable to use sexual lubricants as it would affect sperm motility. Likewise, it is not recommended to enter steam rooms and use laptops directly on the lap for a period of time.It is also unadvisable to frequent hot baths, as it would overheat the testes. If you aim to achieve the required fertility levels, take this advice seriously.

Over-The-Counter Sperm Test

If you are going to buy sperm test kits over-the-counter, here are things that you are going to acquire:

  • Limited clinical value
  • Little amount of information provided
  • Easy to acquire or take
  • Inexpensive method of home testing: $30-$100

If you are diagnosed with azoospermia, the complete absence of sperm, or oligospermia, low sperm count, you should know that tests would further identify the cause of such issues.

For issues of little or no sperm at all, the male semen can be blocked. This can be identified via ultrasound or X-ray tests if there is indeed blockage in the reproductive tract.

Going to the urologist for male fertility testing is the most important way of giving attention to this condition. This is because infertility is a very multifaceted and complex problem.

Moreover, a quick semen analysis can’t provide a complete or clear result. If you really want to have a child, giving information about the cause of the issue to your doctor would be a great help to guide you in getting the best treatment for your case.

Treatment of Male Infertility

Only 1 in 8 infertile males can be treated. This is a case where couples can naturally become pregnant after treatment. The doctor will recommend that couples must seek assisted reproductive technologies, which include IVF or in vitro fertilization.

Although ART will not be able to treat or cure the cause of infertility, they can still help couples achieve pregnancy. This can happen even if the sperm count is quite low.

Another form of IVF is intracytoplasmic sperm injection, or ICSI, in which the single sperm is placed directly into the egg. This will be done by piercing the outer covering of the egg. This method is useful for men with a low sperm count.

Sperm will be removed carefully from the epididymis or collected from the semen. Pregnancy can be achieved via ICSI, even if few sperms will be produced. For IVF, the resulting embryos will be placed into the uterus of the woman after fertilization.

Overview of Treatment

The treatments for male infertility problems vary from person to person depending on the root cause of the issue.

However, there are times that evidence-based solutions need to be used due to the inability to identify the crux of the problem. Each problem will come with its own solution and that is up to the determination of the doctor and what they feel the true issue is to the male’s infertility.

There are multiple ways to treat male infertility. Some are more invasive than others. The most radical would be a surgical procedure to repair or correct damaged reproductive organs or anatomic abnormalities.

This would be for those who are having issues not with the sperm or semen itself but with the physical structures involved delivery system.

Another, much simpler and less invasive treatment would be a medical procedure that would directly deliver sperm to the inside of the female body.

Additionally, there is also egg fertilization, which takes place in a laboratory, and can use sperm from the same partner or a third party to donate sperm.

What Route to Go, Depending on the Issue

Surgical Interventions

If the infertility problem stems from something physical such as varicose veins growing in the scrotum, surgery will be recommended to fix it.

Another reason surgery might be the route you are going is to repair any blockage in the tubes that transport sperm.

Non-Surgical Interventions

If the problem is caused by hormones, the doctor can prescribe hormone therapy to help the body get back to its optimal levels for sperm creation.

Artificial insemination of sperm cells combined with ovarian stimulation is a relatively simple procedure for the man where they are just needed for their deposit.

After their sample is collected it’s manually placed in the uterus or fallopian tubes [7]. While for the man this is relatively simple, it will be more invasive for the woman.

In-vitro fertilization is becoming extremely popular as the ultimate option for couples who are able to spend money on extensive treatments. 

This is, for many, their last resort, where they have tried everything. The sperm and the egg are fertilized in the lab and then places in the woman’s uterus [8].

Again, while this is painless for the male, the process that the woman goes through it significantly more trying.

Sperm donation is another option that some turn to when there is no sperm production at all. Donor sperm is used in this option and placed inside the woman through artificial insemination [9].

There are medications that can be used to treat certain issues affecting male fertility. This includes erectile dysfunction and hormone imbalances.

Otherwise, doctors typically recommend a well-balanced diet, moderate exercise, as well as wearing looser clothing such as boxers instead of tighty-whities as they are called.

Overall, the male infertility treatments cover a wide spectrum, from hormonal treatment to herbal remedies (which are not proven but if you want to go the natural route it can’t hurt to try).

And another consideration is that while it cannot be prevented if it’s something genetic or caused by an illness, there are ways to make you feel “more complete” by having a child and going through some of these routes. And if all else fails, there is always the beautiful option of adoption.


  1. A unique view on male infertility around the globe -ncbi [Link]
  2. How to Increase Sperm Count [Link]
  3. Sexually transmitted infections: impact on male fertility. -ncbi [Link]
  4. Reproductive changes associated with celiac disease -ncbi [Link]
  5. Smoke, alcohol and drug addiction and male fertility -ncbi [Link]
  6. Smoke, alcohol and drug addiction and male fertility -ncbi [Link]
  7. Kumar, N., & Singh, A. K. (2015). Trends of male factor infertility, an important cause of infertility: A review of literature. Journal of human reproductive sciences, 8(4), 191–196. doi:10.4103/0974-1208.170370
  8. Durairajanayagam D. (2018). Lifestyle causes of male infertility. Arab journal of urology, 16(1), 10–20. doi:10.1016/j.aju.2017.12.004
  9. Punab, M., Poolamets, O., Paju, P., Vihljajev, V., Pomm, K., Ladva, R., … Laan, M. (2017). Causes of male infertility: a 9-year prospective monocentre study on 1737 patients with reduced total sperm counts. Human reproduction (Oxford, England), 32(1), 18–31. doi:10.1093/humrep/dew284
  10. Barratt, C., Björndahl, L., De Jonge, C. J., Lamb, D. J., Osorio Martini, F., McLachlan, R., … Tournaye, H. (2017). The diagnosis of male infertility: an analysis of the evidence to support the development of global WHO guidance-challenges and future research opportunities. Human reproduction update, 23(6), 660–680. doi:10.1093/humupd/dmx021
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