Should a couple have trouble conceiving, despite trying for more than a year, both partners may be checked for issues leading to infertility.
Evaluating infertility is different for men and women. The health care provider will start by asking the couple specific questions about their medical history in order to isolate the possible causes of infertility.
Based on the responses received, different diagnostic tests will be recommended for the couple. The typical tests required to diagnose male infertility are discussed here.
Evaluating General Health
The health care practitioner will ask about any recent or past injuries to the genital region. A physical examination will be undertaken to check for discharge or swelling of the prostate, any possible hernia, or extra tumorous growth.
The male will be checked out thoroughly and the health care practitioner will be able to identify any obvious defect in the genital area.
Should there be nothing visibly wrong with the patient, then the next set of diagnostic tests will be suggested.
Testing the Semen
Male infertility can result if there is an inadequate production of sperm to fertilize an egg, if the sperm is not shaped properly and if the sperm is unable to swim as is required.
In order to check if any of these issues exist, a sample of the male’s semen will be collected by ejaculation into a special container.
This specimen sample will be tested in a laboratory to check for sperm count, health, shape and motility.
Any abnormalities in the sperm morphology will also be tested along with signs of other problems and infections. It may be noted that the sperm count can vary from one sample to another. For this reason, a number of samples may be collected over a period of time to obtain accurate results.
Ultrasound of Scrotum
An ultrasound produces images of internal organs, allowing the doctor to check for any structural problems in the testicles.
Problems such as varicocele, in which veins inside the scrotum become enlarged, can be easily diagnosed.
Since nearly 40% of male infertility is caused by varicocele, it is important to exclude this before proceeding to other possible problems.
The ultrasound may also allow the doctor to diagnose torsion, or twisting of the testes within the scrotal sac. This also results in a swelling in the region.
The condition must be surgically treated to ensure that permanent infertility does not result as a consequence of the physical problem.
Testing Hormone Levels
Spermatogenesis is hormone-driven. The hypothalamus releases the Gonadotropin Releasing Hormone (GnRH).
This acts on the anterior pituitary gland, signalling it to release the Follicle Stimulating Hormone (FSH) and the Luteinizing Hormone (LH). FSH flows through the blood and prompt the seminiferous tubules to begin producing sperm. LH encourages the Leydig Cells to produce testosterone.
Each hormone in the chain has an important role to play.
If the hormones are not balanced, spermatogenesis does not take place and only Sertoli cells are seen when a testicular biopsy is conducted.
Some health care practitioners will check the hormones via blood tests to see if there is a problem related to production of sperms.
This test is used to determine whether the sperm production is normal. It is not a commonly suggested test for male infertility.
The process involves removing a sample of sperm from inside the testicle using a needle before studying it in a laboratory for structural problems.
Should there be problems such as the outer layer of the sperm being broken, or the sperm having fragile DNA or impaired motility, they will be easily identified using this diagnostic test.
If the sperm is normal and healthy, then the infertility may be caused by a blockage of the ducts or a sperm transportation issue.
A high frequency transrectal ultrasound shows images of the prostate, seminal vesicles and ejaculation ducts. It allows the health care practitioner to check for any duct blockages in the transportation path of the semen.
A lubricated wand is placed within the rectum to perform the procedure. The small wand allows real time imaging of the seminal vesicles and ejaculatory ducts. This diagnostic test can confirm or eliminate the problem of blockages.
There are a number of other tests to check for male fertility issues, but most of them will not be recommended by the health care practitioner. These tests include the following:
- Vital Staining test – this shows how many sperm in the semen sample are alive
- Antisperm Antibodies test – this checks if sperm have antibodies attached to them, making it difficult for them to swim.
- Semen Culture - this checks if there is an infection affecting the semen
- Hypo-osmotic Swelling test – this checks if the sperm outer layer is intact
- Chromosome analysis – this will check for genetic defects
- Specialized sperm function tests – these allow one to see how well the sperm moves, attaches itself to the egg and manages to penetrate the egg.
Most of these tests are not required to prove male infertility. Once the core problem has been identified, the health care practitioner will provide possible solutions to the couple to overcome the infertility.
Reviewed by Afsaneh Khetrapal BSc (Hons)