Diagnosis of Male Infertility

The main test to confirm male infertility or sub-fertility is a semen analysis. Once the diagnosis is confirmed, a medical history, examination and special investigations can help to find the reason for infertility.

Semen analysis

Automated semen analysis

Automated semen analysis

This is also known as a sperm count and it is the main test performed in males with fertility problems. It should be the first test performed when a couple is being evaluated for infertility. If the semen analysis is normal, the male partner probably does not have an infertility problem.

It is a non-invasive procedure which means there is no pain, needles or surgery involved in obtaining a semen sample. The sample is obtained by masturbation and must be taken after 2-3 days of abstinence. If the male patient recently engaged in intercourse, the semen analysis results could show a false low value.

If the first sperm count is normal, no further tests are performed in the male. If the first sperm count is abnormal another one or two specimens, taken about 2 months apart need to be obtained to confirm the diagnoses of infertility. If both specimens are abnormal, the patient needs further evaluation and management.

The volume of semen, sperm count, sperm motility and sperm morphology is evaluated during a semen analysis. The quality of the sperm present are often more important than the quantity. The four specifics of a semen analysis are briefly discussed according to the World Health Organization’s (WHO) parameters:

  • Semen Volume
  • A semen volume of 2 mls or more is considered normal. Only about 2-5% of semen consists of sperm cells. The rest is made up of fluid secreted by the seminal vesicles, the prostate and the bulbourethral gland. The fluid contains enzymes, nutrients and fructose to give the sperm cells the energy they need and to create an optimum medium for them to move in. The semen also contains prostaglandins which protect the sperm from an immune response when in the vagina. Zinc, present in the prostatic fluid helps to stabilize the DNA contained in the sperm cell. Hypospermia is the term used when the patient has a decreased semen volume.

  • Sperm Count
  • A normal sperm count contains 2 million sperms per millilitre of semen. Therefore in a normal semen volume of 2 mls, 4 million sperms should be present. Men with a low sperm count might still be able to father children. If the patient has no measurable level of sperm cells in his semen, it is known as azoospermia. Patients with azoospermia are not able to father a child unless the cause is successfully treated.

  • Sperm Motility
  • Sperm Motility relates to the sperm cells’ ability to move properly to reach the egg cell after ejaculation has occurred. Sperm cells are microscopic in size so they need a lot of energy to “swim” from the vagina, through the cervix and then into the fallopian tubes. Out of the 4 million sperm present in the semen only one sperm is needed to fertilize an egg cell. If many of the sperm are not able to move effectively, it will decrease the chances of conception.

  • Sperm Morphology
  • sperm_morphology

    Sperm morphology

    The morphology (shape of the sperm cells) is considered to be normal if more than 4% of the sperm cells have a normal morphology. There are many abnormal variations of spermatozoa which give them a disadvantage when it comes to fertilizing an oocyte, egg cell.


Medical, Social and lifestyle History

The medical professional will record various important aspects from the male patient’s history to determine the cause of infertility and to identify treatable aspects that might be contributing to infertility.

Physical Examination

A general physical examination is essential and can also detect possible reasons for infertility. Examination of the testes is also important. Abnormalities like varicoceles, testicular atrophy and other pathology can be diagnosed from a thorough examination. The medical professional will also look out for signs of testosterone deficiency.

Special investigations


Special investigations

The special investigations that will be done will be different for every individual patient and depends on what the doctor found on medical history and examination. A few of the important tests with regards to infertility are the following:

  • Bloods
  • Bloods will be taken if the two semen specimens were abnormal in order to find a reason for the abnormality. Bloods to evaluate endocrine function will also be drawn if considered necessary. These include thyroid function, LH, FSH, testosterone, prolactin.

  • Urine Dipstick and Urine Culture
  • If a urine infection is diagnosed with history and urine dipstick, a urine culture is done to determine the pathogen responsible for the infection. The infection is then treated accordingly.

  • Culture of Infection
  • On physical examination a sexually transmitted disease (STD) could be suspected and a sample of this can also be sent in to the lab for culture and accurate diagnoses.

  • Genetic Studies
  • If it is indicated, a genetic study can determine if there is a genetic component involved causing infertility. Genetic studies are done by obtaining a DNA sample for the patient. This is either blood, hair, saliva or other body fluid.

  • Transurethral Ultrasound
  • A transurethral ultrasound can be done by an experienced medical professional to detect possible obstructions in the urinary system which may hinder the pathway of sperms.

  • Testicular Biopsy
  • If necessary a small biopsy of the testis will be done. A small piece of testicular tissue will be removed under local anaesthesia by a small incision made by the doctor. A needle biopsy can also be done by collecting a small sample of tissue with a special biopsy needle.