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Male Fertility Testing

Male fertility testing at a glance

  • Male fertility factors contribute to approximately 40 percent of all infertility cases.
  • The centerpiece for male fertility testing is a simple semen analysis which looks at the count and movement of sperm.
  • In some cases, tests may also be ordered to check the man’s testosterone hormone level by taking a blood sample.

What is male fertility testing?

Testing for male infertility generally focuses on analyzing sperm production and/or evaluating anatomical concerns like blockages or other dysfunctions with ejaculation.

Sperm abnormalities (male factors) contribute to approximately 40 percent of all infertility cases. In 20 percent of couples, the only identifiable factor is a sperm abnormality.

Typically, male fertility testing focuses on the quantity, quality, and motility of the man’s sperm. Erectile dysfunction, anti-sperm antibodies, infection, and anatomic issues can also play a negative role in fertility.

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In some cases, tests may be done to check the man’s testosterone hormone level by taking a blood sample. Testosterone, responsible for changes in boys during puberty such as the development of a deeper voice and facial hair, also controls the development of sperm. Low levels of testosterone often lead to low sperm counts, which can cause male infertility.

What is a semen analysis?

The centerpiece of testing for men is a comprehensive semen analysis, with strict (Kruger) morphology. A semen analysis evaluates multiple characteristics of the sperm including the volume, the sperm concentration, motility and shape (morphology) of the sperm. Each of these characteristics can have dramatic effects on fertility.

Assuming a normal volume, the parameter which best predicts fertility is the shape of the sperm. The old standard still performed by most labs (without assessing strict morphology) is not adequate for assessing sperm quality.

If you (or your partner) have had a semen analysis done using prior criteria (WHO III criteria, without strict morphology assessment), and the testing was normal, we strongly recommend repeating a formal assessment.

How a semen analysis is performed

The male should schedule the semen analysis in advance, and must not ejaculate for 2-5 days prior to the sample collection. Ideally, the sample is collected at our facility; however, it can be collected at home if it is delivered to our office within 45 minutes of collection.

The sample is collected by masturbation without the use of lubricants, especially water-based lubricants. Once delivered to the lab, the sperm will be processed and assessed for volume, concentration, motility, shape and other parameters.

We will generate a report offering specific recommendations, as needed.


Parameter Normal Range Possible Identifiable Causes of Abnormality
Volume 2-5 milliliters Hypothalamic, pituitary or testicular disorders; ejaculatory disorders, obstruction or poor collection technique.
Concentration >20 million per milliliter Heat (varicocele), nutritional deficiency, genetic abnormality, history of undescended testicle, absence of Sertoli or germ cells, malfunction of Leydig cells, anabolic steroid abuse, endocrine disorders, history of radiation or chemotherapy.
Motility >50% Heat (varicocele), nutritional deficiency, anti-sperm antibodies, prolonged abstinence.
Normal shape (morphology) 14% with strict morphology is normal fertile range; however 9% or greater is essentially indistinguishable from normal. Men with less than 5% normal forms are more likely to require IVF/ICSI. Heat (varicocele), nutritional deficiency, infections, history of undescended testicle.
White blood cells <10 per high power field Prostatitis, prior surgery
Total motile count > 10 million Any of the above, plus obstruction or retrograde ejaculation

Types of semen analysis used in male fertility testing

Antisperm antibody test

An antisperm antibody analysis tests for proteins (antibodies) that develop in blood, vaginal fluids or semen, attacking a man’s sperm and making it difficult for a sperm cell to fertilize the woman’s egg. These antibodies may develop from an immune system response in either the man’s or the woman’s body. Presence of antisperm antibodies is tested through a blood and vaginal fluid sample from the woman and a semen sample from the man.

Sperm penetration tests

Sperm penetration tests check to see if a man’s sperm are able to move through the cervical mucus, into the fallopian tubes, and join with a woman’s egg for fertilization.

During a sperm mucus penetration test, a sample of the man’s sperm and the woman’s cervical mucus during her ovulation period will be collected for testing; the two samples are combined in a lab to measure how far the sperm are able to travel in the mucus.

Additionally, a sperm penetration assay collects a sample of the man’s sperm to test the number of sperm that are able to penetrate and thus fertilize an egg.

Sperm DNA fragmentation

A test for sperm DNA fragmentation checks for damage in the man’s DNA that may be passed on through his sperm. A sperm sample from the man is analyzed for DNA fragmentation as a possible cause of male infertility.

There are two DNA strands in each sperm cell that store the information an embryo will need to grow. Sperm DNA fragmentation is when one of these strands is broken – through chemical damage, heat, constriction, or other causes – and thus loses part of its DNA information. A sperm sample from the man is analyzed for DNA fragmentation as a possible cause for male infertility.

What if the semen analysis is abnormal?

Sperm parameters may vary significantly from day to day. We advise repeating any analysis with significant abnormalities approximately four weeks after the initial test.

If confirmed on repeat assessment, we will develop an individualized treatment plan based on the severity of the problem, the reversibility of the underlying cause, and the wishes of the couple.

Depending on the severity of the abnormality, a urologic evaluation may be indicated. In cases of very low sperm counts (oligospermia) or a complete absence of sperm (azoospermia) a man will be offered hormonal and genetic evaluation prior to referral to a urologist.

Explore your treatment options

Ten couples with the same circumstances may all make very different decisions. IVF, IVF, GnRH, eSET, ICSI — there’s an alphabet soup of possible treatments for infertility, but not all are going to be right for you. TRM helps you decide the best approach for your specific situation.

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