Fertility Testing for Men
Infertility can be just as much a problem for men as it can be for women. If you are young and healthy, doctors recommend spending at least one year having unprotected sex before worrying about whether fertility issues may be a problem for you. Older couples, particularly when the woman is aged 35 and above, should ideally try to get pregnant for 18 to 24 months before seeking fertility testing unless abnormalities or other inhibitors have already been identified.
If a couple is having difficulty getting pregnant, a physical examination is typically recommended for both the man and woman. Men should be prepared to answer questions on their puberty and sexual development, childhood growth and overall development, sexual history, any illnesses, infections and surgeries, both sexually and non-sexually related, medications both current and past, and exposure to any environmental toxins, including alcohol, cigarettes, recreational drugs, radiation, steroids, pesticides and chemicals, including chemotherapy, that you may have been exposed to at any point.
For men, a physical exam can reveal indicators of testosterone deficiency, such as loss of body hair and abnormal testes development, or identify abnormalities in the testicle vein or thickening of the epididymis (the tube leading from the testicle).
Some fertility tests your doctor might suggest for a man include:
- Semen analysis—this test is almost always the first laboratory test recommended by a doctor to gauge sperm count as well as the shape and motility of the sperm. For this test to be most effective, the patient should avoid any form of ejaculation, either sex with a partner or masturbation, for five to seven days immediately leading up to the test. The semen sample can be collected either in the lab or doctor’s office or at home in a sterile laboratory container (or chemical-free condom) provided by your doctor. The sample must be delivered directly to a laboratory within one hour of the sample being collected. If the sample is judged to be abnormal, a second sample will be collected before further testing is recommended. Over the counter tests to gauge the quality of sperm are available as well, but their reliability and accuracy have been questioned.
- Blood testing—these tests evaluate hormone levels that are directly related to male fertility. If a sperm analysis has revealed a low sperm count exists or if the doctor suspects a hormonal imbalance or deficiency, blood tests can be administered to evaluate testosterone, luteinizing hormone (LH), prolactin and follicle-stimulating hormone (FSH) levels.
- Genetic testing—if chromosomal abnormalities or genetic problems are suspected to be a potential cause of infertility, blood tests can identify missing or abnormal levels of the Y (male) chromosome. Some genetic disorders can be inherited but be otherwise asymptomatic (no evident symptoms) yet diminish sperm count significantly. If a genetic defect is shown to exist, your doctor may recommend genetic counseling to discuss the pros and cons of transferring such a genetic abnormality to your child and whether such transmission can be prevented.
- Transrectal ultrasound—this test confirms the presence of a suspected blockage in the epididymis or vas deferens, preventing passage of sperm.
- Urine testing—a simple urine test given after ejaculation can confirm if a condition called retrograde ejaculation is a factor in infertility. Retrograde ejaculation is a condition where semen enters the bladder.
- Testicular biopsy—if a semen analysis shows no evidence of sperm in the sample, a fine needle aspiration or other form of biopsy may be performed to withdraw a small tissue sample. If the tissue shows evidence of sperm when the semen analysis does not, this can indicate a blockage exists, preventing the sperm from being ejaculated in the seminal fluid.
