Male Infertility Tests & Diagnosis
Male infertility testing overview
- Male factors contribute, in part, to approximately 40 percent of the identifiable causes of infertility.
- For sexually active couples, infertility is defined as the inability to get pregnant in one year of practicing unprotected sexual intercourse.
- Testing should be considered after six months if the female partner is 35 or older.
- Obvious symptoms are not common with male infertility so it’s crucial that men are tested.
- Male infertility testing usually involves a physical and medical history exam and a comprehensive sperm analysis, which is the primary test to determine male infertility.
- If a man’s semen does not have sperm present, surgical techniques may be performed to extract sperm for diagnosis and fertility treatment.
Causes & prevalence of male infertility
Infertility is defined as the inability of sexually active couples who are not using contraception to get pregnant within one year. Male factors contribute to approximately 40 percent of infertility cases.
Male infertility is typically due to sperm abnormalities, but any of the following can play a role:
- Genetic or chromosomal issues that result in low sperm production, abnormally shaped sperm or impaired delivery of sperm
- Natural blockage in the man’s reproductive tract (or as a result of vasectomy) that prevents sperm from exiting the penis through ejaculation
- Retrograde ejaculation that does not allow semen to outwardly ejaculate and leave the body
- Cancer treatments such as chemotherapy and radiation that disrupt sperm production and viability
- Spinal, psychological or emotional conditions that cause impotence
When to consider male infertility testing
There are no noticeable symptoms linked to male infertility so it’s important that men, along with the female partner, get fertility testing. A man may decide to get tested if he has a known medical issue that could affect fertility, such as:
- Prior surgery on the genitourinary tract, penis or testes
- Testicle trauma
- Known history of recurrent miscarriage in a female partner
- History of mumps in adulthood
- Previous cancer treatments such as chemotherapy or radiation.
Male infertility testing & diagnosis
A number of factors can affect male infertility. Tests are conducted in our office and involve:
- General physical exam and medical history. This includes questions about any illnesses, injuries, surgeries or inherited conditions that can affect fertility. The doctor may also ask about the man’s sexual habits and lifestyle.
The physical exam will check for a cancerous mass, vein enlargement in the scrotum (varicocele), presence of testes and testes size.
- Semen analysis. Male fertility testing most often requires a semen test. This analysis provides information pertaining to sperm quality, number of sperm that have sound structure and shape (morphology), quantity of production and motility (sperm movement).
- Sperm penetration assay (SPA). Evaluates the ability of a man’s sperm to bind or attach to the egg membrane in order to penetrate the egg and fertilize it. Also known as the “hamster test,” in SPA the sperm’s ability to penetrate a pretreated hamster egg gives information about the sperm’s chances for penetrating a woman’s egg.
- Hormone levels and antibodies. Hormones play a key role in sexual development and sperm production. A doctor may do blood work to check to see if the man has the right amount of these hormones.
Additionally, semen testing may include an antibody test to determine if antibodies are killing or undermining sperm function. This test also analyzes DNA integrity in the sperm.
In some instances doctors may recommend additional tests to help identify the cause of male infertility. These may include:
- Genetic tests to confirm or rule out possible chromosomal defects
- Ultrasounds to assess abnormalities of the internal reproductive organs
- Biopsies to evaluate the presence of infection or malignancies
- Specialized sperm tests to determine how well the sperm function and survive following ejaculation, and to determine if sperm are intact and moving the way they should.
PESA, MESA, TESA and Micro-TESE: surgical sperm extraction
If the semen sample shows no sperm, a doctor may perform one of four minimally invasive procedures to extract sperm directly from the testicles.
- Percutaneous epididymal sperm aspiration (PESA): Using a needle inserted through the scrotum to collect sperm from the epididymis; this is often done in cases where obstruction is an issue.
- Micro-surgical epididymal sperm aspiration (MESA): A microsurgical procedure that collects sperm from the epididymis, which transports sperm from the testes to the vas deferens or urethra; used most often in cases of a blockade in the epididymis or obstruction, such as caused by a vasectomy.
- Testicular sperm aspiration (TESA): A less invasive procedure in which a needle is inserted into the testicle to gather tissue and fluid, this is used when lack of sperm production (azoospermia) is caused by an obstruction of the reproductive tract. The epididymis remains untouched in this procedure to minimize injury.
- Micro-dissection of testis or microsurgical testicular sperm extraction (Micro-TESE): This microsurgical procedure involving the extraction of testicle tissue is often used for individuals with poor sperm production as the cause of infertility (azoospermia).
What are the risks of fertility testing & diagnosis?
Semen analysis, blood work and many imaging tests pose very little risk. A physician will discuss these risks with the patient before administering any tests.
TESA, micro-TESE, MESA and PESA carry minimal risks including:
- Infection at the incision area
- Tenderness or bruising in the scrotum
- Mild pain or discomfort.