Male Infertility Diagnostic Testing

Different Diagnostic Tests for Male Infertility

Infertility affects around 10 percent of married couples. There are numerous diagnostic tests for male infertility. One important test is semen analysis, which is useful in the diagnosis of Klinefelter's syndrome, a common congenital cause for low testosterone. This condition is caused by an extra X chromosome that not only causes male infertility but it leads to sparse facial and body hair, small testes, and abnormal breast enlargement (gynecomastia). Another test, the scrotal ultrasound, is a diagnostic test done to evaluate for scrotal abnormalities, such as masses, absence of one or both testicles, undescended testicles, inflammation, abnormal blood vessels, and fluid accumulation. This test also is used to detect twisting of the spermatic cord (testicular torsion). If the ultrasound fails to show a cause for the infertility, additional tests, such as a testicular biopsy, may be necessary to provide the fertility specialist with more specific information.

Medical History and General Physical Examination

The medical history and general physical examination are two key components of the diagnostic process for male infertility. With the medical history, the doctor asks questions concerning sexual habits, reproductive development during puberty, genetic issues, family history, past surgeries, previous illnesses, current problems, and health concerns. The physical examination consists of a detailed assessment of not only the reproductive organs and structures but the entire body.

Semen Analysis

The semen analysis is one of the main diagnostic tests performed in the evaluation of male infertility. Semen is usually obtained by masturbation or ejaculation into a special container at the fertility specialist's office. The semen is sent to a laboratory to be evaluated for several different elements. These include: (1) number of sperm, (2) motility (movement of sperm), (3) morphology (shape of sperm), (4) pH (acidity/alkalinity of semen), (5) total volume of semen, and (6) infection (white blood cell testing). For most men, several semen analysis tests are done over a period of three to six months. If the sperm analysis is normal, the doctor will order other tests.

The World Health Organization (WHO) set standard values for a normal semen analysis. These include:

  • Number/Concentration: At least 20 million sperm per milliliter.
  • Total volume: Greater than 2 milliliters.
  • Motility: Greater than 50% sperm move forward within 1 hour of ejaculation.
  • Morphology: At least 15% of sperm normal shaped.
  • White blood cells: Fewer than 1 million per milliliter.
  • pH: Between 7.1 and 8.0.

Sperm Mixed Antiglobulin Reaction (MAR)

The sperm mixed antiglobulin reaction (MAR) test is done to detect IgG and IgA antibodies on the sperm. The indirect MAR test detects antibodies in the female or male serum, as well as the cervical mucus of the woman.

Sperm Penetration Assay (SPA)

The sperm penetration assay (SPA) examines the ability of the sperm to penetrate an egg. Also called the sperm-oocyte interaction test, the SPA is done by combining the human male sperm with a hamster egg.

The Immunobead Test

The immunobead test assesses the semen for the presence of antibodies that damage the sperm by mistaking the sperm for a foreign substance. These anti-sperm antibodies destroy or weaken live and motile sperm, rendering them unable to fertilize the egg.

Post-Ejaculation Urinalysis

The post-ejaculation urinalysis test is a screening of the urine following ejaculation. It is done to identify conditions and diseases that affect male fertility, such as diabetes, kidney disease, and recurrent urinary tract infection. Additionally, sperm in the urine indicates retrograde ejaculation, which is a condition where sperm travels backward into the bladder instead of being ejaculated.

Hormone Evaluation

Hormones are produced by the pituitary and hypothalamus of the brain and the testicles. They play a key role in reproductive health, sexual development, and sperm production. Any abnormalities of the organ systems that produce the hormones can result in male infertility.

Genetic Testing

When the sperm concentration is critically low, there could be a genetic cause. A simple blood test could reveal whether there are changes or problems with the Y chromosome, a sign of genetic abnormality. There are many inherited syndromes that can be evaluated with genetic testing.

Scrotal Ultrasound

The scrotal ultrasound is a test that uses high-frequency sound waves to produce images inside the scrotum. This test helps the fertility doctor see any problems of the testicles and supporting structures. An ultrasound tech will use a device called a transducer to direct the sound waves over the scrotum. This assesses the testis, epididymis (tube that transports sperm from the testicle), tissues, and the blood vessels. The sound waves reflect back to the transducer and produce a real-time image of the inside of the scrotum.

Transrectal Ultrasound

The transrectal ultrasound involves the insertion of a small, lubricated wand into the rectum. This test is done to evaluate the prostate, the ejaculatory ducts, and the seminal vesicles. These structures carry and transport the semen and sperm.

Testicular Biopsy

The testicular biopsy involves removal of tissue samples from the testicle with a needle. This is often done when the testicular and/or transrectal ultrasounds are normal. The results of this test tell the fertility specialist if sperm production is normal or faulty.

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