Male Diagnostic Procedures

Male Infertility Testing

Male infertility testing is easily done. Male infertility is a factor in 50 percent of all cases of infertility. When a couple have difficulty with conception, the man could be producing too few sperm to fertilize the egg, the sperm could be sluggish or of poor quality, or there may be a blockage of the male reproductive tract. There are several diagnostic procedures done to assess male infertility. The main ones include semen analysis, hormonal evaluation, and genetic testing. With semen analysis, the semen is thoroughly evaluated for volume, sperm count, liquefaction time, sperm motility, sperm morphology, pH, and fructose level. Hormonal evaluation involves assessment of FSH, LH, testosterone, prolactin, thyroid hormone, plasma estradiol, and liver functions. Many hormonal conditions affect the pituitary-gonadal axis, leading to infertility in men. Genetic tests that are often done include karyotype, CF gene test, and Y chromosome microdeletion test. These tests evaluate for a genetic cause of male infertility.

Semen Analysis

A semen analysis measures the amount of semen a man produces to determine the number and quality of sperm in the sample. This is one of the first tests done to determine the cause of infertility. Problems with the semen and/or sperm affect approximately 35 percent of infertile couples.

Tests Done on the Semen

The tests done during a semen analysis include:

  • Volume. The semen is measured following one ejaculation.
  • Sperm count. This involves the number of sperm present per milliliter of semen.
  • Liquefaction time. Semen is a thick gel that becomes liquid within 15 to 25 minutes after ejaculation. The liquefaction time is a measure of the time it takes for the semen to liquefy.
  • Sperm motility. This is the measure of the percentage of sperm that can propel forward adequately.
  • Sperm morphology. This is the number of sperm that have a normal shape.
  • pH. The semen is analyzed for acidity or alkalinity.
  • Fructose level. Fructose provides the sperm with energy, and this test measures the amount that is present in the semen.

Why it Is Done

A semen analysis is done to determine the cause of infertility. It is also used to evaluate whether a vasectomy has been successful and to see if reversal of vasectomy was successful.

How it Is Done

Semen samples vary from day to day, so the doctor may require you to submit more than one sample over a three month testing period. The semen analysis requires that you provide a semen sample by ejaculating into a specimen cup. This is often done at the clinic or fertility center, or at home if you live close to the facility. The most common means of semen collection is by masturbation, by use of a condom, or by withdrawing from your partner just before ejaculation. Be sure not to use lubricants, spermicides, or any lotions or creams that will affect results.

Results

A semen analysis produces several results. This table explains the normal values of the various tests.

Test

Normal

Abnormal

Semen Volume 2–5 mL per ejaculation Below or above this range
Liquefaction Time 20 to 30 minutes Longer than this time frame
Sperm Count 20 million sperm per mL or more Below this number
Sperm Morphology More than 30% of the sperm are of normal shape Below this number
Sperm Motility More than 50% of the sperm move forward normally after one hour Less than this number
pH 7.1 to 8.0 Outside of this range

What Affects the Test

There are many reasons why the test will not render accurate results. These include:

  • Use of drugs, such as caffeine, alcohol, nicotine, cocaine, and marijuana.
  • Certain medications, such as male hormones, female hormones, and cimetidine.
  • Herbal supplements, such as Echinacea and St. John's wort.
  • Allowing the semen sample to get cold.
  • Exposure to radiation and chemicals.
  • An incomplete semen sample.

Hormonal Evaluation

To evaluate the state of sperm production, the fertility specialist will do an evaluation of the pituitary-gonadal axis. This is the system in the brain and reproductive organs that regulate reproductive hormones. Certain pituitary axis problems that cause infertility include gonadotropin deficiency, hyperprolactinemia, and congenital adrenal hyperplasia.

Common Hormone Blood Tests

There are several hormone blood tests done to assess infertility. These include:

  • FSH. Follicle stimulating hormone is measured to assess the state of sperm production rather than a balance of the endocrine system.
  • LH. Luteinizing hormone is measured when testosterone and FSH are abnormal to detect endocrine problems.
  • Prolactin. Levels of prolactin are assessed when there is an abnormality of FSH and/or testosterone.
  • Testosterone. Free and bound testosterone levels are assessed to measure overall endocrine balance.
  • Plasma estradiol. Measurement of plasma estradiol is reserved for men who have gynecomastia or those who appear to have low levels of androgens.
  • Thyroid hormone. This test is done when there is clinical evidence of thyroid disease, which affects sperm production.
  • Liver function tests. The liver is checked for uncontrolled, chronic disease that can alter sperm production.

Genetic Testing

To identify sperm DNA fragmentation, chromosomal defects, or genetic diseases, the fertility doctor often performs genetic testing. This is mainly done when sperm concentration is excessively low. A blood test can reveal whether or not there are changes in the Y chromosomes, indicating a genetic abnormality.

Three Most Common Genetic Tests

There are several genetic tests for infertility, but the three most common are:

  • Karyotype. Also known as a chromosome analysis, the karyotype examines the number of chromosomes to see if a person is missing or has extra copies of entire chromosomes.
  • Cystic Fibrosis Gene Test. The CF test is done to look for this genetic condition that causes male infertility.
  • Y Chromosome Microdeletion Test. This test assesses the genetic information for missing parts from the Y chromosome.

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