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Tests and diagnosis
By Mayo Clinic staffWhen you see a doctor because you're having trouble getting your partner pregnant, your doctor will try to determine the underlying cause. Sperm production is complex and requires normal functioning of the testicles (testes) as well as the hypothalamus and pituitary glands — organs in your brain that produce hormones that trigger sperm production. Problems with any of these systems can affect sperm production.
Initial examination
Expect to answer detailed questions about your medical history and any sexual issues. Your doctor will do a careful physical examination of your reproductive organs to look for signs of a problem such as a varicocele — a varicose vein of the testicle.
Semen analysis
Low sperm counts are diagnosed as part of a semen analysis test. Sperm count is generally determined by examining semen under a microscope to see how many sperm appear within squares on a grid pattern. In some cases, a computer may be used to measure sperm count. If you have no visible sperm in your semen sample, your doctor may use a more involved test to try to isolate any sperm present in your semen for examination.
To collect a semen sample, your doctor will have you masturbate and ejaculate into a special container. It's also possible to collect sperm for examination during intercourse, using a special condom. Because measurements from sample to sample can vary widely, you'll need to present a few samples for your doctor to get a clear picture of the quantity — and health — of your sperm.
Normal sperm densities range from 20 to greater than 100 million sperm per milliliter of semen. While men can reproduce with much lower numbers of sperm, your chance of getting your partner pregnant decreases along with decreasing sperm counts:
- Less than half the men with sperm counts between 12.5 and 25 million sperm per milliliter are able to get their partner pregnant.
- Less than one-quarter of men with sperm counts less than 12.5 million sperm per milliliter are able to get their partner pregnant.
There are many factors involved in reproduction, and some men with low sperm counts have fathered children. Likewise, some men with normal sperm counts have been unable to father children. The number of sperm in your semen is only one factor. Even if you have enough sperm, you're much more likely to achieve pregnancy if at least half of your sperm have a normal shape and show normal forward movement (motility).
Your doctor may conduct further tests if he or she suspects your low sperm count is caused by an underlying condition. Your doctor will also want to make sure your female partner has been tested for any fertility problems.
Ultrasound
If your doctor suspects your reproductive tract is blocked, he or she may order an ultrasound test. Scrotal ultrasound is used to detect a varicocele or blocked epididymis.
Testicular biopsy
This procedure uses a fine needle to take a small tissue sample of the testicle to look for any abnormalities and to determine if sperm are present. The doctor will numb the area where the samples will be taken (generally one from either testicle). The procedure isn't painful, but you may feel sore for a few weeks afterward.
Blood tests and genetic tests
If your doctor suspects your low sperm count may be caused by an underlying hormonal condition, your doctor may test your blood for hormone levels. In some cases, problems with sperm production are linked to a genetic (chromosomal) abnormality. If your doctor suspects this is the case, genetic testing can be used to check for absent or abnormal regions of the male chromosomes (Y chromosomes).
