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Tests and diagnosis
By Mayo Clinic staffWhen you see a doctor because you're having trouble getting your partner pregnant, he or she will try to determine the underlying cause. Even if your doctor thinks low sperm count is the problem, you and your partner may both need tests to rule out other causes of infertility and to look for any underlying health problems. Testing and diagnosis may involve the following.
General physical examination and medical history
This includes examination of your genitals and questions about any inherited conditions, chronic health problems, illnesses, injuries or surgeries that could affect fertility. Your doctor may also ask about your sexual habits and questions about your sexual development.
Semen analysis
A low sperm count is 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.
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. Often sperm counts fluctuate from one specimen to the next. In most cases, several semen analysis tests are done over a period of time to ensure accurate results.
One of the most common causes of low sperm count is an incomplete or improper collection of a sperm sample. Most doctors will check two or more semen samples over time to ensure consistency between samples. To ensure accuracy in a collection, your doctor will want to:
- Ensure all of your semen makes it into the collection cup or collection condom when you ejaculate
- Wait at least three months after you've recovered from an illness or stressful event to collect a sperm sample
- Have you abstain from ejaculating for at least 48 hours before collecting a sample (but not for more than seven days)
Semen analysis results
Normal sperm densities range from 20 million to greater than 100 million sperm per milliliter of semen. You are considered to have a low sperm count if you have fewer than 20 million sperm per milliliter. Some men have no sperm in their semen at all. This is known as azoospermia (ay-zoh-uh-SPUR-me-uh).
Your chance of getting your partner pregnant decreases along with decreasing sperm counts:
- Fewer than half the men with sperm counts between 12.5 million and 25 million sperm per milliliter are able to get their partner pregnant.
- Fewer 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 get your partner pregnant if at least half of your sperm have a normal shape (morphology) and show normal forward movement (motility).
Other tests
Depending on initial findings, your doctor may recommend additional, more specialized tests to look for the cause of your low sperm count and other possible causes of male infertility. These can include:
- Scrotal ultrasound. This test uses high-frequency sound waves to produce images inside your body. A scrotal ultrasound can help your doctor look for evidence of a varicocele or obstruction of the part of the testicle that stores sperm (epididymis). A small wand is moved over the surface of your testicle sac to produce images on a video screen.
- Transrectal ultrasound. This is similar to a scrotal ultrasound — but for this test, a small lubricated wand is inserted into your rectum. It allows your doctor to check your prostate, and check for blockages of the tubes that carry semen (ejaculatory ducts and seminal vesicles).
- Hormone testing. Hormones produced by the pituitary and hypothalamus glands and the testicles play a key role in sexual development and sperm production. Your doctor may recommend a blood test to determine the level of testosterone and other male hormones that affect sperm count.
- Post-ejaculation urinalysis. This test involves collecting a urine sample after orgasm. The urine is checked for the presence of sperm. Sperm in your urine can indicate your sperm are traveling backward into the bladder instead of out your penis during ejaculation (retrograde ejaculation).
- Genetic tests. These tests are used if your doctor suspects your reduced sperm count or other fertility problems could be caused by an inherited sex chromosome abnormality. When sperm concentration is extremely low, genetic causes could be involved. A blood test can reveal whether there are subtle changes in the Y chromosome — signs of a genetic abnormality. Genetic testing may also be ordered to diagnose Klinefelter's syndrome or cystic fibrosis.
- Testicular biopsy. This test involves removing samples from the testicle with a needle. It may be used if your semen analysis shows no sperm at all. The results of the testicular biopsy will tell if sperm production is normal. If it is, your problem is likely caused by a blockage or another problem with sperm transport.
- Anti-sperm antibody tests. These tests are used to check for immune cells (antibodies) that attack sperm and can affect their ability to function. You are especially likely to have anti-sperm antibodies if you've had vasectomy reversal.
- Vasography. In some cases, contrast dye is injected into each of the tubes that carry sperm (vas deferens) to check for blockage.
- Specialized sperm function tests. A number of different tests can be used to evaluate how well your sperm survive after ejaculation, how well they can penetrate an egg, and whether there's any problem attaching to the egg. If you do have a low sperm count, having healthy sperm can be an important factor in male fertility.
- Guzick DS. Evaluation of the infertile couple. http://www.uptodate.com/home/index.html. Accessed May 7, 2010.
- Sigman M, et al. Male infertility. In: Wein AJ, et al. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa.: Saunders; 2007. http://www.mdconsult.com/das/book/body/198188923-5/0/1445/22.html. Accessed May 7, 2010.
- Swerdloff RF, et al. Evaluation of male infertility. http://www.uptodate.com/home/index.html. Accessed May 7, 2010.
- Bulun SE, et al. Infertility and subfertility in men. In: Kronenberg HM, et al. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa.: Saunders; 2008. http://www.mdconsult.com/das/book/body/199429868-3/0/1555/120.html?tocnode=54107480&fromURL=120.html#4-u1.0-B978-1-4160-2911-3..50020-0--cesec90_1743. Accessed May 7, 2010.
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- Hornstein MD, et al. Optimizing natural fertility in couples planning pregnancy. http://www.uptodate.com/home/index.html. Accessed May 7, 2010.
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