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Tests and diagnosis

By Mayo Clinic staff

Many infertile couples have more than one cause of infertility, so it's likely you will both need to see a doctor. It may take a number of tests to determine the cause of infertility. In some cases, a cause is never identified. Infertility tests can be expensive and may not be covered by insurance — find out what your medical plan covers ahead of time.

Diagnosing male infertility problems usually involves:

  • 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 during puberty.
  • Semen analysis. Semen is generally obtained by masturbating and ejaculating into a special container at the doctor's office. Your semen is then sent to a laboratory to measure the number of sperm present and look for any abnormalities in the shape (morphology) and movement (motility) of the sperm. The lab will also check your semen for signs of problems such as infections. 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. If your sperm analysis is normal, your doctor will likely recommend thorough testing of your female partner before conducting any more male infertility tests.

Depending on initial findings, your doctor may recommend additional, more specialized tests that can help identify the cause of your 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 scrotum to produce images on a video screen.
  • Transrectal ultrasound. This test is similar to a scrotal ultrasound. To do this type of ultrasound, 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 measure your testosterone and other male hormones that can 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. You are especially likely to have anti-sperm antibodies if you've had a 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 check 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.
Treatments and drugs Preparing for your appointment
References
  1. Guzick DS. Evaluation of the infertile couple. http://www.uptodate.com/home/index.html. Accessed May 7, 2010.
  2. 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.
  3. Swerdloff RF, et al. Evaluation of male infertility. http://www.uptodate.com/home/index.html. Accessed May 7, 2010.
  4. 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.
  5. Swerdloff RF, et al. Causes of male infertility. http://www.uptodate.com/home/index.html. Accessed May 7, 2010.
  6. Leibovitch. The vicious cycling: Bicycling related urogenital disorders. European Urology. 2005;47:277.
  7. Wang C. et al. Treatment of male infertility. http://www.uptodate.com/home/index.html. Accessed May 7, 2010.
  8. Eskenazi B, et al. Antioxidant intake is associated with semen quality in healthy men. Human Reproduction. 2005;20:1006.
  9. Jurewicz J, et al. Environmental factors and semen quality. International Journal of Occupational Medicine and Environmental Health. 2009;22:305.
  10. Agarwal A, et al. Prevention of oxidative stress injury to sperm. Journal of Andrology. 26;6:2005.
  11. Agarwal A, et al. Carnitines and male infertility. Reproductive BioMedicine Online. 2004;8:376. http://www.rbmonline.com/4DCGI/Article/Detail?38%091%09=%201200%09. Accessed May 7, 2010.
  12. Burns LH. Psychiatric aspects of infertility and infertility treatments. Psychiatric Clinics of North America. 2007;30:689.
  13. Hornstein MD, et al. Optimizing natural fertility in couples planning pregnancy. http://www.uptodate.com/home/index.html. Accessed May 7, 2010.
DS01038 Sept. 9, 2011

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