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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 examining 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 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.

Your doctor may recommend additional tests to 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 see obstructions or other problems in the testicles and supporting structures.
  • Transrectal ultrasound. A small, lubricated wand is inserted into your rectum. It allows your doctor to check your prostate, and look for blockages of the tubes that carry semen (ejaculatory ducts and seminal vesicles).
  • Hormone testing. Hormones produced by the pituitary, hypothalamus and testicles play a key role in sexual development and sperm production. Abnormalities in other hormonal or organ systems may also contribute to infertility. A blood test measures the level of testosterone and other hormones.
  • Post-ejaculation urinalysis. 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. 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 various congenital or inherited syndromes.
  • Testicular biopsy. This test involves removing samples from the testicle with a needle. 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.
  • Specialized sperm function tests. A number of 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. European Association of Urology Guidelines on Male Infertility: The 2012 Update. Arnhem, Netherlands: European Association of Urology. http://www.uroweb.org/guidelines/online-guidelines. Accessed July 20, 2012.
  2. McPhee SJ, et al. Current Medical Diagnosis & Treatment 2012. 51st ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=1. Accessed July 20, 2012.
  3. Swerdloff RF, et al. Causes of male infertility. http://www.uptodate.com/home/index. Accessed July 19, 2012.
  4. Patel ZP, et al. Male factor assessment in infertility. Medical Clinics of North America. 2011;95:223.
  5. The optimal evaluation of the infertile male: AUA best practice statement. Linthicum, Md.: American Urological Association Education and Research, Inc. http://www.guideline.gov/content.aspx?id=23921&search=male+infertility. Accessed July 19, 2012.
  6. Loughlin KR. Changes in male fertility in the last two decades. Urology Clinics of North America. 2012;39:33.
  7. Asplund C, et al. Genitourinary problems in bicyclists. Current Sports Medicine Reports. 2007;6:333.
  8. Frey KA. Male reproductive health and infertility. Primary Care Clinics Office Practice. 2010;37:643.
  9. Swerdloff RF, et al. Evaluation of male infertility. http://www.uptodate.com/home/index. Accessed July 19, 2012.
  10. Showell MG, et al. Antioxidants for male subfertility. Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007411.pub2/abstract. Accessed July 23, 2012.
  11. Patel SR, et al. Antioxidant therapy in male infertility. Urology Clinics of North America. 2008;35:319.
  12. De Celis R, et al. Semen quality of workers occupationally exposed to hydrocarbons. Fertility and Sterility. 2000;73:221.
  13. Swan SH. Semen quality in fertile US men in relation to geographical area and pesticide exposure exposed to hydrocarbons. International Journal of Andrology. 2006;26:62.
  14. El-Helaly M, et al. Workplace exposures and male infertility - A case control study. International Journal of Occupational Medicine and Environmental Health 2010;23:331.
  15. Murphy LE, et al. Folate and vitamin B12 in idiopathic male infertility. Asian Journal of Andrology. 2011;13:856.
  16. Lenzi A, et al. Use of carnitine therapy in selected cases of male factor infertility: A double-blind crossover trial. Fertility and Sterility. 2003;79:292.
  17. Ross C, et al. A systematic review of the effect of oral antioxidants on male infertility. Reproductive BioMedicine Online. 2010;20:711.
  18. Menezeo Y, et al. Antioxidants to reduce sperm DNA fragmentation: An unexpected adverse effect. Reproductive BioMedicine Online. 2007;14:418.
DS01038 Sept. 15, 2012

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