Male fertility testing is an essential step for couples facing difficulty conceiving. While infertility is often assumed to be female-related, male factors contribute to nearly 40–50% of infertility cases.
Understanding the different diagnostic tests, from semen analysis to hormone panels, can give you knowledge and help you feel more confident in identifying underlying issues and exploring treatment options.
What Is Male Fertility Testing?
Male fertility testing is a set of medical examinations used to evaluate sperm health, hormone levels, and reproductive organ function. These tests help determine whether a man’s reproductive system can successfully fertilise an egg.
Why Should You Go For This Test?
Doctors typically recommend testing if:
- Unable to conceive for 1 year.
- There’s a history of reproductive issues.
- Sexual dysfunction symptoms, such as low libido or erectile problems.
- Past surgeries, infections, or injuries affected the reproductive organ, such as a hernia, testicular surgery, or prior pelvic surgeries.
Semen Analysis: The First and Most Important Test
Semen analysis (also called a seminogram or spermogram) is the first and most important test in assessing male fertility. It provides a comprehensive snapshot of sperm health across multiple parameters.
What Is a Semen Analysis?
A semen analysis examines a fresh semen sample under a microscope and measures key parameters of the semen fluid and sperm cells. It is usually the first test ordered by a urologist, andrologist, or reproductive endocrinologist when assessing male fertility.
How to Prepare for a Semen Analysis
Proper preparation is important for accurate results:
- Avoid ejaculation for 2 to 5 days before the test. Shorter periods reduce the count; longer periods reduce motility.
- Avoid alcohol, caffeine, and tobacco for at least 3 days before testing.
- Inform your doctor of any medications, supplements, or recent illnesses.
- Collect the sample in a sterile container at the lab or at home. If collected at home, deliver it within 30 to 60 minutes.
- Keep the sample close to body temperature during transport.
What Does a Semen Analysis Measure?
Sperm Count (Concentration)
This is the number of sperm per millilitre of semen. The World Health Organisation (WHO) reference value is approximately 16 million sperm/mL or higher. Low sperm count (oligospermia) is one of the most common causes of male infertility.
- Normal: ≥16 million/mL
- Mild oligospermia: 10-15 million/mL
- Moderate oligospermia: 5-9 million/mL
- Severe oligospermia: <5 million/mL
- Azoospermia: No sperm detected
Total Sperm Count
The total number of sperm in the entire ejaculate (concentration x total volume). The WHO reference value is 39 million or more per ejaculate.
Sperm Motility
Motility refers to the percentage of moving sperm. It is divided into:
- Progressive motility (PR): Sperm swimming actively in a straight line or large circles
- Non-progressive motility (NP): Sperm moving but not progressing forward
- Immotility (IM): Sperm not moving at all
Sperm Morphology
Morphology checks for the shape and size of sperm cells. A normal sperm has an oval head, an intact midpiece, and a single uncoiled tail. Abrupt shape and size indicate sperm issues.
Semen Volume
It represents the total volume of fluid ejaculated. Very low volume, less than 1.4ml, suggests hypospermia, which may indicate ejaculatory duct obstruction or retrograde ejaculation. Very high volume can dilute sperm concentration.
Sperm pH Level
Semen is normally slightly alkaline (pH 7.2-8.0), which helps protect sperm from the acidic vaginal environment. Abnormal pH may indicate infection or ductal obstruction.
Liquefaction Time
The time it takes for semen to coagulate and then liquefy. Normal liquefaction occurs within 15-30 minutes. Slowed liquefaction may impair sperm motility.
Sperm Vitality
It checks the percentage of live sperm, measured when motility is very low (<40%), to distinguish dead from immotile-but-alive sperm (necrospermia vs asthenospermia). A normal Reference range is≥54% live sperm.
White Blood Cell Count
An abnormally high white blood cell count (>1 million/mL) may indicate infection or inflammation (leukocytospermia), which can damage sperm through oxidative stress.
Hormone Testing for Male Fertility
Hormones play a vital role in every step of sperm production. Any irregularities in the hormonal pathway from the brain to the testes can interfere with or even stop spermatogenesis. That's why hormone blood tests are usually the next step after semen analysis, helping to shed light on the overall picture.
The Hypothalamic-Pituitary-Gonadal (HPG) Axis
Understanding male reproductive hormones involves the HPG axis. The hypothalamus secretes Gonadotropin-Releasing Hormone (GnRH), which signals the pituitary gland to release FSH and LH. These hormones then stimulate the testes to produce testosterone and sperm.
Key Hormones For Male Fertility Testing
Follicle-Stimulating Hormone (FSH)
FSH plays a vital role by stimulating the Sertoli cells within the testes to facilitate sperm production.
- High FSH: This usually indicates testicular dysfunction, as the pituitary gland is working harder to compensate for poor testicular function.
- Very Low FSH: This suggests a more serious issue may be occurring in the hypothalamus or pituitary gland.
Normal Range: The approximate normal range is 1.5–12.4 mIU/mL (varies by lab cognition).
Luteinizing Hormone (LH)
LH stimulates Leydig cells in the testes to produce testosterone. It is measured alongside FSH to differentiate between primary (testicular) and secondary (pituitary/hypothalamic) causes of infertility—normal range: approximately 1.7-8.6 mIU/mL. (Book now)
Total Testosterone
The Total Testosterone test measures the total amount of testosterone in your blood. Testosterone is vital for several aspects of male health, including overall well-being, sex drive (libido), and, critically, sperm production. Insufficient levels of testosterone, known as hypogonadism, can impact spermatogenesis (sperm production).
Normal range: approximately 300-1000 ng/dL (varies with age and lab).
Free Testosterone
Free testosterone measures the 2-3% of circulating testosterone that is not bound to protein. It may be measured when total testosterone results are borderline or when sex hormone-binding globulin (SHBG) levels are abnormal.(book now)
Prolactin
Prolactin, from the pituitary gland, maintains male reproductive health and sperm count. High prolactin (hyperprolactinemia) suppresses GnRH and LH, lowering testosterone and sperm production, and can cause erectile dysfunction and low libido.
Estradiol (Estrogen)
Men naturally produce small amounts of estrogen. Elevated estradiol (often from obesity, certain medications, or liver disease) can suppress testosterone and FSH via negative feedback, impairing fertility. Normal range in men: approximately 10-40 pg/mL.
Thyroid Stimulating Hormone (TSH)
Both hypothyroidism and hyperthyroidism can affect fertility by influencing sperm production and hormonal balance. A TSH test screens for thyroid disorders that may be contributing to infertility.
Anti-Müllerian Hormone (AMH)
While AMH is primarily used as a marker of ovarian reserve in women, it is also produced by Sertoli cells in men. Low AMH in men can correlate with impaired spermatogenesis, though its clinical use in male fertility is still evolving.
Inhibin B
Inhibin B, produced by Sertoli cells, serves as an indicator of Sertoli cell function and the process of spermatogenesis. Low Inhibin B levels suggest lower sperm production. This test is valuable for differentiating between obstructive and non-obstructive azoospermia. (Book now)
Genetic Testing for Male Infertility
Genetic factors account for 15-30% of cases of male infertility, particularly in men with very low or absent sperm counts. Genetic testing can identify chromosomal abnormalities, gene mutations, and other inherited conditions.
Karyotype Analysis (Chromosomal Testing)
It measures the number of chromosomes, which can help analyse genetic conditions such as Klinefelter Syndrome (47, XXY). This extra X chromosome causes small testes, azoospermia, and high FSH, the most common chromosomal cause of male infertility. Other structural chromosomal issues (translocations, inversions) can also affect fertility or raise miscarriage risk.
Y Chromosome Microdeletion Testing
This test checks for microdeletions in the Y chromosome, which contain regions (AZFa, AZFb, AZFc) essential for sperm production. Microdeletions in these regions are the second most common genetic cause of severe male infertility after Klinefelter. Approximately 10-15% of men with azoospermia or severe oligospermia have a Y microdeletion.(Book now)
CFTR Gene Mutation (Cystic Fibrosis)
Mutations in the CFTR gene can cause congenital bilateral absence of the vas deferens (CBAVD), in which the tubes that carry sperm are absent. Men with this condition usually make normal sperm, but they can’t leave the body. Since CFTR mutations can be passed to children, both partners should get tested before assisted reproduction.
FISH (Fluorescence In Situ Hybridisation)
Check for chromosomal abnormalities in the sperm, such as aneuploidy (extra copies of chromosomes). This is particularly suitablebefore IVF/ICSI, as sperm aneuploidy increases the risk of chromosomally abnormal embryos.
Advanced Sperm Function Tests
Some specialised tests can be used to evaluate sperm function and their ability to fertilise an egg. These are typically used when standard tests are normal, but infertility persists, or before advanced fertility treatments.
DNA Fragmentation Index (DFI)
This test checks for breaks or damage in the genetic material within sperm. High DFI is associated with reduced fertilisation rates, poor embryo quality, increased miscarriage risk, and failed IVF/ICSI cycles. Normal DFI is generally below 15-25% (lab-dependent).
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Antisperm Antibody (ASA) Testing
In some men, the immune system mistakenly produces antibodies that attack and damage sperm. This can occur following vasectomy reversal, testicular trauma, or infection. ASAs can impair sperm motility and their ability to penetrate the egg. Testing is done on semen or blood.
Acrosome Reaction Test
This test analyses the acrosome reaction, which enables sperm to penetrate the egg surface failure of fertilisation.
Sperm Penetration Assay (SPA)
This functional test assesses sperm's ability to penetrate hamster eggs (zona pellucida removed) but has largely been replacedby other assays.
Imaging & Physical Examination
Male fertility evaluation also includes a physical exam and imaging to assess reproductive structures.
Physical Exam
Your Urologist/Andrologist checks testicular size, vas deferens presence, epididymis swelling (blockage sign), and varicocele, a common, treatable cause of infertility.
Scrotal Ultrasound:
Uses sound waves to detect issues such as varicocele, cysts, masses, or other abnormalities.
Transrectal Ultrasound (TRUS):
It examines the seminal vesicles and the ejaculatory ducts for blockages.
Pituitary MRI:
Done if hormones suggest a pituitary disorder, to detect tumours or structural issues.
Vasography:
A contrast X-ray is used during surgery to locate vas deferens obstruction.
Interpreting Results: Normal vs. Abnormal
| Parameter | Result | Meaning |
|---|---|---|
| Semen Volume | 1.4 mL | Low volume (Hypospermia) |
| Total Sperm Count | 39 million | Low count (Oligospermia) |
| Sperm Concentration | 16 million/mL | Low concentration (Oligospermia) |
| Total Motility | ~42% | Reduced movement (Asthenospermia) |
| Progressive Motility | ~30% | Low forward movement (Asthenospermia) |
| Normal Morphology | ~4% | Abnormal shape levels (Teratospermia) |
| Vitality | 54% | Many non-live sperm (Necrospermia) |
| pH | ≥7.2 | If acidic, it may suggest duct obstruction |
| Liquefaction | <60 min | If delayed, semen stays thick longer than normal |
Note: These values are reference ranges, not absolute fertility cutoffs. Many men with results below these levels can still conceive naturally. Proper interpretation depends on overall results, medical history, and clinical context.
WHat Steps Should I take After Testing
Lifestyle & Natural Improvement
Sperm count, motility, and vitality can improve by adopting healthy habits. Since sperm take about 72–90 days to mature, positive changes may show results within 3 months.
You can adopt these healthy habits for better sperm health
- By avoiding smoking, you can improve sperm count, movement, and DNA integrity
- Limit alcohol as excess intake lowers testosterone and sperm quality.
- Chronic stress raises cortisol, which suppresses testosterone, so manage it by doing short practices like yoga or meditation.
- Improve your diet with foods rich in antioxidants, zinc, folate, and omega-3s, which support sperm health.
- Regular activity helps hormones, but avoid extreme endurance training or anabolic steroids.
- Manage your weight, as obesity increases estrogen and scrotal heat.
- Avoid heat exposure, such as Hot tubs, saunas, laptops onthe lap, or tight underwear, which can impair sperm production
Assisted Reproductive Technologies (ART)
If couples are not able to conceive assiste technologies can be use this inclu
- IUI (Intrauterine Insemination): Processed sperm is placed directly in the uterus, best for mild male factor infertility
- IVF (In Vitro Fertilization): Eggs and sperm are combined in a lab to achieve fertilization
- ICSI (Intracytoplasmic Sperm Injection): A single sperm is injected into an egg, used for severe sperm abnormalities or surgically recovered sperm.
Take Charge of Your Reproductive Health
Male fertility testing has advanced significantly, allowing doctors to identify the cause of infertility in most cases and guide effective treatment. Early testing speeds diagnosis and expands your options — from lifestyle changes to medical or assisted reproductive treatments.
If you’ve been trying to conceive for 6–12 months or have risk factors for infertility, consult a specialist and consider a comprehensive evaluation.
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