Male infertility accounts for nearly 50% of all infertility cases. Despite this, many men delay testing due to lack of awareness, embarrassment, or the misconception that infertility is primarily a female issue.
Although tests for male infertility are painless, simple, and non-invasive—especially compared to what many women endure—many men still hesitate to get tested. While their partners undergo blood draws, hormone injections, and even invasive procedures like hysteroscopies or laparoscopies, some men refuse a basic semen analysis. Others delay it until every single test on their partner comes back normal. Some never do it at all. But here’s the truth: men are involved in nearly 50% of infertility cases. Avoiding tests for male infertility doesn’t make someone more masculine—it only delays answers, prolongs uncertainty, and hurts the very dream they long to build.
Modern medicine offers a broad spectrum of tests for male infertility, and understanding each one can empower couples to make informed decisions.
This article provides a comprehensive overview of male fertility testing, including:
Semen analysis and sperm quality tests.
Hormonal evaluations and genetic testing.
Imaging studies and advanced diagnostics.
If you or your partner are experiencing difficulties conceiving, understanding these tests can help identify potential issues and guide appropriate treatment options.
1.Tests for Male Infertility – The First Step: Semen Analysis
A. What Does a Semen Analysis Measure?
A semen analysis is the most fundamental male fertility test. It evaluates:
| Parameter | Normal Range (WHO Criteria) |
| Semen Volume | 1.5–5.0 mL per ejaculation |
| Sperm Count | ≥ 15 million per mL |
| Sperm Motility (Movement) | ≥ 40% actively moving sperm |
| Sperm Morphology (Shape) | ≥ 4% normal forms |
| Sperm Vitality | ≥ 58% alive sperm |
| Leukocyte Count | <1 million white blood cells per mL (higher may indicate infection) |
B. How is the Test Performed?
- The sample is collected via masturbation after 2-5 days of abstinence.
- If abnormal results are found, a repeat test is done after 2-4 weeks for confirmation.
C. Limitations of Semen Analysis
While useful, a normal semen analysis does not guarantee fertility, as some men with normal sperm parameters may still experience infertility due to DNA fragmentation or functional issues.
2. Advanced Sperm Function Tests for Male Infertility
If a semen analysis appears normal but infertility persists, additional tests may be recommended:
A. DNA Fragmentation Test
Assesses sperm DNA integrity, which affects embryo development and pregnancy success.
Higher fragmentation levels are linked to recurrent miscarriages and low fertilization rates in IVF.
B. Reactive Oxygen Species (ROS) Test
Measures oxidative stress, which can damage sperm.
High ROS levels are seen in smokers, men with varicocele, and those exposed to environmental toxins.
C. Sperm Capacitation Test
Evaluates if sperm can undergo necessary changes for egg penetration and fertilization.
3. Hormonal Tests for Male Infertility
After the initial semen analysis, further testing often includes evaluating hormone levels such as FSH, LH, testosterone, and prolactin. These hormones play a direct role in sperm production, and imbalances can point to underlying conditions like hypogonadism or pituitary disorders.
A. Key Hormones to Check
| Hormone | Function | Normal Range |
| Testosterone | Regulates sperm production | 300–1,000 ng/dL |
| Follicle-Stimulating Hormone (FSH) | Stimulates sperm production | 1.5–12.4 mIU/mL |
| Luteinizing Hormone (LH) | Regulates testosterone production | 1.7–8.6 mIU/mL |
| Prolactin | High levels may indicate pituitary dysfunction | 2–18 ng/mL |
| Estradiol (E2) | Essential for sperm maturation | 10–40 pg/mL |
B. When is Hormonal Testing Necessary?
Low sperm count (oligospermia) or no sperm in semen (azoospermia).
Symptoms of low testosterone (fatigue, low libido, erectile dysfunction).
Suspected pituitary gland dysfunction.
4. Genetic Tests for Male Infertility
Genetic testing is particularly relevant when sperm count is extremely low or absent (azoospermia). It can reveal chromosomal anomalies or Y-chromosome microdeletions that impact sperm development. This information not only explains infertility but also influences future treatment options—especially when considering assisted reproductive technologies (ART) like IVF or ICSI.
A. Who Needs Genetic Testing?
Men with:
Azoospermia or severe oligospermia.
A family history of infertility or genetic disorders.
Congenital absence of the vas deferens (CAVD), often linked to cystic fibrosis.
B. Common Genetic Tests
- Karyotyping – Detects chromosomal abnormalities like Klinefelter Syndrome (XXY chromosome pattern).
- Y-Chromosome Microdeletion Test – Identifies missing genetic material needed for sperm production.
- CFTR Gene Testing – Screens for cystic fibrosis mutations, which can cause missing sperm ducts.
5. Imaging Tests for Male Infertility
A. Scrotal Ultrasound
Scrotal ultrasound is another non-invasive tool that can identify structural problems like varicoceles, blockages, or testicular abnormalities. In some cases, a transrectal ultrasound (TRUS) is used to check for ejaculatory duct obstructions or prostate issues that may interfere with semen flow.
Evaluates testicular size, tumors, and varicocele (enlarged veins in the scrotum).
B. Transrectal Ultrasound (TRUS)
Detects blockages in the ejaculatory ducts and prostate abnormalities.
C. Testicular Biopsy
In more complex cases, a testicular biopsy may be performed to determine whether sperm production is occurring at all. Although invasive, this test can provide definitive answers in cases of unexplained infertility.
Used when azoospermia is present to differentiate between:
- Obstructive Azoospermia (sperm is produced but blocked).
- Non-Obstructive Azoospermia (sperm is not produced).
6. Conclusion: The Importance of Tests For Male Infertility
Semen analysis is the first step in male fertility testing.
Hormonal and genetic tests help diagnose underlying conditions.
Imaging and advanced sperm tests provide additional insights.
Men experiencing infertility should undergo a comprehensive evaluation to identify and treat potential causes early. Early diagnosis increases the chances of successful treatment and conception.
By exploring these tests for male infertility, couples gain clarity and direction. Rather than navigating blindly through emotional frustration, they can target the root cause with science-backed insight. The sooner a diagnosis is reached, the sooner effective treatment—or informed next steps—can begin.
If you or your partner are struggling to conceive, consider scheduling a male fertility assessment today!
References
CARDIM, H. J. P. Vencendo a Dificuldade de Engravidar. São Paulo: Editora Pensamento-Cultrix Ltda, 2009.
Available at:
https://www.pensamento-cultrix.com.br/
Accessed on: June 11, 2025.
WORLD HEALTH ORGANIZATION (WHO). Semen analysis standards. Human Reproduction Update, 2021.
Available at:
https://www.who.int/publications/i/item/9789240030787
Accessed on: June 11, 2025.
BARRATT, C. L. et al. The diagnosis and management of male infertility. Lancet, 2020.
Available at:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30641-9/fulltext
Accessed on: June 11, 2025.
PRACTICE COMMITTEE OF THE ASRM. Evaluation of the male partner in infertility. Fertility and Sterility, 2022.
Available at:
https://www.fertstert.org/article/S0015-0282(21)02085-0/fulltext
Accessed on: June 11, 2025.
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