Male Fertility Evaluation

Evaluation of male partner

Semen testing

Testing for a man often involves a semen analysis. This analysis is done to assess the amount of sperm, the shape of the sperm, and the way that the sperm move. Blood tests for men measure levels of male reproductive hormones. Too much or too little of these hormones can cause problems with making sperm or with having sex. In some cases, an ultrasound exam of the scrotum may be done to look for problems in the testes.

A low sperm count or abnormal sperm shape or movement can make it difficult for a man to make a woman pregnant. For about one-third of couples unable to have children, male infertility is the reason. A semen analysis can help figure out the cause of male infertility.

When the reason for infertility is not clear, with a normal semen analysis and partner evaluation, the infertility is termed unexplained. Rarely patients with normal semen analyses have sperm that do not function in a manner necessary for fertility. The purpose of the male evaluation is to identify these conditions when present. Identification and treatment of reversible conditions may improve the male partner’s fertility and allow for conception through intercourse.

Conditions that affect sperm formation

Many different issues can affect the formation of sperm in the testicles. These conditions can lead to sperm that is abnormally shaped or malformed or to low amounts of sperm. Some of the more common issues include:

• Chromosome defects
• Diabetes
• Hyperprolactinemia (overproduction of a hormone called prolactin made by the pituitary gland)
• Injury to the testicle
• Insensitivity to hormones called androgens, which include testosterone
• Swelling of the testicles from infections such as mumps, gonorrhea, or chlamydia
• Chromosome disorder called Klinefelter syndrome
• Thyroid problems
• Cryptorchidism (when one or both testicles are not descended)
• Varicocele, which is the enlargement of veins in the scrotum; enlarged veins disrupt the blood flow in the testicle and cause an increase in temperature, which negatively affects sperm production. This condition is present in about 40% of men with fertility problems.

Remember that lifestyle, environmental, and age-related factors can also play a role in male infertility.