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Diagnostic Testing for Male Factor Infertility
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It is a myth that infertility is a woman's problem. The male may be a contributing factor in as many as 40% of infertile couples. In an additional 20% to 30% of the cases, infertility can be attributed to combined male and female factors. An evaluation of the male should be one of the very first tests carried out in the investigation of infertility in couples. Initially, the male evaluation includes a complete medical history and two semen analyses. In case of abnormalities, the male partner is evaluated by a specialist in male reproduction (urologist or andrologist).
In addition to the history and physical examination, diagnostic testing for male factor infertility may include the following procedures: |
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Semen Analysis |
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Specialized Tests |
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Endocrine (Hormone) Evaluation |
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Genetic Evaluation |
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Semen Analysis |
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It gives an indication of sperm count, motility and morphology. It also gives details of any other cells (for example, white blood cells) which may indicate infection. Multiple analyses are necessary because semen findings normally fluctuate for a given individual. At least two semen samples collected by masturbation on separate days are recommended. Each sample should be collected after abstaining from ejaculation for at least 48 hours, but not longer than five days. Abstinence for a shorter period can decrease ejaculate volume and sperm count whereas prolonged abstinence may impair sperm motility. The complete ejaculate is collected in a sterile container and should be examined within one hour of collection.
A properly performed semen analysis evaluates several parameters whose normal values are listed below: |
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Ejaculate volume: |
≥ 2 ml |
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Sperm count: |
≥ 40 million sperm/ejaculate |
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Sperm motility (movement): |
≥ 50% at one hour |
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Sperm morphology (structure): |
≥ 30% have normal shape (According to World Health Organization criteria ) |
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>14% have normal shape (According to Kruger criteria) |
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PH: |
≥ 7.2 |
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White blood cells: |
< 1 million/ml |
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Consistency: |
Not viscous (not thick)M |
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Concentration: |
≥ 20 million/ml |
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Liquefaction (conversion into a liquid): |
Complete within 60 minutes |
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Appearance: |
Homogeneous, gray-opalescent ejaculate |
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No significant sperm agglutination |
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Specialized Tests |
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These tests may be useful in a small number of patients for identifying a potential male factor in a couple with otherwise unexplained infertility. The value of these tests in selecting therapy is controversial.
Hypoosmotic swelling test: Assesses the sperm membrane for structural integrity
Sperm penetration assay (Hamster egg penetration test): Tests the capability of the sperm to penetrate the egg during in vitro fertilization (IVF). Sperm are mixed with hamster eggs in a laboratory. The number of sperm that penetrate the egg (sperm capacitation index) is measured
Human zona pellucida binding test: Also called the hemizona assay, this test measures the ability of sperm to bind to the zona pellucida (outer covering) of the egg
Computer-assisted semen analysis (CASA): For assessing sperm concentration and specific patterns of sperm motility (velocity, linearity, etc).The equipment is highly expensive. |
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Additional Semen Tests |
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The following additional semen tests can be performed to find out more about the semen or sperm and detect abnormalities or diseases of the male reproductive system:
Vital staining: This test can help identify sperm cells (including non-motile cells) that are alive and viable for reproduction. It differentiates the living sperm from the dead ones.
Antisperm antibodies: This test determines the presence of antibodies, which immobilize or kill the sperm and prevent them swimming up towards the egg.
Semen fructose: The seminal vesicles are a source of fructose. The absence of fructose, a sugar-like substance in the semen, means either the vas deferens are blocked or that the seminal vesicles are absent.
Peroxidase staining: This test differentiates white blood cells from immature sperm to assess for possible infection.
Semen culture: This test checks for genital infection causing bacteria.
Biochemical analysis of semen: This analysis measures different chemicals (such as fructose) in semen.
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Endocrine (Hormone) Evaluation |
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This is a blood test. Testosterone, follicle stimulating hormone (FSH), Luteinizing hormone (LH), and prolactin are usually measured in this evaluation. Any of the following indications necessitate an endocrine evaluation:
Detection of a low sperm concentration
Impaired sexual function
Signs of endocrine disease |
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Genetic Evaluation |
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A significant proportion of infertile men with nonobstructive azoospermia (absence of sperm in semen, not due to blockage) and severe oligospermia (sperm counts of less than 5 to 10 million per ejaculate) have a genetic origin for reproductive failure. These patients may have abnormalities in the number of chromosomes (karyotype) or abnormalities in the structure of the male chromosome (microdeletion of the Y-chromosome). Patients with azoospermia are born without two vas deferens and thus have a mutation of a gene responsible for the disease cystic fibrosis but do not have the disease itself. |
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Conclusion |
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It is important to note that no single semen test can fully predict fertility. An initial evaluation is necessary to decide which other tests are required by you for further investigation into diagnosing the cause of infertility. |
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