How Can Men Check Their Fertility?

Approximately 50% of infertility is related to the male. How can men check their fertility? The most common male fertility test is analysis of the semen. Results from a semen analysis are of the greatest clinical significance. It provides critical data on testicular sperm production, the male genital tract, and the fluids secreted to assist sperm in fertilizing potential. It cannot, however, precisely determine if a man is “fertile” or “infertile.”

Unlike eggs, which are present since you were born, sperm are made all the time following puberty. Since men are producing sperm all of the time, semen samples can vary from month to month, or even day to day because it takes about 72 days for sperm to develop within the testicles.

Male Fertility Test: Semen Analysis

Semen analysis includes:

1. 1. Volume
   2. Sperm Concentration / Count
   3. Motility
   4. Morphology

Parameters and values falling above or below limits do not necessarily predict fertility. Such a variability exists that parameters deemed not to be within range, should always be repeated and paired with the clinical history.

What if Your Semen Analysis Results Are Abnormal?

A semen analysis be an indication of undiagnosed medical issues. These are the cases of azoospermia (no sperm), extremely low counts (<5 million), difficulty in production, and/or a structural change (lump or bump). These findings always merit a separate urologic consultation and assessment.

Male Hormone Testing

Another form of male fertility testing is done with hormone testing. It is of value for men who have impaired libidos, erectile dysfunction , extremely low or no sperm counts, or evidence of hormonal issues on physical exam. The endocrine component of the exam is not as important as it is in the woman. It is warranted when sexual function suggest its origin. In these cases a karyotype (chromosome assessment) may be warranted as well as chromosome specific tests (Y microdeletion).

In the case of no sperm (azoospermia), Cystic Fibrosis testing is recommended (CFTR) as carriers of the gene may have the absence of the vas deferens – no way for the sperm to leave the testicle. There is no benefit to this endocrine testing when there is only isolated morphology issues, yet often it is done.

Sperm DNA Fragmentation Analysis

There are no studies that evaluate the impact of this testing and management of infertility and no studies to demonstrate that it should be performed routinely.  For men with failed IVF pregnancies losses and higher DNA fragmentation rates, testicular sperm aspirates with ICSI may provide some advantage in reducing the pregnancy loss rate. The test and utility remain controversial.

Scrotal or Rectal Ultrasound

These diagnostic studies have both time and place. Scrotal ultrasound can be used to confirm structure of testes, vas deferens, as well as, possible physical exam findings noted on exam (spermatocele and masses). Often varicoceles are found. They are a grouping of dilated blood vessels and rarely symptomatic and even less often, the culprit of infertility. Correction of these normal findings does not improve semen parameters or fertility rates. Rectal ultrasound is merited if there is the possibility of ejaculatory duct obstruction (low volume, low PH, and no sperm).