Male Infertility: How Is it Diagnosed?

Written by Vicky Liu, 4th year Health Sciences co-op student from the University of Waterloo. 

Infertility testing is equally important for men as it is for women, playing a critical role in diagnosing and addressing potential issues that may affect male fertility. Infertility testing can help identify the underlying factors contributing to male infertility, such as low sperm count, poor sperm motility, or abnormal sperm morphology. Determining these factors is crucial for developing targeted treatment strategies.

Tests for Men

The medical history of the male patient is crucial in devising an infertility plan. This involves inspecting the patient’s reproductive organs and inquiring about any hereditary conditions, ongoing health issues, past illnesses, injuries, or surgeries that might impact fertility. The doctor may also inquire about the patient’s sexual activities and the development of their sexual characteristics during puberty. A physical examination is also commonly conducted to exclude any physical abnormalities that could be associated with conception challenges.

During a physical examination, the doctor assesses the testicles for conditions like undescended, neonatal, or retractile testicles. Additionally, the size, shape, and appearance of both the testicles and the epididymis are carefully evaluated. The doctor also conducts a thorough examination of the penis and scrotum, checking for temperature variations and any indications of discharge or abnormal lumps (One Fertility Kitchener Waterloo, 2024).

Semen Analysis

A semen analysis is a test designed to assess the quantity and quality of sperm, as well as the volume of semen produced during ejaculation. Typically, this test is among the initial evaluations conducted to pinpoint the root cause of sperm-related fertility issues.

Components of a semen analysis may include:

1. Volume: The measurement of semen quantity produced in a single ejaculation.
2. Liquefaction time: The duration it takes for the thick gel-like semen to transform into a liquid state after ejaculation.
3. Sperm count: The calculation of the number of sperm present per milliliter (mL) of semen in one ejaculation.
4. Sperm morphology: An evaluation of the percentage of sperm displaying a normal shape.
5. Sperm motility: An assessment of the percentage of sperm capable of moving forward in a typical manner. Additionally, motile density measures the number of sperm exhibiting normal forward movement within a specific volume of semen.
6. pH: The determination of semen acidity (low pH) or alkalinity (high pH).
7. White blood cell count: The detection of any presence of white blood cells, which are typically absent in semen.

Genetic Tests

Genetic conditions can significantly impact both the quality and quantity of sperm, necessitating specific testing beyond routine blood tests. Up to 20% of sperm production problems are attributed to abnormalities associated with genetic syndromes (One Fertility Kitchener Waterloo, 2024). Fertility clinics employ various genetic tests to address these concerns.

Karyotyping, a test examining chromosome structure, can identify genetic conditions contributing to infertility. Additionally, Y chromosome microdeletion testing detects missing chromosome genes that may explain fertility challenges. Due to the high infertility rate (approximately 98%) among men with cystic fibrosis, testing for this condition is also conducted (One Fertility Kitchener Waterloo, 2024).

Testicular Biopsy

This test might be the final step if the previous tests you've undergone haven't provided clear results.

During this procedure, a small sample is taken from the testicle, either using a needle or through a small incision. If the testicular biopsy reveals normal sperm production, your infertility could be due to an obstruction or another issue affecting sperm transportation.

Testicular Ultrasound

A testicular ultrasound, also known as a sonogram, utilizes sound waves to create an image of the testicles and scrotum without the use of X-rays or other radiation. This imaging test enables visualization of structures such as the epididymis, which collects sperm, and the vas deferens, which connects the testicles to the prostate gland.

During the procedure, a small handheld device called a transducer is moved across the scrotum, emitting sound waves that are converted into images by a computer. These images, known as sonograms or echograms, are displayed on a video screen and can be saved for further examination.

Testicular ultrasound is performed for various reasons, including:

• Investigating masses or pain in the testicles.
• Assessing infections or swelling of the testicles or epididymis.
• Checking for testicular torsion, a condition that interrupts blood supply to the testicles.
• Monitoring for recurrence of testicular cancer.
• Detecting undescended testicles.
• Identifying fluid accumulation in the scrotum (hydrocele), epididymis (spermatocele), or other abnormalities such as blood or pus.
• Guiding a biopsy needle for a testicular biopsy, often conducted in infertility evaluations.
• Evaluating genital injuries.

Blood Tests

Hormone testing involves assessing the levels of key hormones involved in sperm production. Hormones that are commonly assessed include follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone. These hormones are essential for the coordinated function of the pituitary gland, hypothalamus, and testicles in regulating sperm production. Through a simple blood test, these hormone levels can be measured to provide insights into reproductive health.

1. FSH: FSH plays a vital role in sperm production. Elevated levels may indicate testicular dysfunction or damage caused by factors such as disease, radiation, or chemotherapy. Conversely, low levels may suggest a deficiency in sperm production.
2. LH: Produced by the pituitary gland, LH stimulates the Leydig cells in the testes to release testosterone, which is necessary for sperm production. LH levels can also be evaluated following the administration of gonadotropin releasing hormone (GnRH) to determine if the issue originates from the pituitary gland or another part of the body.
3. Testosterone: Testosterone levels within the healthy range typically fall between 300 to 1,000 nanograms per deciliter (ng/dL) in men. It's important to note that testosterone levels naturally decline with age, decreasing by approximately 1 percent per year after the age of 40.

Concluding Thoughts

In summary, infertility testing is essential for diagnosing underlying causes, guiding treatment options, and addressing potential health concerns. By undergoing comprehensive testing, healthcare providers can often reveal valuable information that assists them in reaching the correct diagnosis of male infertility. This enables them to provide support to aspiring parents as they navigate the next steps in their journey towards starting a family. To learn more about male fertility testing, book a complementary discovery call with our experienced naturopath, Dr. Wendy.

References

• Lewis, R. (2020, November 30). Fertility tests for men: Options and how they work. Healthline. https://www.healthline.com/health/infertility/fertility-test-for-men
• Mayo Clinic Staff. (2022, December 28). Male infertility. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/male-infertility/diagnosis-treatment/drc-20374780
• One Fertility Kitchener Waterloo. (2024, January 16). Diagnostic tests for male fertility assessments. One Fertility Kitchener Waterloo. https://www.onefertilitykitchenerwaterloo.com/diagnostic-tests-for-male-fertility-assessments/
• https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=aa39523&lang=en-ca#:~:text=Infertility%20tests%20are%20done%20to,blood%20tests%2C%20and%20special%20procedures.