Testing for male infertility can be complicated, time
consuming and expensive. Because the end results of the
many disparate problems that cause male infertility are low
sperm count, abnormal sperm shape, and poor sperm motility,
additional tests besides a semen analysis (described below)
are required to pinpoint the cause of the infertility.
The evaluation of the male begins with a history, physical
examination, and two semen analyses.
At least two semen samples collected on separate days by
masturbation are recommended. Each sample should be
collected after abstaining from ejaculation for at least 48
hours, but not for longer than 3-5 days. The complete
ejaculate should be collected and must be examined within an
hour of collection for optimal accuracy. A general semen
evaluation includes a determination of the time it takes for
the semen to become liquid and an examination of the semen’s
volume, consistency, and pH. The semen is also
microscopically evaluated for sperm count, motility, sperm
shape, agglutination (the sperm’s propensity to clump
together), and the presence of foreign elements such as
bacteria. According to the World Health Organization, a
normal ejaculate should have more than 50 million sperm per
milliliter; at least 60 percent of the sperm should have
forward motility, and more than 60 percent should have a
normal morphology. Contradictions to these criteria
indicate a condition that is causing the male infertility.
To pinpoint the cause of infertility, a variety of other
tests may be performed:
Hormone evaluation--measures blood levels of the hormones
involved in sperm production, abnormal hormonal levels are
indicative of the hormonal problems described that cause
Semen culture--checks for bacteria in the semen which either
cause or indicate a genital infection that may cause
Biochemical analysis of semen--measures various chemical in
semen; a chemical imbalance may impair fertility.
Post-coital/cervical mucus test--checks the compatibility of
a man’s sperm with the mucus of his partner’s cervix. If
the sperm and mucus are incompatible, the sperm is unable to
pass through the mucus into the fallopian tubes and
fertilize the egg.
Sperm penetration assay (Hamster test)--measures sperm-egg
membrane fusion using hamster eggs a man’s sperm: tests the
capability of the sperm to penetrate the egg during IVF.
A thorough physical examination and history can diagnose
physical problems such as varicocoeles, Klinefelter’s
Syndrome, retrograde ejaculation, erectile disfunction, and
An absence of sperm in the semen sample is indicative of
ejaculatory incompetence, retrograde ejaculation, or one of
the conditions that block the spermatic ducts.