Male Infertility – What are the tests done to diagnose male infertility?
When you are trying to become a father with your female partner but failing, remember that in 40% of the cases, the problem exists with male, 40% of the times with female and in rest 20% of the cases, the issue lies in both the partners as per statistical data. As a man, especially in India, the first thing you should do is to stop blaming the woman for not able to bear a child. Secondly, put your woman through infertility testing after your sexologist determines that you are perfectly fertile and good in sexual health.
When you present yourself to your sexologist with infertility or subfertility problem, your doctor will start with a set of questions:
- Your lifestyle including your food habits, alcohol abuse and/or drug abuse
- Your sex life and sex history
- History of your medical conditions and surgeries
- Your workout regime
Those will be few quick things that your doctor will make a note and then the following tests may be advised.
Tests to Analyse Semen parameters
You will be asked to submit your ejaculate multiple times at different windows to the clinic or lab that will be performing the semen analysis test. Semen is collected in a fresh, clean and sterilized bottle at the clinic or you can ejaculate at home and give the sample to your doctor within a stipulated time after ejaculating.
If your culture or religion prevents you to collect sample in a bottle, you will be given a special condom in which you can ejaculate while having sex with your partner. Semen analysis report will have the following things mentioned:
- If you are having any infection, that can show up in your semen.
- Volume of Semen
- Sperm Concentration. Usually, 15 million sperms per millilitre are expected to be present.
- Sperm Vitality. How many of the sperms are alive in your sample.
- Sperm Motility. How well are your sperms able to roll/swim through the semen? Sperm motility above 63% is considered as good in terms of fertility and below 32% indicates subfertility.
- Sperm Morphology. How does your sperm look? Are they well defined as they should or do they have abnormal developments such as short tails or no heads etc.
For more information on semen parameters, please visit our recent article:
Urinalysis
Surprising? Even though all the sperm analysis parameters look fine, you will have trouble having a child. That’s when urinalysis is done.
There are 5 “biomarkers” present in the urine that are evaluated to check for “normozoospermic” infertility. Normozoospermic Infertility is a condition when the sperms cells look healthy and all the parameters are normal but the sperm cells are themselves infertile.
Hormone Levels Testing
Human body is a big interconnected network of tissues, organs, hormones etc. Hormone testing is necessary not just to check the testosterone levels but also other hormones including:
- FSH – Follicle Stimulating Hormone
- Luteinizing Hormone – LH
- Testosterone
The pituitary gland releases FSH and LH that will trigger the production of testosterone by the testicles. Testosterone hormone is required for production of sperms.
High amounts of FSH indicate that the testicles are not functioning properly. Low levels of FHS indicate that you are not producing sperm. The Luteinizing Hormone binds to the receptors in the Leydig cells to release testosterone.
Healthy men have testosterone levels anywhere in the range of 300 to 1000 ng/dL (nanograms per decilitre). As you may be aware, testosterone levels start to decrease at the rate of 1% per year, after a man reaches 40 years of age.
When the hormone levels are also fine, your doctor will then go for imaging tests.
Imaging tests to check anatomical issues and obstructions
- Scrotal Ultrasound is done to look for any infections, tumors, cysts or filling up of fluids, testicular torsion or varicocele.
- Transrectal Ultrasound is done using a probe that is inserted into the anus to check for obstructions in vas deferens, prostate condition.
Looking for Anti-sperm antibodies
Usually semen or sperms don’t mix with any other fluids in the body. For any reason if the immune system or the corresponding cells reach the sperms, they may treat sperms as foreign bodies and start attacking and killing them by producing anti-sperm antibodies.
If the anti-sperm antibodies are present, your doctor may be put on medicine that reduces immune response of the body.
Testicular biopsy
A small sample of testicle tissue is taken (either through a needle or by making an incision on the scrotum) and checked for presence of cancer causing cells.
Genetic Testing
When all the other rest results are good, you will be advised to take a genetic test which can reveal a great deal of information about the DNA and chromosomal abnormalities. If this test is the first one to be performed, it can rule out all other conditions and shorten the diagnosis process.
When every test including genetic testing is Ok and still you are not able to impregnate your partner, what does that mean?
For any disease for which the cause/reason is not known, it is termed ‘idiopathic’ and in case of infertility, it is called ‘idiopathic infertility’ meaning that the reason for infertility is not known or couldn’t be identified.
Conclusion
When you present yourself (and your partner) to a sexologist, after initial few questions, the next thing that happens is testing. You should not be scared to get the tests done. If you are worried about the cost of infertility tests, you should speak to your insurance company or the person in the clinic to find out if the testing cost and treatment is bored by the insurance company.
Cost of each test varies from lab to lab, clinic to clinic and with the specialties the hospital or clinic provides.
