This article explains how male fertility is assessed and what the tests mean. It is general information. It does not offer, advertise or promise treatment for infertility, or any particular result.
How Common Is It?
Doctors call it infertility when a couple has not conceived after twelve months of trying. It affects roughly one couple in seven. In about half of those, something on the male side plays a part. That is why both partners should be checked together from the start — checking one at a time wastes months.
What Lies Behind It
- Varicocele: Swollen veins in the scrotum. Common, and often looked at first.
- Low count or poor movement: Sometimes with no cause found, sometimes from a hormone problem.
- A blockage: Sperm are made but cannot get out. May follow an old infection or past surgery.
- Hormone problems: From the testis itself, or from the pituitary gland in the brain.
- Genetic causes: Found where the count is very low or nil.
- Lifestyle: Smoking, heavy drinking, extra weight, heat, and gym steroids.
- Past infection: Mumps after puberty, or an infection that blocked the tubes.
When to Get Checked
A couple under 35 should see someone after a year of trying. Go sooner, at six months, if either partner is over 35, if there has been surgery in that area, or if the man has had an undescended testis, a varicocele or a past infection.
The Tests
- Semen test: The main one. It measures how many sperm there are, how well they move, and their shape. Give it after two to five days' gap, and expect it to be repeated once. One poor report on its own means very little.
- Hormones: FSH, LH, testosterone, prolactin and thyroid.
- Scrotal ultrasound: Looks for swollen veins, measures the testes, and checks for a blockage.
- Genetic tests: Where the count is very low or nil.
- Testicular sampling: To tell a blockage apart from a production problem.
Testosterone taken from outside — injections, gels or many gym supplements — shuts down your own sperm production. This is common, rarely mentioned, and does not always reverse. If you take any, say so. Stopping should be planned with a doctor.
What Happens After the Tests
What comes next depends entirely on what the tests show, and it is decided with both partners in the room. Some findings can be treated medically. Some are addressed surgically. Some couples are guided towards assisted reproduction, usually with a gynaecologist or fertility specialist involved.
No one can predict the outcome for any individual couple, and you should be wary of anyone who offers you a figure. The purpose of the assessment is to find out what is going on, so that the choice you make next is an informed one.
A semen test and a consultation is the most useful first step a couple can take. Bring both partners' reports if you have them.
Things Worth Doing Anyway
- Stop smoking. Tobacco damages sperm directly.
- Keep alcohol occasional and light.
- Avoid gym steroids and testosterone supplements.
- Get to a healthy weight. Extra weight raises scrotal temperature and lowers testosterone.
- Keep laptops off your lap. Skip long hot baths.
- Eat well — plenty of fruit, vegetables and nuts.
Full guide: what each test means →
