- Both partners should be checked together from the start. A male factor is involved in about half of couples.
- One poor semen report is not a diagnosis. Counts vary a lot. It is always repeated before anything is concluded.
- This page explains the tests and what the words on your report mean. It does not offer or promise any treatment.
This page describes how male fertility is assessed. It is general information. It does not offer, advertise or promise treatment for infertility, or any particular result. Every case differs. What happens next is decided after assessment, usually with both partners seen together and often alongside a gynaecologist.
The Semen Test
Everything starts here, and how the sample is given changes the result more than most people realise.
- Two to five days gap before giving it. Shorter or longer both skew the result.
- Collect the whole sample. The first part holds most of the sperm.
- It should reach the lab within an hour, kept near body temperature.
- Recent fever, illness or antibiotics can lower the count for two to three months. Sperm take about that long to form.
- One abnormal report means very little. It is repeated a few weeks later before drawing any conclusion.
- Oligozoospermia: Fewer sperm than the normal range.
- Asthenozoospermia: Too few are moving forward.
- Teratozoospermia: Fewer are normally shaped.
- OAT: All three together.
- Azoospermia: No sperm found. Confirmed on a second, spun-down sample before it is accepted.
- Low volume: Can point to a blockage, or semen going backwards into the bladder.
Normal ranges describe groups, not individuals. Men below the range do father children, and men within it sometimes do not.
No Sperm Found — Two Very Different Things
The key question is whether sperm are being made but cannot get out, or are not being made in useful numbers. Hormones, testis size and examination separate the two.
- Blocked: Production is fine, the path is not. Causes include past infection, past surgery such as a hernia repair, or a tube missing from birth. Testis size and FSH are usually normal.
- Not producing: The testis itself is affected. Testes are often small and FSH is high. Genetic tests are standard here, both to find the cause and because it matters for any children.
Other Tests
- Examination: Testis size, whether the tubes are present on both sides, and whether there are swollen veins. A big part of the assessment, and no test replaces it.
- Hormones: FSH, LH, testosterone, and prolactin if needed. These show whether the problem sits in the testis or the pituitary gland.
- Scrotal ultrasound: Confirms swollen veins, measures the testes, and picks up any lump. A solid lump found during a fertility check is investigated urgently in its own right.
- Urine after ejaculation: To see whether semen is going backwards into the bladder.
- Genetic tests: Where no sperm are found, or counts are very low.
- Sugar and thyroid, and a review of all medicines and gym supplements.
Testosterone taken from outside — injections, gels, or many gym supplements — shuts down the body's own sperm production. This is common, often not mentioned, and sometimes does not fully reverse. If you are taking any, say so. Stopping should be planned with a doctor, not done suddenly.
Things That Can Be Addressed
Some findings have a cause that can be worked on. Whether that changes the outcome for any one couple cannot be predicted, and no one should promise it. Finding them is simply part of a complete assessment.
- Swollen veins in the scrotum, linked with poorer sperm quality in some men. More on this →
- Hormone problems, including pituitary causes, treated with medicine.
- A blockage, sometimes repairable, or sperm can be retrieved for assisted reproduction.
- Infection or inflammation of the genital tract.
- Heat, smoking, alcohol, extra weight and uncontrolled sugar: Worth correcting on their own merits.
- Certain medicines known to affect sperm, where alternatives may exist.
Male and female factors go together often enough that checking only one wastes months. Consultations are private and unhurried.
What to Bring
- All semen reports, with dates and the gap noted on each.
- Any hormone reports — FSH, LH, testosterone, prolactin.
- Scrotal ultrasound reports.
- Your partner's reports and tests so far.
- Past surgery — hernia, undescended testis, a twist, or any groin operation.
- Mumps after puberty, injury to the testis, or genital infection.
- All medicines and supplements, including anything from the gym.
Related: male infertility — what you should know.
This page provides general information only. It is not a substitute for medical advice, diagnosis or treatment. Consult a qualified urologist for assessment appropriate to your situation.