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Diagnosing Male Infertility

Diagnosing male infertility should begin with a complete medical history and physical examination performed by a provider with expertise in male infertility.

Men will need to provide at least one semen sample for analysis. The semen sample, obtained through masturbation into a sterilized cup, will be assessed for factors such as volume, count, concentration, movement and structure of the sperm that may help or hinder conception. Even if the semen analysis shows low sperm numbers, or even no sperm, it does not necessarily mean absolute infertility. Low values in any of the above categories may just indicate a problem with the development or delivery of sperm that simply requires further evaluation.

Besides a semen analysis, your doctor may order a hormonal profile to check for any abnormalities that may contribute to male infertility. These blood tests can discover the sperm-producing ability of your testicles and rule out other serious conditions that may be affecting your fertility. For instance, follicle-stimulating hormone (FSH) is the pituitary hormone responsible for stimulating testicles to produce sperm. High levels may indicate that the pituitary gland is trying to stimulate the testicles to make sperm though they are not responding. Low testosterone levels may also indicate that the testicles are not functioning normally.

A testicular biopsy may be needed when a semen analysis shows very low number of sperm or no sperm. This test is performed in an operating room under general or local anesthesia through a small cut in the scrotum. It may also be done in a clinic using a needle inserted through skin over the testicle that has been anesthetized. In either case, a small piece of tissue is removed from one or both testicles for microscopic evaluation. The biopsy serves two purposes: to determine the cause of infertility, and, if necessary, to retrieve sperm for use in assisted reproductive technologies.