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When a couple has failed to conceive for over a span of at least a year, infertility is most often the diagnosis, as up to 15% of couples are infertile. A range of tests can help examine the fertile status of men, as it is believed that men contribute to infertility cases nearly 50% of the time. The most common test begins with the analysis of semen and sperm and goes all the way up to genetic testing.
What is Male Fertility Testing?
Male infertility can be due to factors such as low sperm production, blockages that prevent sperm delivery, abnormal sperm function, hormonal imbalances, chronic health problems, injuries, illnesses, lifestyle choices, and certain other factors. Male fertility testing involves a range of physical and medical examinations that determine the cause of infertility in men and recommend the treatment for infertility.
Most Common Fertility Tests for Males
To check fertility in men, urologists rely on different methods to determine the causes. Some of the most commonly done tests are as follows:
1. Semen & Sperm Analysis
This is the most common and the most important of all the tests and involves evaluation of semen in a laboratory by a trained expert. He checks for the sperm count, shape, movement and other aspects that determine if a man has low fertility. However, it has many exceptions, as sperm is not always as healthy as it looks and a lot of men who have low sperm count or abnormal semen are still fertile. It must be noted that about 15% of infertile men have normal semen and sperm. The semen analysis parameters to check for infertility include:
- Sperm concentration: It gives a measure of how many sperms are present in a millilitre of semen produced. The measurement will be done to count if they are less or more than 20 million sperms per millilitre in the ejaculated fluid.
- Motility: This exam is an evaluation of the mobility of the sperm and how well they are moving. There is a grading of sperms on the basis of their motility. Sperms with more than 40% motility are considered normal.
- Morphology: This looks for how many sperms have normal shape; the minimum being 4% normal morphology. However, it is considered as the least important of the parameters for fertility in semen.
2. Hormone Testing
Hormones, such as testosterone determine the production of sperm in men; therefore it can be a useful tool in identifying problems with sperm production. The two main hormones tested for are:
- FSH (follicle stimulating hormone): This hormone is crucial for sperm production. The normal FSH levels should be between 5 to 10 mIU/mL.
Testosterone: It is also related to sperm production. The normal levels should be 300 to 1,111 nanograms per decilitre.
3. Genetic/DNA Fertility Testing
DNA fertility testing is employed in case of unexplained infertility, where despite the presence of normal levels of sperm in the semen, they may not function properly. This test examines abnormalities in genes that may be stopping their proper functioning.
Other Male Fertility Testing Options
When the tests for semen and hormonal analysis return to normal, other tests need to be performed to look for the exact cause of infertility. Some of those tests include:
1. Sperm Agglutination
This test involves the examination of sperm under a microscope in a laboratory. The aim is to see if the sperms are sticking together and if so, then how many. If the sample shows that half of the sperm are stuck together, the report would say 50% sperm agglutination. Sperm in the semen can stick together at the head, tail, or head to tail, which binds them making them unable to swim. Sperms need to swim freely and in a straight manner to make it through the cervical mucus.
2. Sperm Penetration Assay
The sperm penetration assay is a test to predict the capacity of a sperm to fertilize a woman’s egg. In the lab, sperm is joined with specially prepared hamster eggs and the number of penetrated eggs are measured. It indicates whether the sperm is undergoing the required physiological changes for fertilization. This test is rarely used though.
3. Hemizona Assay
It is a laboratory testing of sperm function where a non-usable human egg is cut in half and one half is incubated with the sperm of the patient and the other half with a donor who is known to have normal sperm. The aim of the procedure is to see whether the sperm is able to get through the outermost protective layer of the egg.
4. Acrosome Reaction
This laboratory test is done to determine if the sperm heads are capable of undergoing the necessary chemical changes to dissolve the egg’s tough outer shell. It is a critical step at the start of the fertilization for the sperm to dissolve the coating on the egg to create a gap for it to enter.
5. The Hypo-osmotic Swelling Test
This test is used for infertile men who have genetically immotile sperm. It uses a specific sugar and salt solution to evaluate the sperm’s tail to move and thus move to penetrate the egg. Healthy sperm tails tend to swell in the solution whereas abnormal or dead sperm tails do not swell.
6. Testicular Biopsy
In this procedure, a tiny piece of tissue is removed from the testicles while the man is on local or general anaesthesia. The procedure involves a surgical cut into the skin of the scrotum and removal of a tiny piece of testicular tissue. The samples are examined to see how well the sperm are being produced.
It is an X-ray exam used to look for blocks or leaks of sperm in the vas deferens. In the procedure, a radiographic dye is injected into the vas deferens. X-rays from multiple angles are taken as the dye flows through the ducts to search for blockages.
Ultrasonography uses a small ultrasound transducer to locate blockages or damages in the reproductory tract. It is also used to examine the prostate, ejaculatory ducts and seminal vesicles to search for abnormalities that could lead to infertility.
1. What Is it That Fertility Tests Can’t Tell Us?
A majority of the fertility tests mentioned above look for the presence of sperm and check whether they can reach and fertilize an egg. As infertility can be a highly complex and multifaceted problem, semen analysis can’t be considered for a clear answer. In some cases, advanced testing is required to tell if one needs to continue trying naturally or move to IVF.
2. Are There Any Male Fertility Tests Which Can Be Performed at Home?
There are home test kits available that can be used to measure the sperm count at home. It usually requires a man to ejaculate into a cup and although semen transfer procedures vary for different kits, the results are usually available in less than 10 minutes. The measured parameter is that the sperm count per millilitre of semen should be about 20 million. Some of the test kits work by detecting a protein that is only found in sperm, along with the number, they can also confirm the presence or absence of sperm. The results show up as a shade of colour which when compared with a control template can tell if the sperm count falls below 20 million. Another type of kit comes with a microscope that contains an inbuilt ‘grid’ system which offers a field of view. Built into the lens, this system allows you to see the presence of sperm along with enabling you to count them. By comparing your result with the interpretive guidelines provided, you can determine the sperm count. Since it allows you to see the sperm, you can also test for their motility.
3. How Accurate Are These Tests?
The home fertility kits are decently accurate when it comes to checking for sperm count. A normal sperm count does not indicate whether a man is fertile or not. These kits don’t measure many other factors that cause infertility as a specialist does, such as shape (morphology), movement (motility), vitality (percent alive), semen volume, etc.
Fertility testing is an effective way to know the cause of your fertility problem that assists your doctor in guiding you to the best treatment that can help you conceive. Similarly, women should also visit the doctor if you are facing problem in getting pregnant. Infertility, better known as subfertility in women is common too, but it can be treated.
Also Read: 8 Effective Fertility Foods For Men