When a couple struggles to conceive after a year of unprotected sex, both partners are usually advised to undergo testing for infertility. The process for evaluating infertility differs between men and women. In men, several tests help identify possible causes and determine the right course of treatment.
Step 1: Medical History and Physical Exam
Doctors begin by reviewing the couple’s medical history. This helps narrow down potential issues. For men, the healthcare provider will ask about any past or recent injuries to the genital area. A physical exam follows to check for swelling of the prostate, abnormal discharge, hernias, or lumps. If nothing unusual is found, more detailed tests will be recommended.
Step 2: Semen Analysis
Semen testing is a key part of diagnosing male infertility. The man provides a semen sample by ejaculating into a sterile container. This sample is examined in a lab to assess:
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Sperm count
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Sperm shape (morphology)
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Sperm movement (motility)
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Overall sperm health
Since sperm quality can vary between samples, doctors may request multiple samples over time to get accurate results.
Step 3: Scrotal Ultrasound
An ultrasound of the scrotum helps detect physical issues in the testicles. One common problem is varicocele, which is an enlargement of the veins inside the scrotum. This condition accounts for around 40% of male infertility cases and is easily spotted using ultrasound. The scan can also detect testicular torsion, where the testicle twists, causing swelling and pain. This needs urgent surgical treatment to avoid permanent infertility.
Step 4: Hormone Testing
Hormones play a crucial role in sperm production. The process starts with the brain releasing hormones like GnRH, FSH, and LH, which signal the testicles to produce sperm and testosterone. Blood tests can check whether these hormones are balanced. If levels are off, sperm production may be affected.
Step 5: Testicular Biopsy
A testicular biopsy involves using a needle to take a small tissue sample from the testicle. This sample is examined for sperm production and structure. Though not commonly performed, it can reveal if the sperm is normal or if there are deeper issues like damaged DNA or poor motility. If healthy sperm are found, the infertility may be due to a blockage.
Step 6: Transrectal Ultrasound
A transrectal ultrasound provides clear images of the prostate, seminal vesicles, and ejaculatory ducts. A small lubricated wand is inserted into the rectum to check for blockages in the sperm ducts. This test helps identify or rule out physical obstructions in the path of the semen.
Other Specialized Tests
Some less commonly used tests may also be available:
- Vital Staining Test – Measures how many sperm are alive.
- Antisperm Antibody Test – Detects antibodies attached to sperm that may prevent movement.
- Semen Culture – Checks for infections in the semen.
- Hypo-osmotic Swelling Test – Tests the strength of the sperm’s outer layer.
- Chromosome Analysis – Looks for genetic issues.
- Sperm Function Tests – Examines how well sperm swim, attach to, and penetrate the egg.
These tests are usually done only if needed. Most men do not require all of them. Once the main issue is found, the doctor will suggest suitable treatment options for the couple.
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