Infertility in men — diagnostic tests to identify the problem

Couples who face difficulty conceiving even after a year of having unprotected intercourse have higher chances of infertility issues. And, infertility isn’t just women’s problem. ‘Men can have problems with fertility, too. When a couple is having a hard time getting pregnant, it is just as likely to be caused by a problem with a man’s fertility as it is with a woman’s fertility,’ says Dr Abha Shroff, chief pathologist and director at Disha Pathology Labs, Mumbai.

‘1 out of 3 times, infertility is due to a problem with the man. That’s why it is essential that both the man and the woman should get tested for fertility problems,’ she says.

If you’re one of those men who have been ignoring this issue for a long time, you should get yourself tested. Here’s an account on infertility profiling for men with inputs from Dr Shroff.

The basic tests for infertility are common for men and women.

1. These basic tests include:

• Complete Blood Count (CBC)
• Erythrocyte Sedimentation Rate (ESR)
• Blood Sugar – Fasting and PP
• Vitamin B12, Vitamin D3
• Syphilis (VDRL)
• Hepatitis HbsAg

You can read about these tests in detail in this post: Infertility profiling: 8 tests to check why you’re not getting pregnant.

Infertility problems in men mainly arise due to low sperm count, poor sperm quality and hormonal problems. To check the quality of sperm, you’ll need to get your semen tested. Semen is the sperm containing fluid that is released when you ejaculate. 

2. Semen Analysis: This is basically done to check the sperm count and quality. For the test, typically 1.5 and 5.5 milliliters (mL) of semen is required.

• Sperm count: It is measured in ‘sperm per milliliter of semen.’ A count of 20 million sperms or greater is considered to be normal. Lower range may indicate infertility.

• Sperm quality: Sperm quality is measured based on two parameters: the shape and the mobility of sperms. Sperm mobility is the percentage of sperms that move actively in the sample. They are also graded based on the speed with which they travel and their direction of movement. If 50% or more sperms are found to be motile after one hour of obtaining the sample, the results are considered to be normal. Also, they should be moving with a good speed forward in a straight line. If 50% or less number of sperms are found to be non-motile, then a sperm viability test is done, where a coloured dye or stain is used to identify the dead sperms.

• Sperm morphology: The structure, size, shape and appearance of sperms is also observed. Abnormal sperms may have defective heads, midsections and immature forms. Ideally, over 14% of sperms should have normal heads. The semen should have pH between 7.2 and 7.8. 

Below is a table summarizing the sperm analysis test:

Test Parameters	Results: Normal	Results: Abnormal
Sperm count	20 million sperms or more per mL of semen	<20 million sperms/mL
Sperm mobility	Over  50 percent of sperms moving normally, with good speed and in a straight line	Less than 50% of normal sperms
Sperm morphology	Normal size and shape	Defective head, midsections and immature sperms
Semen pH	7.2 and 7.8	Beyond the range

 3. Semen Culture: A semen culture is done to check for contamination of the fluid with harmful pathogens. If the semen is infected with bacteria, it may affect semen quality and the sperms. A positive result may indicate urinary tract infection.

4. Testosterone: It is a male reproductive hormone that plays a key role in development of tissues in testis and prostate gland. It is a strong determinant of male sexual features. The hormone is regulated by the pituitary gland in the brain. So, if the level of testosterone is low it could also indicate problem with the pituitary gland and not just the testicles.