Tests and Analysis to Determine Causes of Male Infertility

Did you know that 15% of couples trying to have a baby are unable to do so within a year? Among various factors, male infertility stands as a significant concern. The causes of male infertility can range from issues with sperm production to problems occurring during ejaculation, and they may stem from hormonal, physical, or even genetic factors.

How to diagnose male infertility

The most reliable way to diagnose male infertility involves a series of tests such as semen analysis, blood tests, transrectal ultrasounds, urine tests, and genetic testing. Additionally, healthcare professionals examine lifestyle factors, chronic health conditions, and environmental elements that might contribute to male infertility.

Men contribute 50% to causes due to sperm problems. Semen Analysis is a common test used to determine male infertility by measuring sperm number and quality. Male fertility is determined by various tests, with semen analysis being the most important. The test involves collecting a semen sample in a sterile container after 2-5 days of abstinence and evaluating it for volume, concentration, motility, and morphology in the laboratory. Low sperm count doesn’t necessarily indicate infertility; there could be issues with sperm production or delivery. The following are commonly identified causes of male infertility:

• Hormonal imbalance – Dysfunctions in the thyroid, adrenal and pituitary glands, as well as the hypothalamus, can contribute to infertility.
• Physical causes – Obstructions in the ejaculatory pathway due to surgery, injuries, or other conditions like diabetes, medication, retrograde ejaculation, or spinal injuries can also be underlying causes of male infertility.
• Infections – Conditions like sexually transmitted diseases like HIV or gonorrhoea can create blockages or cause permanent testicular damage, affecting fertility.
• Varicocele – Swelling of veins that drain the testicle can lead to poor sperm quality, although this condition is generally treatable and reversible.
• Sexual issues – Early or painful ejaculation, erectile dysfunction, or the inability to ejaculate can be causes of male infertility.
• Genetic factors – Single gene mutations or chromosomal abnormalities like Kalman’s syndrome, cystic fibrosis, or Klinefelter’s syndrome can impact fertility.
• Anti-sperm antibodies – In some cases, the immune system produces antibodies that attack and neutralise sperm.
• Medication – Certain medications for conditions such as arthritis, cancer, and ulcers, as well as long-term use of anabolic steroids, can impair sperm production.
• Lifestyle and environmental factors – Regular exposure to hazardous materials, prolonged sitting, smoking, alcohol consumption, obesity, and drug abuse can all degrade sperm quality.

Common Causes of Male Infertility:

1. Low Sperm Count (Oligospermia): When a man’s semen contains fewer sperm than the normal reference range (typically fewer than 15 million sperm per milliliter), it can lead to infertility.
2. Poor Sperm Motility: If a significant portion of the sperm in the semen have impaired mobility, they may struggle to reach and fertilize the egg.
3. Abnormal Sperm Shape (Morphology): Abnormal sperm morphology can hinder their ability to penetrate the egg successfully.
4. Sperm Transport Issues: Conditions such as obstructive azoospermia, where there is a blockage in the reproductive tract preventing sperm from being ejaculated, can cause male infertility.
5. Ejaculatory Dysfunction: Problems with ejaculation, such as premature ejaculation or retrograde ejaculation (when semen is directed into the bladder instead of out of the body), can lead to infertility.
6. Hormonal Imbalances: Hormonal imbalances affecting the production of testosterone or other reproductive hormones can impact fertility.

Tests and Analyses to Diagnose Male Infertility:

1. Semen Analysis (Sperm Count, Motility, and Morphology): Semen analysis is one of the first diagnostic tests performed to assess male fertility. A sample of semen is collected and analyzed to determine sperm count, motility (ability to move), and morphology (sperm shape). Abnormal results in any of these parameters may indicate male infertility.
2. Hormone Testing: Hormonal imbalances can affect sperm production. Blood tests can measure hormone levels, including testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin.
3. Genetic Testing: Genetic factors can contribute to male infertility. Genetic testing may identify chromosomal abnormalities, gene mutations, or conditions like Klinefelter syndrome.
4. Physical Examination and Medical History: A thorough medical history and physical examination can help identify potential issues, such as varicoceles (enlarged veins in the scrotum) or testicular abnormalities.
5. Scrotal Ultrasound: A scrotal ultrasound can provide detailed images of the testicles and the surrounding structures. It is commonly used to detect varicoceles and other structural abnormalities.
6. Post-Ejaculatory Urinalysis: This test checks for the presence of sperm in the urine after ejaculation, which can occur in retrograde ejaculation.

1. Anti-Sperm Antibody Testing: Sometimes, the immune system can produce antibodies that attack and impair sperm function. This test helps identify the presence of anti-sperm antibodies in the semen.
2. Sperm DNA Fragmentation Testing: High levels of sperm DNA fragmentation can impact fertility. This specialized test assesses the integrity of sperm DNA.
3. Testicular Biopsy: In cases of obstructive azoospermia or when other tests are inconclusive, a testicular biopsy can be performed to obtain a tissue sample from the testicles for further analysis.
4. Functional and Genetic Testing of the Epididymis and Vas Deferens: These tests can help diagnose obstructive azoospermia or other issues affecting sperm transport.

Additional Factors to Consider:

It’s important to recognize that male infertility may not always have a single identifiable cause; it can be multifactorial. Lifestyle factors, such as smoking, excessive alcohol consumption, obesity, and exposure to environmental toxins, can also contribute to male infertility. Thus, it’s crucial to address these factors as part of the diagnostic process.

Treatment and Management of Male Infertility:

Once the causes of male infertility are identified through tests and analysis, appropriate treatment options can be explored. These may include:

1. Lifestyle Modifications: Adopting a healthy lifestyle, including regular exercise and a balanced diet, can positively impact fertility.
2. Medications: Hormone therapy or other medications can address hormonal imbalances and improve sperm production.
3. Surgical Procedures: Surgical interventions, such as varicocele repair or vasectomy reversal, may be necessary in some cases.
4. Assisted Reproductive Technologies (ART): ART procedures, such as intrauterine insemination (IUI) or in vitro fertilization (IVF), can be used to overcome male fertility issues.
5. Donor Sperm: In cases where infertility cannot be treated, the option of using donor sperm for artificial insemination or IVF may be considered.
6. Counseling and Support: Coping with male infertility can be emotionally challenging. Counseling and support services are available to help individuals and couples navigate this journey.

Your next steps

If you’re concerned about fertility issues, consult with our experts at Advance Fertility and Gyne Centre. We will thoroughly examine the causes of male infertility and create a personalised treatment plan to address your specific needs.