Fertility Problems: Evaluation for Males

Your healthcare provider will ask about your health history. This to see if any health or lifestyle factors may affect your fertility. You may be asked:

• How often you have sex
• If you have a child
• What medicines you take
• What vitamins and herbal remedies you take
• If you smoke
• If you use drugs
• If you drink alcohol
• How much exercise you get
• If you have chronic health conditions, such as diabetes

They will ask if you have had any of these:

• Injury to the testicles
• Surgery in the groin or pelvis
• A sexually-transmitted infection (STI)
• Past urinary or prostate infection
• Mumps as an adult
• Exposure to toxic chemicals
• Radiation therapy

Your healthcare provider may give you a physical exam. They are looking for problems that can affect fertility. The exam may include checking these:

• Body weight. The healthcare provider will weigh you. This is because body weight can affect fertility.
• Penis. The provider will look for signs of scarring, sores, or other problems.
• Testicles. These are checked to make sure they’re a normal size and in the right position. In some cases, a testicle may not be fully descended.
• Scrotum. This is the sac that holds the testicles. It’s checked for enlarged veins called varicoceles. These can affect sperm count and quality.
• Prostate. This gland may be checked for signs of infection or other problems.

A semen analysis measures the quantity and quality of sperm. These are factors that can affect the ability of sperm to fertilize an egg. The test is done by checking a semen sample under a microscope in a lab. A semen analysis looks at:

• Volume of semen. This is checked to make sure enough semen is being ejaculated.
• Sperm count. This measures the number of sperm per cubic centimeter of semen.
• Sperm motility. This measures the amount of sperm that are active and moving.
• Shape of the sperm. This is known as morphology. This is checked to make sure enough sperm have a normal shape.

You may be asked to give a semen sample at home or in the healthcare office. There is no need to feel embarrassed giving a sample. It’s a very important test. Sperm counts can change daily. Because of this, more than one sample is often needed. To help make sure your test is accurate:

• Don't ejaculate for 2 to 3 days before giving your sample.
• Include all of your semen in the container provided by the lab.
• If you collect the sample at home, get it to the lab within 1 hour.
• Keep the container warm. Put it in a pocket or under your arm.

Depending on the results of your exam and semen analysis, you may have one or more of these:

• Blood tests. These measure levels of hormones such as testosterone, LH, and FSH. A blood test can also look for genetic conditions that affect fertility.
• Ultrasound. This uses painless sound waves to view tissues inside the body. The test can help show abnormal changes in the testicles. It can also be used to look for blockages in the tubes.
• Testicle biopsy. If semen analysis shows that you have only a few sperm or no sperm, your provider may remove a small piece of tissue (biopsy) from each testicle. The sample will be checked under a microscope.

Your healthcare provider will explain your test results. They will talk with you about next steps for fertility treatment, if needed.