Why Male Fertility Testing is Important

Updated: Nov 18, 2021

Globally, one in eight to twelve couples experience infertility.

If a couple has not achieved a pregnancy after 12 months or more of regular unprotected sexual intercourse, they are living with infertility.

One third of infertility cases are due to factors related to the male e.g. sperm quality or quantity, one third of cases are due to a mixture of male and female factors or are unexplained.

So male fertility testing is just as important as fertility testing in females.

This article will discuss male fertility testing. It is the final article of the 3-part-series on fertility testing. This article will answer these questions:

What are male fertility tests?
When should I have a male fertility test?
Where can I get a male fertility test done?
How much does a male fertility test cost?
Having a male fertility test at the doctors?
What happens after the tests?

Be sure to read part 1 and part 2 of the series. Part 1 covers the basics of conception, gives a definition of fertility, explains how fertility tests work and discusses whether you should have a fertility check before you start trying to conceive.

Part 2 covers how a woman’s fertility is test, fertility testing at home and by the doctor, fertility tests for women over 35 and a specific section on anti-müllerian hormone (AMH) testing.

Male fertility testing is important. One third of problems with fertility are related to problems with the male reproductive system.

The main and most common male fertility test used is the semen analysis also called the sperm test.

A normal semen analysis does not guarantee that you are fertile.

If you and your partner have been trying to conceive for more than 12 months (female partner aged 35 or under) or 6 months (female partner age 36 or older) see your GP/family physician for initial investigations.

You should attend the appointment together with your partner. When you book the appointment let the receptionist know you are coming together so they can book enough time e.g. a double appointment.

9 in 10 couples trying to conceive (under 40 years) will conceive within 2 years of regular unprotected sex twice a week and 8 out of 10 couples (under 40 years age) will conceive within 1 year of regular unprotected sex twice a week (with no other contraception). It takes longer for couples aged 40 or over to conceive.

The Sperm DNA fragmentation Test is a measure of quality of semen more specifically it looks for damage to the DNA (genetic material) in the sperm. Making lifestyle changes, ideally 3 months, before trying to conceive can reduce sperm DNA damage. The Sperm DNA fragmentation test is now available on the NHS.

Excessive alcohol intake is detrimental to semen quality. The department of health’s recommendations of 3-4 units per day for men is unlikely to affect semen quality

Elevated scrotal temperature can lead to reduced semen quality. Although it is uncertain whether wearing loose-fitting underwear improves fertility, the recommendation is to avoid wearing tight underwear.

There is an association between smoking and reduced semen quality. Although the full impact of smoking on male fertility is uncertain, it may reduce sperm DNA damage and stopping smoking will improve your overall health.

Men who have a BMI of 30 or over may have reduced fertility.

A diet rich in vitamin E, vitamin C, zinc and selenium can improve sperm quality.

What are male fertility tests? Why is male fertility testing important?

Globally, one in eight to twelve couples experience infertility. If a couple has not achieved a pregnancy after 12 months or more of regular unprotected sexual intercourse, they are living with infertility. One third of infertility cases are due to factors related to the male e.g. sperm quality or quantity, one third of cases are due to a mixture of male and female factors or are unexplained and one third of cases related to female factors alone.

Therefore, when having fertility investigations, it’s just as important to investigate causes that could be related to the male as it is to investigate causes in the female.

Some cases of male factor infertility can be resolved with lifestyle changes or medical treatment.

Fertility tests can help determine whether one or more of those events within the sequence are working or are likely to be working and therefore may help understand the chances of becoming pregnant.

One test is not usually enough though. Several tests are required to gain a fuller picture of fertility. However, tests are expensive, and tests do not look at all parts of the conception process.

Read part 1 for more information on this and to watch the video on the processes involved of becoming pregnant.

What fertility tests are available for males?

These are the tests that are specific to males:

· Semen analysis

· Sperm DNA fragmentation

· Other tests e.g. anti-sperm antibodies

1. Semen analysis or sperm test

Semen analysis is the most common male fertility test that is performed. This requires a sample of semen which is sent to the lab for analysis.

You will provide a fresh sample of semen directly into a sterile container, after masturbation. It is important to follow the instructions that have been given. Some labs require abstinence from masturbation and sex before the sample should be provided.

Usually the sample needs to be taken to the lab as soon as possible; ideally within one hour.

What doctors look for:

· Volume of Semen: Normal range - 1.5ml or more

· pH of semen: Normal range -7.2 or more

· Concentration of sperm in the sample: Normal range - 15 million sperm per mililitre or more

· Total number of sperm in the sample: Normal range - 39 million sperm or more in the

whole sample

· Total motility (moving well): Normal range - Motile 40% or more and Progressive

motility (the range of sperm that move well compared with those not moving at all)

of 32% or more

· Vitality (% of living sperm): Normal range- 58% or more live sperm

· Sperm morphology (normal shape vs abnormal sperm): Normal range - 4% or more

· White cells in the sample which could indicate infection

The normal ranges above are from NICE guidance which is based on information from the World Health Organisation (WHO).

**The normal ranges will vary in each lab that analyses the sample. Therefore, you should refer to the ranges provided by the lab you use. Your doctor will give you the relevant information**

Oligospermia is a low sperm count (where the total sperm number below 33 million sperm)

Azoospermia is where no sperm are found in the sample.

If semen analysis is within the normal reference ranges, this does not guarantee that fertility is normal. This is because the semen analysis does not include a full assessment of the quality sperm and causes of infertility may not be identified.

If the first semen analysis is abnormal it should be repeated ideally around 3 months later.

In the UK, semen analysis can be arranged by your GP.

2. Sperm DNA Fragmentation

Another male fertility test is the sperm DNA fragmentation test which shows if there is damage to the DNA structure of the sperm. This means the sperm contains abnormal genetic material and this can lead to male subfertility, IVF failure and miscarriage. There is not enough data to support a consistent relationship between increased or high DNA fragmentation and reproductive outcomes.

This test is done with a separate semen sample; a frozen semen sample is needed. The test is expensive and is not routinely requested or performed.

The sperm DNA fragmentation test can be arranged through a private clinic but is only generally used to investigate couples that are experiencing infertility and miscarriage.

The sperm DNA fragmentation test is now available on the NHS.

DNA damage can be rectified by lifestyle changes, treating any underlying infection, removing pollutants and toxins and by taking antioxidants (see summary and information below)

You do not need to have a sperm DNA fragmentation test to improve DNA fragmentation. Making simple lifestyle changes can improve DNA fragmentation and therefore improve quality of the sperm. These changes include:

· Reduction or stopping alcohol and smoking

· Reducing heat, radiation or chemical exposure to the testes e.g Saunas, work related

exposure

· Having a healthy BMI

· Treatment of any Sexually Transmitted Infections (STIs)

· Avoid wearing tight underwear

· Eating a diet or taking supplements rich in these vitamin and minerals i.e. vitamin E, selenium, vitamin C, zinc, L-carnitine, co-enzyme Q10. The most effective being vitamin C, vitamin E, zinc and selenium.

3. Antisperm Antibodies

Antisperm antibodies are antibodies that form an immune response against the sperm. They can be detected in the semen sample but can also be detected in females.

This test is not routinely offered in the UK. NICE do not recommend offering a screening test for antisperm antibodies because there is no evidence of effective treatment available to improve fertility related to antisperm antibodies.

When should I have a sperm test?

This is mostly down to choice. You can arrange to be tested before you start trying to conceive. In the UK you will have to arrange to do this at a private clinic or pay to buy a home testing kit for semen analysis. The amount of information provided in a home testing kit will vary as will the quality of the test.

Male fertility testing is only available on the NHS if you have not become pregnant after a period of trying to conceive.

The recommendation by NICE is for male partners to be referred to a specialist for clinical assessment and investigation for infertility after:

1 year of unprotected sex if age 35 or under.
6 months of regular unprotected sex if age 36 or more.
6 cycles of intrauterine insemination (IUI).

If you or your partner have a known clinical cause of infertility or have a condition that could potentially cause infertility, then specialist consultation may be arranged much earlier than the timeframes above. If it’s appropriate, referral may even be made before you start trying to conceive.

Having the male fertility assessment with the Doctor

Your GP will do an initial assessment and may refer you to a fertility clinic after initial tests have been completed.

As part of the clinical assessment males will be asked a number of questions including:

· Frequency of sex.

· Ability to ejaculate.

· History of previous children or pregnancies.

· History of any illness or medical conditions, STIs.

· History of groin operations or undescended testes in childhood.

· History of surgery.

· Current medication or drugs taken including recreational drugs, smoking and alcohol.

· Family history of genetic conditions.

A physical examination will be done to check the size of the testes and look for lumps, swellings, excess fluid or tenderness in the testes scrotum (skin surrounding the testes), prostate gland and tubes such as the epididymis and vas deferens. Varicose veins on the scrotum, Varicoeles, may require treatment.

A blockage in the epididymis, could be caused by inflammation due to infection or physical obstruction e.g. stricture. This could lead to lack of semen being ejaculated (obstructive azoospermia). Treatment with antibiotics for the infection or surgical correction for the stricture may relieve the obstruction.

Here is more information on the male reproductive system.

If a man has problems with ejaculating for other reasons e.g. stress or other psychological reasons, then this can be addressed with appropriate psychological therapy treatment.

Hormone blood tests may be required. These may include the male sex hormone and other endocrine hormones such as

Other tests may be taken e.g. Blood test for Genetic Karyotyping which analyses genetic material for any genetic or chromosomal disorders.

What happens after the tests have been done?

If any problems are found, you will usually require a repeat test for confirmation.

After this you will be referred to a urologist or fertility specialist, depending on the outcome of the assessment.

If it’s relevant, you are most likely to benefit from a multidisciplinary approach. This might include a dietician, a nurse, a psychologist, a surgeon as well as your fertility doctor.

Where can I get tested?

If you are just starting to try for a baby, you won’t be offered fertility testing on the NHS. You do not require a fertility test although if you want to take one you can arrange to have investigations done at a private clinic or arrange a home testing kit (will be discussed in a future blog post).

If you are having problems trying to conceive or you or your partner have a known cause of infertility make an appointment to see your GP. When you book the appointment explain that you are attending with your partner so that the right appointment is booked (usually a double appointment) then make sure both you both attend the appointment together. You will be assessed and referred to an NHS Fertility specialist for testing.

If you want to see an Independent Private Specialist and wish to arrange this through your insurance provider you may need a letter of referral then your GP who will be able to do this. Alternatively you can approach the Independent fertility clinic directly.

Unless you have been given specific advice from your GP or Fertility specialist, I would not advise using at home testing kits if you are having difficultly getting pregnant. I recommend you are seen by a fertility specialist and have tests analysed in a reputable laboratory.