Tests Used for Male Fertility Assessment
The initial screening for male fertility should include a comprehensive reproductive history and two semen analyses performed at least one month apart, as recommended by the American Urological Association and American Society for Reproductive Medicine. 1
Initial Evaluation Components
Reproductive History
The reproductive history should include:
- Frequency and timing of intercourse
- Prior fertility and duration of current infertility
- Childhood illnesses and developmental history
- Systemic illnesses and previous surgeries
- Sexual history, including sexually transmitted diseases
- Gonadal toxin exposure, including heat exposure
- Prescription and non-prescription drug use
- Family reproductive history 1
Physical Examination
The physical examination should focus on:
- Examination of the penis, including location of the urethral meatus
- Measurement and palpation of the testes
- Checking for presence and consistency of vasa and epididymides
- Checking for presence of varicocele
- Body habitus and secondary sex characteristics
- Digital rectal examination 1
Semen Analysis
Collection Guidelines
- Abstain from sexual activity for 2-3 days before collection
- Collection by masturbation or intercourse using semen collection condoms
- Keep specimen at room or body temperature during transport
- Examine within one hour of collection 1
Standard Parameters
| Parameter | Normal Value |
|---|---|
| Volume | 1.5-5.0 mL |
| pH | >7.2 |
| Sperm concentration | >20 million/mL |
| Total sperm number | >40 million per ejaculate |
| Motility | >50% |
| [1,2] |
Important Considerations
- Semen parameters are highly variable biological measures
- At least 2 semen analyses obtained a month apart are important, especially if the first SA has abnormal parameters
- WHO lower limits are based on the lowest fifth centile of values for fertile males whose partners became pregnant in 12 months 1
Advanced Testing
Hormonal Evaluation
When indicated, hormonal evaluation should include:
- Follicle-stimulating hormone (FSH)
- Luteinizing hormone (LH)
- Testosterone
- Inhibin B
- Anti-Müllerian hormone (AMH) 2
Genetic Testing
Genetic testing is recommended for men with non-obstructive azoospermia:
- Karyotype analysis
- Y-chromosome microdeletion analysis 2
Functional Tests
For cases with unexplained infertility or failed assisted reproductive technology:
Cautions and Pitfalls
Point-of-care and mail-in semen tests: While these kits provide some information, numerous factors can impact their accuracy. There is no substitute for testing conducted in a specialized andrology laboratory 1
Interpretation challenges: Semen analysis results alone do not provide a diagnosis and must be interpreted in conjunction with other medical investigations of the couple 4
Limitations of conventional parameters: Traditional semen parameters may not fully predict fertility potential, as 25% of infertility cases worldwide remain unexplained despite normal semen parameters 5
Threshold considerations: Studies have found that pregnancy rates are significantly lower only when sperm concentration values are less than 5 million/mL, with no clear threshold values for sperm motility and morphology 6
By following this structured approach to male fertility assessment, clinicians can effectively evaluate and guide treatment decisions for men experiencing fertility challenges.