If you’re planning to father a child, know that fertility is a 50-50 deal: half egg, half sperm. So it probably isn’t coincidental that male fertility is a factor in 50 percent of infertility challenges.

This isn’t a blame game, though. It’s about empowering yourself with the knowledge you need to get the outcome you want. If you and your partner are having a hard time getting pregnant, it’s a good idea for you — both of you — to get checked.

Let’s take a look at male fertility testing and what may (or may not) be contributing to the challenge of having a child.

Research shows that male infertility affects up to 6 percent of men in North America. But what causes it? Several factors could contribute:

  • anatomical or genetic abnormalities
  • systemic or neurological diseases
  • infections
  • trauma
  • gonadotoxic radiation therapy
  • sperm antibodies

When you’re feeling the sting of another letdown, you may start weighing the pros and cons of home fertility tests. These lists give you a full picture:

The pluses

  • A home kit relieves you of the stress of providing a sperm sample in the doctor’s office.
  • Your concerns remain private.
  • The kits are inexpensive, as well as quick and easy to use.
  • A good kit, like SpermCheck Fertility can reliably tell you whether your sperm count is typical, low, or very low. This will help you plan your next step.

Shop for SpermCheck Fertility online.

The minuses

  • Home kits won’t give you all the information you need. While they can tell you if your sperm count is normal or not, these numbers are only one factor in male fertility.
  • The range for low and optimal sperm counts varies between the kits.
  • Some kits don’t measure sperm counts below certain levels.

For these reasons, while a home kit might be a helpful first step, you’ll need to be medically evaluated by a doctor for a more complete picture of your fertility.

You’ve booked the initial appointment. Knowing that you’re prepped will ease any tension you may be feeling. Here’s a breakdown of what to expect.

First comes the physical exam. The medical practitioner will examine your penis and testicles.

Next, you’ll be asked questions about your:

  • medical history
  • lifestyle
  • sex life

Questions about your medical history may include:

Questions about your lifestyle may include:

  • How much do you exercise? (Give an honest answer!)
  • Do you smoke or take recreational drugs?

When it comes to your sex life, you can expect a frank discussion that includes any problems you may have, such as:

After the physical exam and the questions, you’ll be asked to provide a semen sample.

How semen analysis is done

Semen samples are given in two different ways.

You can ejaculate into a special container at the doctor’s office. If this isn’t an option because of your religious or cultural beliefs, you can use a special condom during intercourse.

Be prepared to possibly provide several samples, because sperm counts do fluctuate from one specimen to the next.

What semen analysis shows about fertility

You’ve done your part by providing the sample. Now it’s up to the clinician to analyze it. According to a 2015 study done in India, as much as 2 percent of all men have sperm measurements that aren’t optimal.

So what is your doctor looking for? In a nutshell:

  • Signs of infection. The presence of certain bacteria in semen can indicate infection.
  • Volume of semen. This is a measurement of how much semen in total is in your sample.
  • Sperm concentration. The World Health Organization (WHO) classifies sperm counts at or above 15 million sperm per milliliter of semen as average.
  • Vitality. This examines what percentage of sperm are alive.
  • Motility. Are the sperm moving? Above 63 percent motility indicates fertility, while less than 32 percent of sperm with motility indicates subfertility.
  • Morphology. How are the sperm shaped? Believe it or not, the majority of sperm in your sample won’t be perfect. But if more than 12 percent are of normal size and shape, it indicates fertility. A sample with less than 9 percent normal morphology could mean sub- or infertility. (Between 9 and 12 percent is inconclusive.)

So much for the numbers. Now let’s crunch them.

While the numbers help to distinguish between fertility, subfertility, and indeterminate fertility, none of them actually diagnoses infertility. That said, here are two things to keep in mind:

  • A semen sample with a decreased sperm concentration often also shows abnormalities in sperm motility and morphology.
  • The percentage of sperm with normal morphology is perhaps the best indicator of healthy semen.

Sometimes, sperm cells pass all the standard medical tests for fertility, but you still have trouble growing your family.

That could indicate a condition called normozoospermic infertility, meaning that the sperm cells themselves are infertile. Here’s where urinalysis comes in.

How urinalysis is done

At the doctor’s office or the testing facility, you’ll be given a plastic cup and asked to be provide a small, clean urine sample. Use the cleaning wipe you’ve been given to wipe around your urethra to prevent bacteria on your penis from entering the cup.

What urinalysis shows about fertility

A 2014 study shows that doctors can now test for normozoospermic infertility by tracking the levels of five biomarkers (small molecules) in urine.

While standard fertility tests may capture 75 percent of cases, the researchers were able to correctly identify 86 percent of the infertile men and 87 percent of the fertile men.

What does that mean for you? While there’s still more research needed in this area, researchers suggest that the variant levels of these biomarkers may point to physiological problems as the root of normozoospermic infertility.

Making sperm is an energy-intensive process and any spoke in the production wheel could disrupt proper sperm production. The more we learn about the biomarkers, the easier it will be to fix any physiological problems.

The pituitary gland, hypothalamus, and testicles work together when it comes to sperm production.

Follicle stimulating hormone (FSH) and luteinizing hormone (LH) — acting together with testosterone, which is produced in the testicles — are involved in the process.

A simple blood test will show the level of these three important hormones in your blood.


This hormone contributes to sperm production.

High levels may indicate that your testicles aren’t functioning properly or have been damaged by disease, X-rays, or chemotherapy. Low levels may show that you aren’t producing sperm.


This is produced in the pituitary gland. In the testes, LT binds to receptors in the Leydig cells to release testosterone, which is needed to produce sperm.

LH levels can also be measured after giving an injection of gonadotropin releasing hormone (GnRH). The advantage to measuring LH this way is that your doctor can then pinpoint whether the problem is with your pituitary gland or another part of your body.


Healthy testosterone levels for men range between 300 to 1,000 nanograms per deciliter (ng/dL). Keep in mind that after the age of 40, testosterone levels decrease by an average of around 1 percent every year.

In some cases, your doctor may ask for imaging to check that your anatomical structure is OK and that there are no obstructions.

Scrotal ultrasound

In this exam, a handheld probe is swept across your scrotum. The scan uses high-frequency sound waves to check for:

  • infections
  • cysts
  • a collection of fluids inside the testicles
  • tumors

The test also checks for testicular torsion and varicoceles. While many adult men have a varicocele and are never bothered by it, if you’re dealing with infertility, your doctor may recommend surgery.

Transrectal ultrasound

A small, lubricated wand is inserted into your rectum. The imaging helps your doctor to check your prostate and check that there are no blockages in the vas deferens. Blockages can be corrected with surgery.

Usually, sperm doesn’t come into contact with the rest of your body and immune system. However, injury, surgery, or prostate gland infections can interfere with this protective system.

And when sperm comes into contact with your immune system, the body may produce anti-sperm antibodies.

Your doctor may ask for an anti-sperm antibody test if the cause for infertility is still missing.

You’ll be asked to provide a sample of semen. The test checks your semen for antibodies that fight against your sperm by using a substance that binds only to affected sperm.

The higher the level of sperm affected by antibodies, the lower the chance of a sperm fertilizing an egg. (These antibodies can also be found in women, so your doctor may ask for your partner to get tested too.)

Doctors are divided over whether this testing is advisable. Some say it doesn’t help set a treatment plan for infertility; others advise taking medication to lower the body’s immune response.

This test may come at the end of the line if the other tests you’ve done aren’t conclusive.

In this test, a sample is removed from the testicle, either with a needle or through a small cut. If the results of the testicular biopsy show that sperm production is normal, your infertility may be caused by a blockage or some other problem with sperm transport.

Following the development of in vitro fertilizing techniques, research on genetic causes for infertility has expanded. Genetic abnormalities are found in 10 percent to 20 percent of men who have severe disorders with sperm production.

Genetic testing carried out on DNA can help rule out chromosomal abnormalities, especially in men with either azoospermia (no sperm present in the semen) or oligozoospermia (low sperm count).

The test results can:

  • relieve you of uncertainty
  • help you avoid unnecessary surgical or medical treatments
  • help you make informed decisions on what your next steps should be

If you’ve done all the tests and everything has come up as normal, you may hear your doctor saying “idiopathic infertility.” Basically, this means that at the moment, there’s no way of figuring out the cause for your infertility.

While it won’t ease your frustration and pain, know that your uncertainty is shared by many. Idiopathic infertility is an extremely common infertility diagnosis in both men and women.

Depending on your diagnosis, you may find that you need to draw on reserves that you never knew you had.

But there are many options for medically assisted pregnancy. And remember many male infertility diagnoses can be successfully treated.