Male factors are involved in about half of all infertility cases. Sometimes alone. Sometimes alongside a female factor. Even so, male fertility testing is the part of an infertility workup that most often gets skipped or put off. At ojiivf, one of the best fertility clinics in Gurgaon, we assess both partners from the start. The right male fertility tests, done early and read together with the female partner's results, usually lead to a faster and more accurate diagnosis.
What Does a Semen Analysis Actually Measure?
The semen analysis is the main test in a male fertility evaluation. It is usually the first test a man does. A few things get measured:
- Sperm count is the number of sperm per millilitre of ejaculate. The reference is ≥16 million/mL, per WHO 2021 criteria.
- Motility, meaning the percentage of sperm that are moving forward in a progressive way.
- Morphology looks at the percentage of sperm with a normal shape.
- Semen volume and pH, which are relevant when an ejaculatory duct issue is suspected. Results can vary between samples. Illness, stress or the abstinence period can each shift a reading. For this reason the AUA/ASRM guideline recommends at least two semen analyses before any conclusion is drawn. One abnormal result is not a diagnosis.
Is a Physical Examination Really Necessary?
In most cases, yes. A physical examination by a specialist checks for a varicocele, which is an enlargement of the veins in the scrotum. A varicocele is present in around 40% of men evaluated for infertility. It is the most common surgically correctable cause. The examination also assesses testicular size and consistency. It checks for the presence of the vas deferens. Absence of the vas deferens can point toward a genetic condition associated with obstructive azoospermia.
When is a Hormone Panel Indicated?
Hormonal evaluation, including FSH and testosterone, is recommended for infertile men with impaired libido, erectile dysfunction, oligospermia (low count), azoospermia (no sperm), atrophic testes, or signs of a hormonal abnormality on physical exam. The panel usually includes a few things:
- FSH where an elevated level points toward impaired sperm production in the testes.
- Testosterone A low level may mean hormonal treatment is an option.
- LH and prolactin are added if testosterone is low, or if libido is significantly affected.
- TSH covers thyroid function, which can affect the overall hormonal balance.
What Does a Scrotal Ultrasound Add?
A scrotal ultrasound is used to confirm or further assess what the physical examination finds. That may be a suspected varicocele, a structural abnormality, or signs of obstruction that were not clear on exam alone. It can add detail that changes the clinical decision in a fair number of cases. It is also far less invasive than any surgical investigation.
What is Sperm DNA Fragmentation Testing and Who Needs It?
Sperm DNA fragmentation testing measures the degree of DNA damage within sperm. A standard semen analysis does not capture this. It is not a routine first-line test. It is considered in specific situations. These include recurrent miscarriage where the male factor has not been fully evaluated.
They include repeatedly failed IVF cycles with no clear explanation. They also include cases where sperm parameters are normal but fertilisation or embryo development has been poor. It is not recommended as a blanket addition to every workup. The right combination of these tests depends on what is found at each stage. At ojiivf, male fertility testing is part of the same evaluation as the female partner's workup. It is not run as a separate process later on.
