What Is a Male Fertility Assessment?

Infertility, or the ability to conceive after one year of regular, unprotected intercourse, is an issue that affects all people, despite misconceptions that prevail.

And while there are many factors involving the female reproductive system that could lead to pregnancy challenges, it is important to note that male infertility is a factor in 40-50% of all couples who are having trouble conceiving.

“We recommend male [fertility] assessment if a couple has been trying to get pregnant for a year,” says Jennifer Knudtson, MD, an OB/GYN and reproductive endocrinologist with Aspire
Fertility in San Antonio, Texas. “With older couples, that might be earlier, like at six months.”

And if you have any health conditions like diabetes or other autoimmune conditions, it might be worth getting evaluated even sooner, says Susan Hudson, MD, a reproductive endocrinologist
with the Texas Fertility Center. Research shows that diabetes can affect sperm quality, which could make it harder to conceive.

Additionally, if you have a history of anything that could affect your testes or sperm production,
which might include a history of cancer treatments like chemotherapy or radiation, testicular surgery, or a past incidence of testicular torsion, that might also warrant a fertility assessment sooner rather than later.

“We’d rather know than assume everything is normal,” says Dr. Hudson.

What Happens at a Male Fertility Assessment?

An initial male fertility assessment typically includes three main parts: a comprehensive medical history report, a physical examination that focuses on the male genitalia, and a semen analysis.

During your medical history report, your healthcare provider will assess you for any conditions that might affect your fertility, as well any behaviors that could have an impact, too. For example, a history of testosterone use is relevant information. “It can actually decrease a man’s sperm production, and sometimes can be permanent,” says Dr. Hudson.

What Is a Semen Analysis?

The semen analysis is the key part of the male fertility work-up. In fact, if you and your partner are just starting down the road to conception, your healthcare provider might suggest beginning with a semen analysis and then going from there, depending on the results. Once you have that information, you can ask about your options and undergo any additional testing, if necessary.

As you may expect, a semen analysis requires that a patient ejaculate into a cup or other vessel. The sample will be collected and analyzed for several things, including volume of semen, sperm count, the movement of the sperm (motility), the size and shape of the sperm (morphology), the pH level of the semen, and the viability of the sperm—that is, the percentage of live sperm present.

According to standard values for semen characteristics, here’s what you’d want to see, on average, in a 2 mL sample of semen:

• 15 million or more sperm per mL of semen
• Total of at least 39 million sperm
• 40% or more progressive motility
• 4% or more normal forms, or normal shape and size
• 58% or more live spermatozoa, meaning that at least 58% of the sperm in the sample are alive
• pH level of 7.0 to 8.0

It's important to note that if your numbers fall below those levels, it doesn’t necessarily mean that you are infertile. "A semen analysis is a spot-check in time," says Dr. Hudson, noting that major decisions are typically not made based on a single analysis.

Some professionals recommend two semen analyses. In that case, your healthcare provider might suggest an additional workup, after which you can discuss treatment options. But experts don’t want you to panic if you receive abnormal results on these tests. “There is still a lot of hope,” says Dr. Knudtson.

Other Factors in a Male Fertility Assessment

The results of your semen analysis may spur your healthcare provider to recommend additional testing. For example, an infection could be the culprit for a less-than-ideal result, or there could be a hormonal imbalance at the root of the problem.

Other issues that could be affecting your fertility may include:

• Medications that impact your ability to ejaculate
• Varicoceles, or swelling in the veins of the testicles
• Cancer or non-malignant tumors
• Undescended testicles
• Injuries to the tubes that carry sperm

Once you know what you’re dealing with, you can decide whether you want to proceed with treatment. For example, your healthcare provider might do a physical exam or a scrotal ultrasound to determine that you have varicoceles in your scrotum, resulting in decreased sperm production. This is a fairly common phenomenon that affects about 15 in 100 men. From there, you can consider if you want to undergo a surgical procedure to fix it.

Genetic Testing for Male Fertility

Not every person with infertility issues will need a genetic work-up. For example, if you know you have a history of exposure to gonadotoxic chemo drugs—that, is cancer drugs or treatment that might have damaged your sperm-producing abilities—you might not need to get any genetic testing. Same goes for someone with a history of injury to the testicles.

But if your healthcare provider suggests that genetic testing might be a good idea, there are a few different options that might be offered to you.

Carrier Screening

Carrier screening is often offered to people of any sex before trying to conceive a baby. You may not even know that you’re a carrier for a particular genetic disease, but this kind of test can uncover if you carry a gene with a condition that you might pass down to your biological offspring.

Chromosome Analysis

A karyotype test is one type of chromosome analysis that you might be interested in getting. It analyzes the number and structure of your chromosomes to alert you if something’s out of whack that could be affecting your fertility or your health.

Y Chromosome Microdeletion Analysis

This genetic test is designed to find tiny missing parts of the Y chromosome that might be wreaking
havoc on your sperm production.

A Word From Verywell

Just because you decide to undergo a male fertility assessment doesn’t mean you’re committing
to any kind of treatment. It’s just about acquiring some information that can guide you in considering the available options, and making the decision that’s right for you.

“It helps [patients] choose a part of fertility treatment that’s going to be right for that individual
or couple,” says Dr. Hudson.

Knowing the various choices available to you may be reassuring, especially if you want to keep your options open for conceiving in the future.