Approximately one in every 25 men is infertile. Low sperm counts or poor semen quality account for about 90 percent of cases. Treating male infertility begins with testing.
At first the doctor sees both partners together. They will be asked about their practices in sexual intercourse, how they time sexual intercourse in relation to ovulation, and whether they use lubricants and detergents with spermicidal effects.
Next, the doctor sees the partners individually. The man will be asked about mumps and testicular injury during childhood and adolescence. He will be asked about anosmia (lack of a sense of smell), galactorrhea (production of breast milk), visual changes, and any recent sudden loss of interest in sex to rule out a pituitary tumor.
The doctor will consider any history of sexually transmitted diseases, exposure to the chemical DES, diabetes, liver disease, kidney disease, testicular cancer, and hemochromatosis, the iron overload disease that can cause a buildup of estrogen levels.
Then the doctor will rule out infertility that may be caused by prescription medication.
Also considered will be exposure to certain chemicals that imitate estrogen, such as pesticides, lead, and plasticizers.
The doctor will palpate the testicles to test their consistency and to feel cysts and tumors. The testicles will be measured. The doctor will feel the canal leading from the testes to the prostate gland, to make sure it is not obstructed by swelling or scar tissue. The size and curvature of the penis will be evaluated to make sure the man can deposit semen where needed in the uterus. It will also be necessary to test the man's sperm.
The man masturbates into a cup, and the semen is analyzed for volume, semen quality, sperm density, and sperm motility. The sample is also tested to make a majority of the sperm are fully formed, with head and tail, capable of swimming through the cervical mucus into the uterus to fertilize the egg.
The semen is analyzed for antibodies, signs that the man's immune system is attacking his sperm. And there will be measurements of most of a variety of hormones and possibly ultrasound imaging of the testes and epididymis, the tube that conducts sperm into the prostate to be mixed with semen. Low semen volume may indicate retrograde ejaculation, flow of semen back into the prostate.
Semen that does not liquify may indicate hormonal imbalance. Low sperm density may indicate a hormonal imbalance or a physical obstruction, or antibodies destroying sperm as it is created. And low sperm motility may also indicate a problem with errant antibodies created by the man's immune system. When there are few or no sperm, the doctor may perform a needle biopsy to assess the condition of tissue within the testicles.
There are literally thousands of male infertility tests. Conducted over a period of a few days to a few weeks, they give the doctor a starting point for correcting male infertility for couples trying to conceive.