The diagnosis of male infertility would start by a physical exam, during this exam the doctor will look of swelling of the veins that drain the testicle (varicoceles), also other physical problems where the testicles are not in the proper position,this may cause infertility. The hair growth in the genital area will also be assessed,the prostate gland will be examined , you would also be asked to produce semen samples for an analysis, and blood samples to asses the reproductive hormones. Apart from this another series of tests would be conducted after a full analysis is done of the previous medical history and family history.
Male Infertility Test
Semenis usually the first part of the evaluation. The analysis is done at a lab or doctor's clinic, the semen is straight away tested as soon as it is produced. The patient must refrain from ejaculation for the next 48 hours, but not more than that.
The volume of semen is around 2-5 millilitres (one teaspoon), if this is low it could indicate the the semen vesicles are not making enough fluid, or the tubes are blocked, a low volume of semen could be that the prostate gland is not contributing enough fluid to the semen
Sperm Number (Count)
The sperm count normally is around 40 million to 300 million millilitre, if it is below 10 million per millilitre, this is considered poor semen , the sperm count has to be over 20 million , and the shape and movement should be normal.
Motility and Velocity
The motility and velocity of the sperm and the ability to move is rated at a % between 0-100, at least 50% should be active, the quality of the sperm movement in addition would be assessed and reach on a scale of 0-4, if the score is of 2 or4 more it is considered adequate.
This refers to the sperm's ability to move. The percentage of sperm that are active will be rated (from 0% to 100%), with normal considered at least 50% active. In addition, the quality of sperm movement (forward progression) will be assessed and rated on a 0 to 4 scale, with a score of 2 or more considered adequate.
The sperm is considered normal, the shape of the sperm is important, it must have an oval head and a tail, an abnormal sperm will have a tapered head and two tails. The head of the sperm consists of enzymes that break the protective coating of the egg and allow the sperm to penetrate into the egg
To predict the level of sperm fertilization, the sperm is analyzed by some sperm clinics (by the Kruger method of classification ) across the country, which can accurately evaluate the sperm shape or otherwise the WHO reports the percent of normal-shaped sperm as greater than 60%
Other Semen Tests
If fructose is absent ,in the semen it is considered as a congenital absence of the vas deferens or seminal vesicles, an obstruction in the ducts, this is noticed when an semen analysis report is done to detect the presence or the absence of fructose.
The semen, normally forms into a gel, and then about 20 minutes liquefies, if does not happen there could be a problem in the seminal vesicles.
If there are any antibodies that attach itself to the head of the sperm , the sperm would not be able to penetrate through the egg, normally the sperm moves and dumps , antibodies on the tail of the sperm reduce the motility of the sperm
Semen culture test, is taken to check if any bacterial infections, that could lead to infertility.
Cervical Mucus Penetration Test
This test assesses how well the sperm can move through mucus, which is normally present in the woman's cervix. For this test, cervical mucus is simulated with cow mucus.
A blood test is conducted, to evaluate the intensity reproductivee hormones, which include follicle-stimulating hormone (FSH)androgen's's(testosterone),luteinizing hormone(LH),and also prolactin
Genetic evaluation Test is done on the evaluation of the previous family history. If the sperm count is very very low that it could be that you may have a chromosomal abnormality, that affects the ability to produce sperm, this abnormality can be determined through a blood test, that is sent to a lab that will prepare a karyotype to look at the chromosomes.
Other Possible Tests
In certain cases it depends, that your doctor may request you to do other tests which may include:
Ultrasound -a test that uses sound waves to examine structures inside the body
X-ray -a test that uses radiation to take a picture of structures inside the body
Testicular Biopsy -removal of a small sample of testicle tissue for testing
Post-coital Test -if the sperm is compatible to the mucus in your partner's cervix