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Fertility Tests for Men: Options and How They Work

All About Male Fertility Testing

Medically reviewed by Carolyn Kay, M.D. — Written by Rhona Lewis on November 30, 2020

This article is a repost which originally appeared on Healthline

Edited for content

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.

Factors that can affect male fertility

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

Can you just use a home fertility test kit and call it a day?

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.

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.

What to expect at an initial medical evaluation appointment

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:

  • Which medications do you take?
  • Have you had any sexually transmitted infections?
  • Have you had past surgeries?

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:

  • erectile dysfunction (ED)
  • delayed ejaculation
  • retrograde ejaculation

Semen Analysis

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.

Urinalysis

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.

Hormone testing

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.

FSH

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.

LH

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.

Testosterone

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.

Imaging to check for anatomical issues and any obstructions

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.

Anti-sperm antibodies testing

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.

Testicular biopsy

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.

Genetic testing

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 everything checks out A-OK for you and your partner

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.

The bottom line

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.

Men’s Health Month – Testicular health

Men’s Health Month – Testicular health

Leigh Day

This article is a repost which originally appeared on LEXOLOGY

Edited for content

United Kingdom November 23 2020

We have reached the end of Men’s Health Awareness Month and we are now heading towards our first Coronavirus Christmas. My November has been spent in lockdown, glued to the US election whilst growing a tashe for Movember, a month-long charity event set up to highlight and fundraise for men’s health causes that include mental health, suicide prevention, prostate cancer and testicular cancer.

Did you know that in the UK, men visit their GP on average half as many times as women? On top of this worrying statistic is the fact that we are currently stuck in a global pandemic that has no end in sight. In April 2020, NHS England found that four out of 10 people were not seeking help from their GP because they were afraid of being a burden during a pandemic.

Being a burden should never be a consideration for not visiting your GP if you are worried about your health, regardless of how big or small you perceive the problem to be. The sooner a problem is shared, the quicker it can be solved.

One area that is important for men not to ignore is testicular health. Testicles are responsible for the production of sperm and also testosterone so it is vital we look after them.

Problems with your testicles can start when you develop a lump or a swelling. Whilst both these are not usually caused by anything serious, you should always speak with a doctor and get them checked.

The longer a problem with your testicles is left untreated, the worse it can get. With some testicular problems, time is very much of the essence and if you don’t act fast, there can be serious consequences.

In my role as a healthcare solicitor at Leigh Day, I have come across three different types of testicular problems where early discovery and diagnosis is vital to having the best long-term outcome. It is important that we all know the early signs of these problems, so that we seek GP advice if we are worried.

Testicular Cancer

Testicular cancer is where a tumour forms on or inside one of the testicles. Typical symptoms of testicular cancer include:

  • A painless swelling or lump in one of the testicles,
  • A change in shape, texture, firmness or appearance of a testicle,
  • A dull intermittent ache or pain or the feeling of heaviness in the scrotum.

Testicular cancer is the most commonly diagnosed cancer of men between the ages of 15 and 49 years old in the UK. It is also one of the most treatable types of cancer and it has a survival rate of above 95 per cent. However, if undiagnosed, the cancer can spread further than your testicles and become far more complicated to treat.

Testicular Torsion

Testicular torsion is when the testicle twists around the spermatic cord. When this happens, it cuts off the blood flow to the testicle. Symptoms of a testicular torsion include:

  • A sudden, severe pain on one side of the scrotum,
  • Swelling of the scrotum,
  • Abdominal pain,
  • Nausea and vomiting,
  • A testicle that’s positioned higher than normal or at an unusual angle,
  • Frequent urination,
  • Fever

A testicular torsion can happen at any time – during exercise, sitting, standing or even sleeping. It is a medical emergency and should be treated within four to six hours of the onset of pain. If the blood supply is not restored quickly, it will cause the testicle to shrink and die.

Testicular Infection

Epididymitis is a testicular infection where the tube at the back of the testicle becomes painful and swollen. Symptoms of epididymitis include:

  • A sudden or gradual pain in one or both testicles,
  • The scrotum feeling warm, tender and swollen,
  • A build-up of fluid around the testicle that feels like a lump or swelling

Whilst epididymitis can be treated easily with antibiotics, if it is ignored it can spread to the testicle and can lead to chronic testicular pain, the growth of an abscess, infertility and the loss of your testicle.

Examining yourself

It is important to examine your testicles once a month to check for any changes, swellings or lumps. The best time to do this is after you have taken a bath or shower by resting your testicles in the palm of your hand, and gently rolling each one between a finger and your thumb. For further information on examining yourself, please visit the Movember “guide to checking your nuts”. (https://www.bismillahrestaurant.com/)

If you find something strange, are experiencing swelling or sudden and unexplained pain in one or both of your testicles, don’t stew over whether it’s serious or not – get checked out by a doctor. The earlier a problem is diagnosed, the better the chance of successful treatment will be.

Conclusion

I understand that for some men, the idea of sitting and talking with a doctor about your testicles can be embarrassing, worrying or stressful. I also appreciate that whilst we are in a middle of a global pandemic, people want to avoid visiting the doctor. However, if there is a problem or you are worried about your testicles, go see a doctor and tell them what is worrying you.

The earlier the problem is diagnosed, the sooner treatment can be given and the better your chances will be of a full recovery will be.

Testes: Anatomy and Function, Diagram, Conditions, and Health Tips

Testes: Anatomy and Function, Diagram, Conditions, and Health Tips

Medically reviewed by Alana Biggers, MD on May 29, 2018 — Written by Tim Jewell

This article is a repost which originally appeared on HealthLine

Edited for content

What are testes?

The testes — also called testicles — are two oval-shaped organs in the male reproductive system. They’re contained in a sac of skin called the scrotum. The scrotum hangs outside the body in the front of the pelvic region near the upper thighs.

Structures within the testes are important for the production and storage of sperm until they’re mature enough for ejaculation. The testes also produce a hormone called testosterone. This hormone is responsible for sex drive, fertility, and the development of muscle and bone mass.

Anatomy and function of testes

The main function of the testes is producing and storing sperm. They’re also crucial for creating testosterone and other male hormones called androgens.

Testes get their ovular shape from tissues known as lobules. Lobules are made up of coiled tubes surrounded by dense connective tissues.

Seminiferous tubules

Seminiferous tubules are coiled tubes that make up most of each testis. The cells and tissues in the tubules are responsible for spermatogenesis, which is the process of creating sperm.

These tubules are lined with a layer of tissue called the epithelium. This layer is made up of Sertoli cells that aid in the production of hormones that generate sperm. Among the Sertoli cells are spermatogenic cells that divide and become spermatozoa, or sperm cells.

The tissues next to the tubules are called Leydig cells. These cells produce male hormones, such as testosterone and other androgens.

Rete testis

After sperm is created in the seminiferous tubules, sperm cells travel toward the epididymis through the rete testis. The rete testis helps to mix sperm cells around in the fluid secreted by Sertoli cells. The body reabsorbs this fluid as sperm cells travel from the seminiferous tubules to the epididymis.

Before sperm can get to the epididymis, they can’t move. Millions of tiny projections in the rete testis, known as microvilli, help move sperm along to the efferent tubules.

Efferent ducts

The efferent ducts are a series of tubes that join the rete testis to the epididymis. The epididymis stores sperm cells until they’re mature and ready for ejaculation.

These ducts are lined with hair-like projections called cilia. Along with a layer of smooth muscle, cilia help move the sperm into the epididymis.

The efferent ducts also absorb most of the fluid that helps to move sperm cells. This results in a higher concentration of sperm in ejaculate fluid.

Tunica: Vasculosa, albuginea, and vaginalis

The testes are surrounded by several layers of tissue. They are the:

  • tunica vasculosa
  • tunica albuginea
  • tunica vaginalis

Tunica vasculosa is the first thin layer of blood vessels. This layer shields the tubular interior of each testicle from further layers of tissue around the outer testicle.

The next layer is called the tunica albuginea. It’s a thick, protective layer made of densely packed fibers that further protect the testes.

The outermost layers of tissue are called the tunica vaginalis. The tunica vaginalis consists of three layers:

  • Visceral layer. This layer surrounds the tunica albuginea that shields the seminiferous tubules.
  • Cavum vaginale. This layer is an empty space between the visceral layer and the outermost layer of the tunica vaginalis.
  • Parietal layer. This layer is the outermost protective layer that surrounds almost the entire testicular structure.

What conditions affect the testes?

Many conditions can affect the testes. Here’s a list of some of the most common ones.

Hydrocele

A hydrocele happens when excess fluid builds up in the cavities around one of your testicles. This is sometimes present at birth, but it can also result from an injury or inflammation.

Hydrocele symptoms include:

  • testicular swelling that gets more noticeable as the day goes on
  • a dull ache in your scrotum
  • feeling heaviness in your scrotum

Hydroceles usually don’t require treatment unless they’re very large or painful. Most go away on their own, but more severe cases might require surgical removal.

Testicular torsion

Testicular torsion means that your testicle has rotated in the scrotum. This can wind up the spermatic cord, cutting off blood supply, nerve function, and sperm transport to your scrotum.

Symptoms of testicular torsion include:

  • severe scrotum pain
  • swelling of the testicle
  • lower abdominal pain
  • feeling nauseous
  • vomiting
  • feeling like the testicle is out of place
  • urinating more than usual

Several things can cause testicular torsion, including:

  • injury to the scrotum
  • exercising too long or hard
  • being exposed to cold temperatures
  • free movement of the testicle in the scrotum caused by a genetic condition

Your doctor can treat testicular torsion by moving the testicle by hand. Some cases might require surgery to untwist the spermatic cord.

Orchitis

Orchitis refers to a swollen or inflamed testicle. Like epididymitis, orchitis often results from an infection caused by an STI.

Orchitis symptoms include:

  • testicular pain and tenderness
  • a swollen testicle
  • fever
  • feeling nauseous
  • vomiting

Both bacterial and viral infections can cause orchitis. A combination of antibiotics or antiviral medication, along with nonsteroidal anti-inflammatory drugs or cold packs can help reduce discomfort and pain. Orchitis usually disappears in 7-10 days.

Hypogonadism

Hypogonadism happens when your body doesn’t make enough testosterone. It can result from a testicular issue or because your brain doesn’t properly stimulate hormone production.

You can be born with this condition. It can also happen due to an injury, infection, or other condition that affects testosterone production.

Symptoms of hypogonadism vary depending on age:

  • In infants. The genitals might not be clearly male, or both sets of genitals might be present.
  • In teenagers. Symptoms may include:
    • a lack of muscle development
    • little body hair growth
    • no voice deepening
    • unusual arm and leg growth relative to the rest of the body
  • In adults. Symptoms may include:
    • a lack of fertility
    • loss of body hair
    • growth of breast tissue
    • loss of bone density
    • an inability to get an erection

Hypogonadism is usually treated with hormone replacement therapy. It’s aimed at either the brain or testes, depending on the source of low testosterone production.

Testicular cancer

Testicular cancer happens when cancerous cells multiply within the tissue of your testicles. It commonly starts in the tubular testicle structures that help produce sperm.

The cause of testicular cancer isn’t always clear.

Symptoms of testicular cancer can include:

  • a lump in your testicle
  • feeling heaviness in your scrotum
  • fluids in your scrotum
  • testicular pain
  • abdominal or back pain
  • swollen or tender breast tissue

Sometimes, your doctor can surgically remove the affected tissue. In other cases, you may need to have an entire testicle removed. Radiation therapy or chemotherapy can also help destroy cancer cells.

What are common symptoms of a testicular condition?

See your doctor if you notice any of the following symptoms in one or both of your testes:

  • long-term pain that’s either dull or sharp
  • swelling
  • tenderness
  • a sensation of heaviness

Other symptoms of a problem with the testes include:

  • feeling sick
  • throwing up
  • abnormal abdominal or back pain
  • having to pee frequently
  • abnormal growth of breast tissue

Tips for healthy testes

Try the following to keep your scrotum in good health:

Do a monthly testicular self-exam

Roll each testicle around in your scrotum using your fingers. Check for lumps and swollen or tender areas.

Bathe regularly

Take a shower or bath every day to keep your entire genital area clean. This reduces your risk of infections that can cause other complications. Keep your penis and scrotal area dry after bathing. Moisture trapped in the area can quickly become a breeding ground for bacteria.

Wear loose, comfortable clothing

Try to avoid wearing tight underwear and pants. Allow your scrotum to hang naturally from your body to help keep the scrotal temperature low and prevent injury.

Wear protection when you have sex

Wear a condom when doing any kind of sexual activity involving your penis. This helps to prevent sexually transmitted diseases that affect your scrotum and testicles.

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