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.

This Secret Muscle in Your Penis Makes You Seem Smaller Than You Are

This Secret Muscle in Your Penis Makes You Seem Smaller Than You Are

And more eye-opening insights from a leading urologist’s new book.

By Piet Hoebeke
Nov 18, 2020

This article is a repost which originally appeared on Men’s Health

Edited for content

The following is an excerpt from Members Club: A User’s Guide to the Penis, a new book by urologist Piet Hoebeke, M.D., Ph.D.

Funnily enough, the average penis in humans is far longer than strictly necessary. Gorillas and chimpanzees do it with a lot less and they still manage to fertilize their females. When erect, a grown gorilla has a penis length of four centimeters, and a chimpanzee erection measures eight centimeters. With an average length of over 13 centimeters, humans outshine their close relatives.

What do we have to thank for the over-proportional size? Usually, natural selection does away with characteristics that don’t serve a function–for example, the body hair that humans for the most part have lost. Things that aren’t needed are done away with, because making excess tissue wastes energy.

So why does man have such a long penis?

The answer is because, alongside natural selection, there is another mechanism at play: sexual selection. Natural selection ensures that a species adapts optimally to its environment, sexual selection supplies the characteristics to give a species the greatest chance of mating. Therefore, sexual selection exaggerates some characteristics without natural selection undoing them. Think of the long, colorful tails of birds of paradise or peacocks. For one reason or another, female birds like a long tail, so a male with a long tail has more chance of reproducing, even if such an impractical attachment increases the risk of him being caught by a predator.

In the animal kingdom, we see an endless range of tactics for attracting potential partners. The huge chest muscles of male gorillas are another example. The male gorilla has an imposing presence, even though he only has a small penis. Homo sapiens generally flaunt a smaller muscular structure, but they have the largest penis of all primates, in terms of both proportion to body height and absolute length. This points to sexual selection.

Exactly how this came about in evolution, we don’t know. There were no scientists around at the time observing primitive humans. We suspect the civilization process played a role in it. For a long time, man was a predator; a hunter-gatherer searching for food in the wild. Physical fitness was necessary to survive. At a certain time–or, even, over a period of time–humans became farmers. We took nature into our own hands and brute strength slowly lost importance. With farming, it wasn’t about who could run fastest or jump furthest; it was who could produce the most from his land. The physical characteristics needed to impress females became less prominent. Perhaps that is why, as compensation, the penis grew bigger.

Coitus was a brief affair in primitive humans. There was no foreplay: humans lived in a threatening environment and men were well aware that others could be close by on the look-out for a woman who was ready for sex. The faster they could deposit their sperm, the better. And how did women know that a man was ready for sex? Attraction is a game of smell, pheromones, blushing cheeks and deep breathing, but the most important sign of arousal is the erection. Because sex had to take place so quickly, a large penis facilitated a quick selection.

Over time, humans started wearing clothes and that created a nice paradox: the very fact that humans were covering up their body made the penis more prominent. For that we have a muscle to thank that has since lost its function.

Most mammals have a layer of muscle under the skin. Horses, for example, can use it to twitch their skin to get rid of flies. Primitive humans could do that too. Now we only have the remains of such a muscle in the human body, for example in the groin, where we have the fascia of Scarpa. We also still have one of these superficial muscles in the neck, a small muscle in the hand, and a muscle in the skin of the scrotum and penis: the dartos muscle.

Most people with a penis have no idea that there is a muscle around their sex organ, because you can only see it if you look at the penis skin under a microscope. Men don’t walk around displaying biceps in their penis, and the dartos muscle doesn’t let you twitch your penis, either. So what does it do?

Not a single male mammal walks around waving its penis, apart from when a male feels a great desire to mate. In most mammals, the dartos muscle neatly tucks the flaccid penis inside the body. When Homo sapiens walked around naked, their penis was also hidden from view. When you’re climbing over sharp rocks or running through thorny bushes, you want to keep your genitalia as close as possible to the body. Only with sexual arousal did the dartos muscle relax and the penis come out.

The muscle also runs as far as the skin of the scrotum, where it helps with the temperature regulation of the testicles. Each testicle is connected to a vas deferens which is also surrounded by a muscle. When the testicles get too warm, the vasa deferentia let the testicles hang down; if it suddenly gets cold, they tuck the testicles in. At the same time, the dartos muscle contracts the skin of the scrotum. That’s why your penis looks small if you swim in cold water.

As people started to wear clothes, the purpose of this muscle diminished. Clothing took on its protective role, and men with a strong dartos muscle no longer had an evolutionary advantage from this. Natural selection did its work, but a redundant body part doesn’t disappear in 20 or even 100 generations. In 10,000 years there have been around 330 generations, but the dartos muscle is still there.

It’ll keep the penis company for a while longer, but it just does less than before. The penis and scrotum are no longer drastically drawn inside the body of modern man; at most they shrivel up a little.

Some men might be sorry that the dartos muscle is an involuntary muscle, over which they have no control. I can imagine that some would jump at the chance to make their penis look longer in a communal changing room. But, alas, the dartos muscle only relaxes at higher temperatures or in the case of moderate arousal. In the case of strong sexual arousal, the dartos muscle contracts again, to prepare for ejaculation.

An erect penis doesn’t decrease in size because of this, but the testicles are pressed closer to the body. Two penises can be exactly the same length when erect, but the man with an active dartos muscle will appear to have the smallest penis when flaccid. He might think to himself about the other man: Blimey, he’s well hung! But what he could perhaps think is: Poor thing, he’s got a bit of a lazy dartos muscle there!

Therein lies the second paradox that burdens the male member. As I mentioned earlier, compared to other animals, men have an oversized penis. Because it also hangs outside the body, it catches the eye even more. So what do men do? They compare. And then all too quickly they come to the conclusion: Oh no, mine is too small.

Funnily enough, many men–and women–don’t even know how long the average penis is.