Male Infertility – Diagnosis

Diagnosing Male Infertility

Couples who are facing infertility and trouble conceiving a child naturally are often directed to have the female tested for fertility problems. However, male factor infertility alone accounts for 20 to 30 percent of all cases. A simple semen analysis is most often the initial step in the workup of the infertile couple.  Due to the simple nature of the examination and testing it is recommended that the male partner be evaluated for infertility issues first.   

All men with a low sperm count should be evaluated by a male infertility specialist like Dr. Fenig, since in 6% of men previously undiscovered urologic problems are discovered*. When it comes to treating infertility and helping couples conceive a child, Dr. Fenig understands how emotional the diagnostic process can be and aims to make the evaluation, and subsequent treatment, as straight forward and as successful as possible.

Steps for Diagnosing Male Infertility

  • Comprehensive physical examination: Dr. Fenig will take your medical and family history, assess hormones in the blood, and obtain a semen analysis.
  • Physical examination: This will focus on the penis, size of the testes, presence of an obstruction of the vas deferens (the ducts that carry sperm) or epididymis, and detection of a varicocele, abnormally enlarged veins in the scrotum that may impair sperm production or quality. 

Several laboratory tests may also be ordered including:

Semen analysis

Semen is the fluid that is released in a man’s ejaculate.  Semen carries the sperm in fluids that should nourish and protect it. The semen analysis provides pertinent information about the quantity and quality of both semen and the sperm it contains.

Blood Tests

A blood test is used to measure hormone levels and evaluate for underlying health conditions that can interfere with fertility.  Important hormones such as testosterone control sperm production, as well as libido and your ability to perform sexually. The two most important hormones for reproduction are follicle stimulating hormone (FSH) and testosterone (T). Other hormone levels might also be checked, including luteinizing hormone (LH), estradiol, and prolactin.

Genetic Screening 

When patients have severe oligospermia, defined as sperm counts less than 5 million/mL, Dr. Fenig may order genetic screening.


Dr. Fenig will test your urine for infection. This test can also tell if there are any sperm in the urine. Some men suffer from what is called retrograde ejaculation, in which semen that is normally expelled through the urethra is instead diverted into the bladder. This can occur when there is a blockage in the urethra, from diabetes, or other hormonal and neurologic conditions. 

Testicular Mapping/Testis Biopsy

The testes produce the male hormone testosterone as well as sperm. Sometimes a diagnostic testis biopsy is performed if the cause of azoospermia is unclear, in order to determine whether the problem is one of production or obstruction. Testis mapping is performed in patients with non-obstructive azoospermia in order to find viable sperm.  If sperm are found they may often be frozen (cryopreserved) for future use in IVF.  


*[Kolettis J Urol 2001].