Male Fertility Testing: What Every Man Should Know

Half the Equation Gets Ignored

When couples struggle to conceive, the woman typically undergoes extensive evaluation first. Blood work, ultrasounds, HSG procedures, cycle tracking — months of testing before anyone suggests checking the man.

This is backwards. Male factor contributes to infertility in approximately 50% of cases. A semen analysis takes one visit and a few days for results. It should be done first — or at minimum, simultaneously with female evaluation.

If you are a man whose partner is struggling to conceive, or if you are planning for the future and want to know where you stand, here is what male fertility testing actually involves.

The Basic Semen Analysis

This is the starting point. You provide a semen sample (typically through masturbation into a sterile cup at a lab or at home with a short transport time). The lab evaluates:

Volume

Normal: 1.5 mL or more per ejaculate.

Low volume can indicate retrograde ejaculation (semen going into the bladder), short abstinence period, or incomplete collection.

Sperm Count (Concentration)

Normal: 15 million sperm per mL or more. Total count should be 39 million or more per ejaculate.

Below this is oligospermia. Severely low counts (less than 5 million/mL) often point to genetic or hormonal causes.

Motility

Normal: 40% or more of sperm should be moving. At least 32% should show progressive motility (actually swimming forward, not just twitching).

Immotile sperm cannot reach the egg. Even with a normal count, poor motility reduces fertility.

Morphology

Normal (strict Kruger criteria): 4% or more normal forms.

This is the most controversial parameter. Even fertile men have 96% abnormal-looking sperm. Morphology below 4% correlates with reduced fertility but is not a death sentence for conception.

Additional Parameters

• pH, liquefaction time, and fructose levels
• White blood cell count (elevated suggests infection)
• Anti-sperm antibodies (if indicated)

Beyond the Basic Analysis

If the initial semen analysis is abnormal, further workup includes:

Hormone Panel

• Total and free testosterone — low levels impair sperm production
• FSH — elevated FSH suggests the testes are failing to produce sperm adequately
• LH — helps differentiate primary from secondary hypogonadism
• Estradiol — excess estrogen suppresses sperm production
• Prolactin — elevated levels can shut down the reproductive axis

Genetic Testing

• Karyotype — Klinefelter syndrome (47,XXY) is the most common genetic cause of male infertility
• Y-chromosome microdeletion — deletions in the AZF regions cause severely low or absent sperm
• CFTR gene — mutations cause congenital absence of the vas deferens

Imaging

• Scrotal ultrasound — evaluates for varicocele (dilated veins), testicular masses, or structural abnormalities
• Transrectal ultrasound — if ejaculatory duct obstruction is suspected

Common Causes of Male Infertility

Varicocele (35-40% of infertile men)

Dilated veins in the scrotum raise testicular temperature, impairing sperm production. Often correctable with surgery or embolization.

Hormonal Imbalance

Low testosterone, elevated estrogen, thyroid disorders, and hyperprolactinemia all reduce sperm production. Many of these are treatable without IVF.

Lifestyle Factors

• Obesity (increases testicular temperature, raises estrogen)
• Smoking (reduces count, motility, and morphology)
• Excessive alcohol
• Anabolic steroid use (shuts down sperm production — sometimes permanently)
• Heat exposure (hot tubs, laptops on lap, tight underwear)
• Certain medications (SSRIs, opioids, testosterone itself)

Prior Conditions

• Undescended testicles (even if corrected in childhood)
• Prior chemotherapy or radiation
• Testicular injury or torsion
• History of STIs (chlamydia, gonorrhea can cause scarring)

The Testosterone Paradox

This trips men up: exogenous testosterone (TRT) makes you infertile, not more fertile. Testosterone replacement therapy signals your brain to stop producing FSH and LH, which means your testes stop making sperm.

If you are on TRT and want to conceive:

• Switch to clomiphene or hCG (which stimulate natural testosterone AND sperm production)
• Stop testosterone injections/gel
• Expect 3-6 months for sperm production to recover (sometimes longer)

If you are considering TRT and want children in the future, discuss fertility preservation first.

When to Get Tested

• After 12 months of unprotected intercourse without conception (6 months if partner is over 35)
• Before starting testosterone therapy
• Before or after varicocele repair (to document improvement)
• If you have risk factors (prior steroid use, cancer treatment, undescended testicles)
• If you want a baseline before actively trying

What Abnormal Results Mean

An abnormal semen analysis does not mean you cannot have children. It means the probability per cycle is reduced. Options range from:

• Lifestyle optimization and repeat testing in 3 months
• Hormone optimization (clomiphene, hCG, anastrozole)
• Varicocele repair
• IUI (intrauterine insemination — helpful for mild male factor)
• IVF/ICSI (for severe male factor — single sperm injected directly into egg)

Even men with very low counts often have viable paths to biological fatherhood.

The Bottom Line

Male fertility testing is simple, inexpensive, and informative. If you are trying to conceive or planning to in the future, knowing your numbers gives you power to act early. If something is off, most causes are correctable — especially when caught before years of frustration.

At Coral, we offer fertility-related hormone panels and can guide you through the evaluation process. [Start your visit](/start) if you want to know where you stand.