Fertility Testing
Testing for Men
Sperm abnormalities (male factors) contribute to approximately 40 percent of all infertility cases. In 20% of couples, the only identifiable factor is a sperm abnormality. In most cases, the question in not whether men have sperm or not, rather it is a question of how much sperm, the quality of the sperm and the motility.
Erectile dysfunction, ejaculatory dysfunction, anti-sperm antibodies, infection, and anatomic issues can also play a negative role in fertility.
The centerpiece of testing for men is a comprehensive semen analysis, with strict (Kruger) morphology. A semen analysis evaluates multiple characteristics of the sperm including the volume, the sperm concentration, motility and shape (morphology) of the sperm. Each of these characteristics can have dramatic effects on fertility.
Assuming a normal volume, the parameter which best predicts fertility is the shape of the sperm. The old standard still performed by most labs (without assessing strict morphology) is not adequate for assessing sperm quality. If you (or your partner) have had a semen analysis done using prior criteria (WHO III criteria, without strict morphology assessment), and the testing was normal, we would strongly recommend repeating a formal assessment.
How a semen analysis is performed:
- The man will need to schedule the semen analysis ahead of time.
- The man should not have an ejaculation for 2-5 days prior to the semen analysis. The sample is collected by masturbation without the use of lubricants, especially water-based lubricants.
- Ideally, the sample is collected at our facility; however, it can be collected at home if it is delivered to our office within 45 minutes of collection.
- Once delivered to the lab, the sperm will be processed and assessed for volume, concentration, motility, shape and other parameters.
- We will generate a report offering specific recommendations, as needed.
Parameter |
Normal Range |
Possible Identifiable Causes of Abnormality |
Volume |
2-5 milliliters |
Hypothalamic, pituitary or testicular disorders, ejaculatory disorders or obstruction or poor collection technique. |
Concentration |
>20 million per milliliter |
Heat (varicocele), nutritional deficiency, genetic abnormality, history of undescended testicle absence of Sertoli or germ cells, malfunction of Leydig cells, anabolic steroid abuse, endocrine disorders, history of radiation or chemotherapy. |
Motility |
>50% |
Heat (varicocele), nutritional deficiency, antisperm antibodies, prolonged abstinence. |
Normal shape (morphology) |
14% with strict morphology is normal fertile range; however 9% or greater is essentially indistinguishable from normal. Men with less than 5% normal forms are more likely to require IVF/ICSI. |
Heat (varicocele), nutritional deficiency, infections, history of undescended testicle. |
White blood cells |
<10 per high power field |
Prostatitis, prior surgery |
Total motile count |
> 10 million |
Any of the above, plus obstruction or retrograde ejaculation |
What if the semen analysis is abnormal?
Sperm parameters may vary significantly day to day, therefore prior to making recommendations, we would advise repeating any analysis with significant abnormalities approximately 4 weeks after the initial test.
If confirmed on repeat assessment, fertility treatment will be individualized based on the severity of the problem, the reversibility of the underlying cause, and the wishes of the couple. Depending on the severity of the abnormality, a urologic evaluation may be indicated. In cases of very low sperm counts (oligospermia) or a complete absence of sperm (azoospermia) a man will be offered hormonal and genetic evaluation prior to referral to the urologist.