Male fertility test

If you are unable to conceive a child after one year of regular unprotected sex, your doctor may ask you to get these tests done. 

Generally, the only sign of infertility is the inability to conceive a child. However, at times, an underlying cause of infertility such as: 

• Abnormal sperm quality or quantity 
• Varicocele (swollen veins in the scrotum which cause poor blood drainage and can affect sperm growth)
• Retrograde ejaculation (semen goes into the bladder and is not ejaculated out)
• Blockages in any part of the reproductive tract due to surgery, infections, developmental defects or swelling
• Hormonal imbalance 
• Chromosomal abnormalities (Sperms have chromosomal material. If there is any problem with regards to structure or number of chromosomes in the sperm, the sperm will not be able to fertilize the egg. This will lead to infertility)

Some of the that may prompt your doctor to ask for a fertility panel test are: 

• Pain, swelling or a lump in testicles (Read more: Testicular pain cause)
• Problems with sexual function, such as difficulty in maintaining an erection, difficulty in ejaculating, ejaculating a lesser than normal volume of semen or decreased libido 
• Inability to smell
• Recurring respiratory infections 
• Abnormal breast growth 
• Decreased facial or body hair
• Decreased sperm count

None of these tests needs special preparation. Discuss all medications you’re taking with your doctor, including vitamins, herbs, supplements, over-the-counter drugs or illicit drugs. Also, let him/her know if you have any health problems.

Testosterone and prolactin levels are usually checked in the morning in fasting state when their levels tend to be the highest. 

For semen analysis, your doctor may ask you to abstain from sex for two to seven days before the test. 

For semen culture, avoid consuming any antibiotics for at least seven to 10 days before the test. Wash your genital area properly with clean water before collecting a semen sample and do not use any antiseptic that could contaminate the sample.

The LH, FSH, prolactin and testosterone levels are checked through a blood test. Blood sample for these test will be collected from a vein in your arm.

There are some minor risks associated with a blood test, such as:

• Bruising
• Bleeding
• Infection
• Feeling lightheaded

For semen analysis and semen culture, a sample of semen is required. The sample can be collected by different methods:

• You can ejaculate into a sterile cup in a private room at the doctor’s office. 
• You can obtain a sample at home by ejaculating into a condom which has no lubricants or additives. You will need to deliver this sample to the laboratory within an hour of ejaculation. 
• Your doctor may fit a vacuum device around your penis. This method increases blood flow to the penis, leading to ejaculation. 
• A vibrator may be used to encourage ejaculation if you have a spinal cord injury. 

For both these tests, more than one sample may be collected in a week or two, as the semen quality can vary. Semen sample collection has no risks.

Normal results:

The test results depend on different factors, such as:

• Age
• Medical history
• Gender 
• The method used for the test

Normal values of these tests are as follows:

• LH: 1.24-7.8 IU/L (international units per litre)
• FSH: 1.4-15.5 IU/mL (international units per millilitre)
• Prolactin: Less than 20 mcg/L (micrograms per litre)
• Testosterone: 280-1100 ng/dL (nanograms per decilitre)
• Semen analysis
  • Volume: 2-5 mL (millilitre)
  • Liquefaction time: 20-30 minutes after collection
  • pH: 7.12-8.00
  • Sperm motility: 60%-80% actively moving
  • Sperm count: 50-200 m/mL (million per millilitre)
  • Sperm morphology: 70%-90% normally shaped
• Semen culture: Normal or negative results indicate that no disease-causing bacteria were found.

Abnormal results:

For semen culture, abnormal results indicate the presence of some disease-causing bacteria. Sensitivity testing may be done to determine which drugs the isolated bacteria are sensitive to.

Results that are not within the normal range may indicate decreased fertility. However, some men with low sperm counts can be fertile, while some with high sperm counts may have decreased fertility. Further tests such as scrotal ultrasound, genetic testing and post-ejaculation urinalysis may be performed to determine the cause for infertility and recommend the appropriate treatment.

Certain factors can affect the test results. Prolactin levels can be elevated due to:

• Liver disease or kidney disease
• Medicines like hypothyroid drugs or psychiatric drugs

Testosterone levels can be affected by:

• The time of the day
• Antifungal drugs like ketoconazole

Results of semen analysis may be affected by:

• Consumption of alcohol, tobacco, caffeine or other recreational drugs
• Prescription medicines like cimetidine
• Herbs like St. John’s wort
• Use of lubricants or condoms containing lubricants

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.