Fertility Tests for Men: Options & How They Work

Fertility Tests for Men: Options & How They Work

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6 mins

It’s a biological fact: it takes two to create a baby.

Trying to conceive can be an exciting time for a couple. But when conception seems to be taking a while, concerns can creep in. Both partners might be asking themselves, Is it me?

Fertility issues affect both sexes, but we often hear more about testing for females. In a 2021 global study, males were found to be solely responsible for 20-30% of infertility cases, and sperm issues are a contributing factor in 50% of cases overall.

If you’re male and your female partner isn’t getting pregnant, what options are available to you to test your fertility?

You can start with an at-home testing kit. They can be 97% accurate at determining whether your sperm are within “normal” ranges or not.

Cindy Golubisky, Clin Ops & Fertility Clinician at Hera Fertility advises men with fertility concerns to “start by scheduling an appointment with a healthcare professional, such as a urologist or reproductive endocrinologist who specializes in fertility issues.”

This might make you feel nervous or anxious, and that’s normal. But take some comfort in this: You’re in good hands. Fertility specialists understand the worries and vulnerabilities that you might be feeling. And their goal is to help get to the bottom of any potential issue.

Medical evaluation

So what does a medical exam involve? Typically there will be a physical exam and questions about your health and lifestyle. You can expect to be asked about your medical history, which medications you take, your diet and exercise habits, stress levels, and whether or not you smoke, drink alcohol, or use recreational drugs. There will also be questions about your sex life and any sexually-transmitted diseases.

It’s important to be “open and honest” with your responses, Golubisky explains. This step is all about gathering enough information to get a clear picture on where any issues might lie.

Semen analysis

Yes, semen analysis definitely requires a sperm sample. Providing one can feel a bit embarrassing or awkward, but rest assured: It’s a normal, everyday process for the clinic staff, and they will help you feel as comfortable as possible.

To ensure the best quality sample, you might be asked to refrain from intercourse or masturbation for a few days prior to your testing day.

Semen analysis checks for sperm count, concentration, shape, vitality and movement, as well as semen volume and any signs of infection. Issues with semen can also be a result of physical factors such as a blockage between the testicles and penis, missing vas deferens (the sperm “pipeline”) and complications from an earlier surgery.

Blood test

If you have a low sperm count, reduced sex drive, erectile dysfunction, hair loss, fatigue, depression or unexplained weight gain, your doctor might request blood tests to investigate further.

These typically check your hormone levels, such as:

  • Testosterone (the main male sex hormone)
  • TSH: Thyroid stimulating hormone (impacts metabolism)
  • PR: Prolactin (can cause lower sex drive or erectile dysfunction)
  • FSH: Follicle-stimulating hormone (controls sperm production)
  • LH: Luteinizing hormone (stimulates testosterone production by the testes)
  • E2: Estradiol/Estrogen (can cause ED and other issues)

However, blood tests are also used to check markers for other health indicators like HBA1C (used to diagnose Type 2 Diabetes), red blood cells and other factors.

Whether or not there’s been an abnormal semen analysis, urologists say that “all men can benefit from checking for subclinical testosterone deficiency,” Golubisky explains, adding that some evidence suggests that up to 15% of those tested show low testosterone. Early screening increases awareness and best chances for future fertility.

Beyond these primary tests, there are other options available to evaluate your fertility.

Post-ejaculation urinalysis

This is a urine test performed after ejaculation. If sperm appears in the urine, retrograde ejaculation (when semen flows backward into the bladder instead of the urethra) is suspected.

Anti-sperm antibodies testing

This is a semen test that looks for specific proteins (antibodies) that produce an immune response against sperm in vaginal fluids, blood, and even semen.


A scrotal and transrectal ultrasound can detect abnormalities in testicles, blood vessels and structures inside the scrotum.

Genetic testing

This semen test is used to evaluate sperm DNA. It is used to check for karyotypic abnormality, Y chromosome microdeletion and other genetic causes of azoospermia (no sperm to ejaculate) and severe oligozoospermia (low sperm count). A reproductive urologist can also use sperm DNA fragmentation testing to get a closer look at sperm quality.

Testicular biopsy

When the causes for infertility are unexplained — known as idiopathic infertility — a biopsy on one of the testicals might help to determine the cause. This surgical procedure is typically considered an end-of-the-line option.

By taking proactive steps to undergo fertility testing and seeking appropriate medical guidance, “you can gain valuable insights into your reproductive health,” Golubisky says.

Along the way, have open communication with your partner and lean on each other for support. Fertility is a journey, and you’re in it together.

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