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What is a Male Fertility Test? 

Male infertility is any condition due to which a man is unable to get a woman pregnant. It may occur due to issues in the production or delivery of male reproductive cells called sperms.

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Sperms are produced in the testes, which are located in the scrotum (a sac behind the penis). The sperm are then transported through delicate tubes until they mix with fluids to form semen and are ejaculated out of the penis. All of these functions are controlled by hormones. 

If the semen is ejaculated into the female reproductive tract and a sperm fuses with an egg (fertilisation), pregnancy can occur. However, fertilisation depends on factors such as genetics, environment and hormones.

A male fertility panel is a set of tests performed to detect the cause of infertility in men. It includes semen analysis along with blood tests to measure the levels of hormones, such as:

  • Luteinising hormone (LH): The pituitary gland in the brain produces LH. LH makes the testes produce testosterone.
  • Follicle-stimulating hormone (FSH): FSH is produced by the pituitary gland. It makes the testes produce sperms.
  • Prolactin: The pituitary gland also produces prolactin. Excessive prolactin can decrease the production of testosterone.
  • Testosterone: Testosterone is secreted by the testes. It is a male sex hormone that is responsible for the development of masculine features. Testosterone also helps in the growth of the penis, testes, muscles and hair during puberty. In adults, testosterone aids in sperm production and boosts libido. Men with low testosterone can have problems with fertility. (Read more: Natural remedies to boost testosterone)
  • Semen analysis: Semen analysis is a group of tests performed to assess the health of the sperm and semen. The tests determine the volume and pH (acidity) of semen, the sperm count, sperm motility, sperm morphology (shape and size) and the liquefaction time (time taken for the semen to change from a gel-like substance to a liquid). The quantity and quality of sperm are important factors for fertility. Results of this test can determine the treatment of infertility. 
  • Culture sensitivity: This test checks for the presence of bacteria in the semen, which may cause or indicate an infection in the genitals that, in turn, could result in infertility. If the semen sample tests positive for bacteria, further testing is performed to determine the type of bacteria and its sensitivity (which antibiotic can kill the bacteria).
  1. Why is a Male Fertility test performed?
  2. How do you prepare for a Male Fertility Test?
  3. How is a Male Fertility test performed?
  4. Male Fertility test results and normal values

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
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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:

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:

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.

References

  1. Urology Care Foundation. American Urological Association [internet]. Maryland. U.S.; What is Male Infertility?
  2. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; Luteinizing Hormone (Blood)
  3. You and your Hormones [internet]. Society for Endocrinology. Bristol. U.K.; Prolactin
  4. Stanford Health Care [internet]. Stanford Medicine. Stanford Medical Center. Stanford University. US; Testing for Male Infertility
  5. University of Utah Health School of Medicine [internet]; U.S.A.; Semen Culture
  6. Evans-Hoeker EA, Eisenberg E, Diamond MP, et al. Major depression, antidepressant use, and male and female fertility. Fertil Steril. 2018;109(5):879–887.
  7. Jameson JL, et al., eds. Clinical management of male infertility. In: Larry Jameson Leslie De Groot. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, Pa.: Saunders Elsevier; 2016.
  8. Eunice Kennedy Shriver National Institute of Child and Human Development. National Institute of Health: Us Department of Health and Human Services; How common is male infertility, and what are its causes?
  9. National Center for Complementary and Integrative Health [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Using Dietary Supplements Wisely
  10. Wein AJ, et al., eds. Campbell Walsh Urology. 11th ed. Philadelphia, Pa.: Elsevier; 2016.
  11. Yao David F., Mills Jesse N. Male infertility: lifestyle factors and holistic, complementary, and alternative therapies. Asian J Androl. 2016 May-Jun; 18(3): 410–418. PMID: 26952957.
  12. Townsend CM Jr, et al. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 20th ed. Philadelphia, Pa.: Elsevier; 2017.
  13. Institute for Study of Urological Diseases [Internet]. Greece; Semen Culture
  14. Sevim Gullu. Prolactin: an underestimated hormone . Endocrine Abstracts. 2008; 16ME9.
  15. Health direct [internet]: Department of Health: Australian government; Testosterone blood test
  16. National Health Service [internet]. UK; Blood Tests

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