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March 1, 2021

Male fertility testing: finding the best option for you


You and your partner have decided to have a baby, and you're ready for fatherhood—but is your sperm ready? When trying to conceive and struggling with infertility, most people look towards the woman first. But the reality is, fertility is 50-50. Statistically, men have a role in 40–50% of infertility cases.

That’s why, if you and your partner are having a hard time conceiving, it's a good idea for both of you to take a fertility test. (With Legacy’s kit, you don't even have to leave your home or wait weeks for an appointment with a specialist to get an in-depth look at your fertility.)

Here, we cover seven male fertility tests, what they are used for, and who should get them. Let's get started.

Male fertility testing basics

Semen analysis

A semen analysis, or a sperm count test, analyzes the quantity and quality of your sperm. Many tests will measure a few benchmarks for sperm health—sperm count and maybe motility—but more advanced tests will measure the five key factors:

  • Count: This measures the number of sperm produced. A healthy sperm count is associated with improved chances of conception, and is generally a good indicator of your overall health.
  • Concentration: This value uses semen volume and sperm count measurements to find the ratio of sperm produced per millimeter of semen.
  • Motility: This measures how well your sperm moves. Semen samples in which most sperm are motile will have the best chance of reaching the egg for fertilization.
  • Morphology: This is an evaluation of your sperm’s shape. Sperm with proper structure will have a greater chance of reaching and fertilizing an egg, whereas sperm with shape abnormalities, such as an uneven head or a coiled tail, may have trouble.

A semen analysis is often the first fertility test issued for men. These five major benchmarks will provide a good view of your general fertility. If you suspect infertility, have been struggling to achieve pregnancy, or simply want to understand your body better, starting with a semen analysis is a great first step.

Sperm DNA fragmentation analysis

Sometimes DNA damage occurs within sperm, called sperm DNA fragmentation. Damage can occur for a number of reasons, such as smoking, which causes oxidative stress in the body. 

A sperm DNA fragmentation analysis will provide you with a DNA fragmentation index (DFI), which is the percentage of your sperm with damaged DNA. The higher your DFI is, the more genetic damage a man's sperm contains—which can have an impact on fertility. Research shows that sperm with a high DFI is correlated with lower pregnancy rates and higher miscarriage rates.

There are a few risk factors that may increase the likelihood of a high DFI, such as:

  • Over the age of 40
  • Smoking
  • History of illness or infections (cancer, influenza, STIs)
  • Chemical, toxin, or radiation exposure

If you are struggling with fertility and have any of the risk factors outlined above, then it may be a good idea for you to get a sperm DNA fragmentation analysis.

Male fertility hormone testing

Hormone production plays an important role in fertility. Testosterone is the hormone most people associate with male fertility, but there are two other very important hormones that work together with testosterone: follicle stimulating hormone (FSH) and luteinizing hormone (LH).

FSH prompts certain cells, called Sertoli cells, in the testes to start sperm production (spermatogenesis). LH stimulates other cells, known as Leydig cells, to produce testosterone. Testosterone helps drive the differentiation of spermatozoa, and feeds back to the hypothalamus and pituitary glands to regulate the balance of hormones.

Abnormal levels of any of these hormones may have an impact on male fertility. For example, low levels of FSH may cause a patient to produce low numbers of sperm (or no sperm at all). LH is responsible for releasing testosterone, so if there is an imbalance there, your body may not be releasing the testosterone necessary to help sperm develop. If you have received results from a sperm analysis that show low sperm count or poor sperm health, hormone imbalance could be the culprit.

Hormones—testosterone, specifically—also drive sexual function. If you've been experiencing a decrease in libido or issues with sexual function (which has an impact on time to conception), that could be an indicator of imbalanced hormones.

Learn more about male fertility.

Advanced male fertility testing

Genetic testing 

Lifestyle, age, and environment are big factors when it comes to male fertility—in those cases, it may be possible to improve your sperm health with healthy changes.

However, sometimes the cause for infertility is genetic. If you've gone through rounds of male fertility testing but cannot pinpoint the cause of your infertility, then it may be a genetic anomaly that's causing issues with your sperm production. A genetic test for chromosomal abnormalities is known as a “karyotype.”

Chromosomal issues that affect fertility include:

  • Klinefelter syndrome: This is a disorder that affects the sex chromosomes, X and Y. Most people have just two sex chromosomes (either XX or XY). With Klinefelter syndrome, a person has three sex chromosomes, XXY. One of the possible effects of this is male infertility.
  • Cystic fibrosis transmembrane conductance regulator (CFTR) gene mutation: Cystic fibrosis requires inherited genes from both parents. But some men who carry the cystic fibrosis gene can experience a dysfunction of the CFTR protein that is associated with male infertility. This will also determine whether you are a carrier of the cystic fibrosis gene that can be passed onto your children.
  • Y-chromosome micro-deletions (YCMD): Another disorder of the sex chromosomes. A male with YCMD has typical XY chromosomes, but the Y-chromosome is missing some genes. This can cause infertility.

If you’ve experienced infertility for over a year, have had recurrent miscarriages or a stillborn, or have azoospermia (no sperm), you may want to do a genetic karyotype for fertility.

Testicular biopsy

A testicular biopsy is a surgical procedure that involves removing a piece of tissue from the testicles.

Years ago, this was a common test for male infertility diagnosis. Now, other non-invasive male fertility testing methods like sperm analysis, DNA fragmentation, and hormone testing provide a great deal of insight. This means that testicular biopsies are generally only performed if you have taken other fertility tests, like those mentioned above, and have either been diagnosed with azoospermia (the absence of sperm in semen) or have unexplained infertility.

In cases where you haven't been able to determine the cause for infertility, testicular biopsies can sometimes help find an answer. For example, if your semen analysis results show no sperm, but a biopsy finds sperm in the testicle tissue, then you may be experiencing a blockage that is preventing sperm from traveling from the testes to the urethra, which can be resolved with surgery.

Ultrasound 

Ultrasounds may be used to visualize the contents of the scrotum, the muscular sac that holds the testicles, and check for blockages or diagnose a varicocele.

An ultrasound may be performed after a sperm analysis that indicates low sperm count, or no sperm production at all (azoospermia). This diagnostic tool may be preferable compared to a testicular biopsy, as it’s less invasive. However, depending on your doctor's findings, a more complex imaging technique such as a testicular venography may be necessary.

Antisperm antibodies semen testing

This is a rare case, but if the immune system malfunctions, it may mistakenly attack sperm cells using antibodies. This test looks for those antisperm antibodies in semen, where they can damage or kill sperm. This male fertility testing method may be ordered by a doctor if they see abnormal results in a semen analysis, such as sperm agglutination (sperm sticking together), or if you have unexplained infertility.

At-home male fertility testing

Your fertility and your journey into fatherhood is highly personal. When you know more about your body, you're armed with the knowledge to make the best decisions for you—and your future family. Taking ownership of your health is a great first step into fatherhood, because it impacts you, your partner, and your future children.

At-home male fertility testing makes it easier for you to understand your body and improve your fertility. At-home tests also protect your privacy, and relieve you of the stress of providing a semen sample at a doctor's office. If you want to gain a better understanding of your fertility, an at-home semen analysis is the best way to start.


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