Male fertility testing – the NOW-fertility approach to what and when

NOW-fertility in conversation with Ian Stones, Director, testhim

Male fertility is a crucial component of reproductive health, yet it often receives less attention compared to female fertility. However, for couples trying to conceive, understanding both partners’ fertility is vital.

When should men test their fertility?

There are various scenarios when men should consider testing their fertility. While some men proactively test their fertility out of curiosity, most men pursue testing when they encounter difficulties conceiving with a partner. According to experts, a man should consider a fertility evaluation if:

1. Struggling to conceive for a year: If a couple has been actively trying to conceive for 12 months without success, it’s a red flag that both partners should get tested. For couples where the female partner is over 35, testing is recommended after six months of trying.
2. Known health issues: Men with certain medical conditions such as diabetes, hormone imbalances, or autoimmune diseases may be at higher risk of fertility problems. Similarly, those who have undergone cancer treatments, including chemotherapy or radiation, should consider testing.
3. History of genital surgery or injury: Past trauma, surgeries (such as for undescended testicles or varicocele repair), or infections affecting the testicles may impact sperm production.
4. Lifestyle and environmental factors: Men exposed to certain chemicals, radiation, or prolonged heat (such as from regular use of saunas or hot tubs) may experience reduced sperm quality. Lifestyle factors like smoking, excessive alcohol consumption, or drug use can also influence fertility.
5. Symptoms of hormonal imbalance: Men experiencing symptoms such as reduced sex drive, erectile dysfunction, or abnormal hair growth patterns might benefit from fertility testing. These could be indicators of underlying hormonal issues impacting sperm production.

Semen Analysis

The cornerstone of male fertility testing for many decades is the semen analysis which will often form the initial assessment on the male side. A semen analysis offers a good starting point for men and examines the health of the sperm in terms of:

• Sperm count: The number of sperm present in a sample. A normal sperm count is typically over 16 million sperm per millilitre of semen.
• Sperm motility: The percentage of sperm that are actively moving. Healthy sperm need to move efficiently to reach and fertilise the egg.
• Sperm morphology: The shape and structure of sperm. Abnormally shaped sperm may have difficulty penetrating an egg.

A semen analysis can also identify issues such as low semen volume, sperm clumping or the presence of white blood cells, which could indicate an infection.

Much as a semen analysis is held up as the “gold standard” it has its limitations and short falls and doesn’t really tell us much about a mans fertility potential. Rarely are men routinely offered further tests beyond a semen analysis which offer far more diagnostic and predictive value.

Further tests to consider

For men with unexplained infertility or those looking for a deeper understanding of sperm health, advanced tests are becoming more common. These tests can reveal issues at the cellular or molecular level that may not be detectable with a standard semen analysis.

Advanced testing for men requires good clinical oversight, a comprehensive medical history and clear guidance on next steps. In some cases the diagnosis can have a profound effect on a man’s identity and his mental health so it’s imperative that the right support is in place. Alongside these tests, treatment options can help address underlying fertility issues.

Further testing could include:

Sperm DNA fragmentation testing

Sperm DNA fragmentation refers to the presence of damaged or broken DNA strands within the sperm. High levels of DNA fragmentation have been associated with lower fertility rates, higher miscarriage risks, and poor embryo development. This test can be especially useful in cases of unexplained infertility, repeated miscarriages, or poor outcomes in assisted reproductive technologies like IVF. DNA fragmentation can result from oxidative stress, infections, age, smoking, or exposure to environmental toxins.

Seminal oxidative stress testing

Oxidative stress occurs when there’s an imbalance between free radicals and antioxidants in the body. In sperm, oxidative stress can damage cell membranes and DNA, leading to reduced motility, abnormal morphology, and increased DNA fragmentation. Seminal oxidative stress testing measures the levels of oxidative damage within semen, offering valuable insights into sperm quality beyond the standard analysis.

Scrotal ultrasound

A scrotal ultrasound uses sound waves to produce images of the testes and surrounding structures. It can help diagnose physical problems such as varicoceles (enlarged veins in the scrotum), blockages, or abnormal testicular structures that may impact sperm production and delivery.

Hormonal blood tests

Hormones play a key role in regulating sperm production, and imbalances may result in fertility problems. Blood tests can measure levels of:

• Testosterone: The primary male hormone responsible for sperm production.
• Follicle-Stimulating Hormone (FSH): A hormone essential for sperm development.
• Luteinizing Hormone (LH): This hormone regulates testosterone production.
• Prolactin and Estrogen: Elevated levels of these hormones can indicate an underlying issue affecting sperm production.

Semen microbiome testing

Recent studies have uncovered the important role of the semen microbiome in male fertility. The microbiome refers to the community of bacteria and other microorganisms living in the reproductive tract. An imbalance or the presence of pathogenic bacteria in semen can negatively impact sperm health and function, potentially through oxidative stress and DNA fragmentation leading to fertility issues.

Genetic testing

For men with very low or absent sperm counts, genetic testing may be recommended to look for chromosomal abnormalities. Conditions such as Klinefelter syndrome (an extra X chromosome) can affect fertility. Y chromosome microdeletions (missing sections of the Y chromosome) are another possible cause of male infertility.

Post-ejaculation urinalysis

For men suspected of experiencing retrograde ejaculation (when semen is redirected into the bladder instead of exiting through the penis), a post-ejaculation urine test may be conducted. This test checks for the presence of sperm in the urine, which can confirm the condition. This test is particularly relevant for men with poorly managed diabetes.

Testicular biopsy

In rare cases, usually for those men who have little or no sperm in their ejaculate, a testicular biopsy may be needed to directly assess sperm production in the testes. A small piece of testicular tissue is removed and examined for sperm presence. This test is typically reserved for cases where other tests have been inconclusive.

When to Consider Advanced Fertility Testing

While a semen analysis is a good first step, there are certain situations where advanced testing may be beneficial. Men may consider pursuing further tests in the following circumstances:

1. Unexplained infertility: If a couple is struggling to conceive despite normal semen analysis results and no clear female factor infertility, advanced testing can help identify hidden issues.
2. Repeated miscarriages: High sperm DNA fragmentation has been linked to increased miscarriage risk. If a couple has experienced multiple pregnancy losses, assessing sperm DNA integrity may offer important insights.
3. Poor IVF or IUI outcomes: Couples undergoing assisted reproductive techniques (ART) such as in vitro fertilization (IVF) or intrauterine insemination (IUI) may benefit from advanced sperm testing if previous attempts have failed or resulted in poor embryo quality.
4. Age-related concerns: Men over the age of 40 may experience increased oxidative stress and sperm DNA fragmentation. Testing can help determine whether these factors are contributing to reduced fertility.
5. Lifestyle or environmental exposure: Men who smoke, are exposed to environmental toxins, or have a history of poor lifestyle habits may be at risk for oxidative stress, sperm DNA fragmentation or microbiome imbalances. Testing can guide interventions to improve sperm quality.
6. Varicocele diagnosis: Varicoceles are known to affect sperm production and quality. Even after surgical correction, some men may still experience fertility issues that advanced testing could help explain.

Treatment options

Treatment options after further testing will vary much depend on the issues found.

• Lifestyle modifications: Reducing smoking, alcohol consumption, and exposure to environmental toxins can help reduce DNA fragmentation and oxidative stress. Improving diet and exercise with a diet rich in fruits and vegetables, particularly those high in antioxidants, can also be beneficial.
• Antioxidant therapy: High levels of antioxidants, like vitamins C and E, CoQ10, and zinc, may help repair sperm DNA and reduce fragmentation and reduce oxidative stress however men must be aware that more is not always better.
• Antibiotic therapy: If harmful bacteria are identified in the semen microbiome, antibiotics can help clear the infection, improving sperm quality
• Probiotic supplements: For men with imbalances in their microbiome, taking probiotics can help restore a healthy bacterial environment in the reproductive tract.
• Surgery or embolisation: For men with a confirmed varicocele and high DNA fragmentation surgery or embolisation to remove the varicocele may improve sperm quality and DNA integrity.
• Hormone therapy: For men with a hormonal imbalance then hormone therapy may be offered but this must be overseen by a suitably qualified clinician.
• Testicular sperm extraction: For men with very low sperm counts and where a biopsy hasn’t shown any sperm more invasive techniques may be considered to try and retrieve sperm from within the testicle.

Conclusion

Male fertility testing has evolved significantly, offering more comprehensive insights than ever before. From basic semen analysis to advanced tests like sperm DNA fragmentation, oxidative stress, and microbiome analysis, these assessments provide a detailed picture of a man’s reproductive health. However for them to be of value they need to be adopted more routinely and have the appropriate clinical oversight enabling men to get the right treatment options.

If any abnormalities are identified, targeted treatments ranging from lifestyle changes to medical therapies can help address underlying issues and improve sperm quality and it’s important all avenues are explored before moving forward with fertility treatment as so many issues relating to male fertility are entirely treatable.

About testhim

testhim aims to bridge the gap in fertility education and support for men.

By offering a free questionnaire, men can quickly discover how their lifestyle and health history may be affecting their fertility, with instant recommendations for health, lifestyle changes, and advanced fertility tests.

Check out their free questionnaire: https://portal.testhim.com/
Listen to their award-winning podcast: https://podcasters.spotify.com/pod/show/testhim

 

If you would like to speak to NOW-fertility’s expert team about male infertility, please contact us here.

 

Published by NOW-fertility’s Communication Department.
Communication Manager: Annette Eckersley
E: annetteeckersley@now-fertility.com

This information was correct at the time of publishing and may not reflect our current practices, prices or regulations