Detailed personal, medical, and sexual history will need to be given to your doctor. Similar to women, the diagnositc process is threefold; semen analysis & physical exam, hormone assessment, and a third step of further testing if necessary, such as genetic tests, and biopsies.
Semen Analysis & Physical Exam
Physical examination consists of checking for normal testicle size and shape, looking for varicocele, undescended testes, or any other evidence of physical abnormalities.
For the semen analysis, the man is asked to ejaculate into a sterile container,…masturbation on demand is not so easy, mentally prepare for this part. They can also send you away with a special condom that can be brought back at a later time. It is important to refrain from ejaculation for 3-4 days before the sample is required. A urine sample after ejaculation may also be asked for to check for retrograde ejaculation.
Illness that has happened in the last 3 months should also be offered to the doctor, it takes 100 days for sperm to mature, so problems at anytime in the last 3 months could effect the semen sample. Other factors that may effect the quality of the sample are medication, excess heat, alcohol, smoking, and other important things to avoid can be found at Improving Sperm Quality.
Also, be sure and have your tests done at a fertility lab, or a lab specially designed for male testing. Regular labs that do not understand the importance of the accuracy and timing of these tests may disregard the little things. It would be worth spending as little extra money if it is necessary. It is also worth doing more than one test because semen results can vary a lot depending on stress, illness, and many other factors.
Understanding the results
Appearance: normal semen is opalescent and grayish. Yellowish semen may show high intakes of vitamin supplements, abstinence, or jaundice. An infection may show some red in the semen.
Volume: total volume can range from 1-5ml. Too much can mean it is diluted. Low volume may show past infection blocking the tubes, retrograde ejaculation, or problems with accessory glands such as the seminal vesicles or the prostate. Sometimes there is an abscence of the vas deferens.
Liquefaction: after about 10 minutes semen becomes very runny (to swim better), if this does not happen within an hour, assisted techniques may need to be employed.
Acidity: semen has a pH between 7.2 and 8.
Agglutination: when sperm stick to one another it usually means there is anti-sperm antibodies that coat the sperm and bind to cervical mucus preventing proper movement and difficulty fertilizing the egg.
Antibodies: these tests are usually only done when all else has been ruled out.
MAR (mixed agglutination reaction): if the immunobead test shows less than 50 percent binding, antibody levels should not affect fertility.
Round Cell Concentration: immature sperm or white blood cells. Too many of these in a sample may indicate infection.
Sperm Concentration (count): 20 million sperm per ml of semen is normal. It may be too low, or sperm may be completely absent. Excess ejaculation may lower concetration. Caffeine, tobacco, alcohol, drugs, diet, exercise, and stress can also effect this. If it is very low there may be a genetic chromosomal defect.
Motility: swimming capabilities, fast and straight percentage is what is measured here. Too little or too much ejaculate can adversely effect motility. It is said that one big drinking binge can effect sperm for up to 3 months.
Morphology: shape of the sperm. Big or small heads, small or coiled tails. At least 15% of the sperm should be normal in shape. Avoiding things that are toxic to sperm are very important with morphology.
FSH, LH, Prolactin, and Testosterone. LH stimulates the production of testosterone (necessary for the healthy production of sperm), Prolactin can interfere with LH induced testosterone production. FSH is essential for sperm development.
If there are high FSH and LH, and low testosterone, this may show testicular failure. Low levels of testosterone and FSH may indicate hypothalamic dysfunction.
Cell Culture: inflammation of the testes can reduce or totally obstruct sperm and testosterone production.
Ultrasound: this will show physical problems such as infection, tumors, surgical lesions in the testes, scrotum, prostate, seminal vesicles, epididymis, or absence of vas deferens. Varicocele can also be found this way.
Testicualr biopsy: this shows if sperm are even being made.
Chromosome testing: if counts are lower than 5 million per ml this should be explored. This could represent the possible passing on of cystic fibrosis, Young’s syndrome, Kartagener’s syndrome, or Klinefelter’s syndrome to the offspring.