Infertility is when a couple is unable to get pregnant despite having regular unprotected sex for a year or more. About 4 in 5 couples will conceive (have a pregnancy) naturally within a year if they have unprotected sex every 2 to 3 days. If this isn’t happening for you, male fertility tests could help you find out why.
The usual test for male fertility is to analyse a sample of semen (cum) – the fluid that carries sperm that’s released on ejaculation. Although self-testing kits are available, most testing is done in hospital laboratories. A self-test kit should never replace a health professional’s advice.
When should I speak to my doctor about a male infertility test?
If you and your partner have been having regular sex without using contraception for more than a year and haven’t been able to conceive, discuss this with your doctor. They’ll be able to arrange some simple initial tests to try and identify the problem.
5 ways to test for male infertility
Semen analysis
Semen analysis is a test that checks for male fertility problems. It’s based on semen analysis done on 2 occasions, 1 month apart. The sample of semen is collected by masturbating into a container. It’s done after you’ve not ejaculated (cum) for at least 2 days (but not more than 5). These results show your ability to conceive (start a pregnancy), providing information about:
- volume – how much semen is produced
- count – how many sperm are present per millilitre of semen
- motility – how many sperm are moving and how quickly they’re moving
- morphology – how many are of normal shape and size
The results will also show if the semen is unusually thick (viscous), if the sperm tend to stick together (agglutination) or if there are any other cells in the semen.
If done at home, you’ll need to take the sample to your local hospital laboratory within 1 hour of production, keeping the container in a pocket close to your body so it stays warm. It’s essential that all the ejaculate is collected, as the first part is often the richest in sperm numbers.
Blood tests
If you’re found to have a low sperm count (less than 15 million sperm/mL) your doctor or fertility specialist may check your blood levels of hormones, such as follicle-stimulating hormone (FSH), leutinising hormone (LH), free and total testosterone, estradiol, sex hormone-binding globulin and prolactin levels.
FSH is a hormone that's made by your pituitary gland, a small gland located underneath the brain. It tells the testicles to make sperm. High levels may mean your pituitary gland is trying to get the testicles to make sperm, but they can’t.
Low levels of testosterone suggest hypogonadism, where your testes (balls) don't make enough sex hormones (mainly testosterone). You may also be tested for genetic conditions that can affect sperm production.
Urine tests
You may be asked to provide a urine sample. This is to check for retrograde ejaculation, where your semen is ejaculated backwards into your bladder instead of outside your body.
An ultrasound scan of your testes
Your doctor may suggest this if you’re not producing any sperm.
A testicular biopsy
This test, done under local anaesthetic, involves using a needle to remove small samples from the testicle. If the results show that your sperm production is normal, it’s likely any fertility problem is caused by a blockage or other sperm transport problem.
Home test kits for male fertility
There are now a number of male fertility home-testing kits available to buy online or from pharmacies that claim to be able to test for a low sperm count. Some men prefer the idea of using these rather than seeing their doctor to arrange a test. However, home tests haven’t been extensively researched and some classify a low sperm count at a level that international guidelines say is normal.
Some home test kits also only check the number of sperm and not their motility or morphology. Because of this, there’s a risk that they may give you false reassurance or suggest your sperm count is low, when it's actually perfectly normal. It’s usually better to see your doctor for a proper semen analysis at an accredited laboratory.
If you do buy a self-test kit online, make sure the kit is sealed and has no damage to the packaging, and that it’s within its expiry date. Check that the instructions for use are clear and easy to follow, and that it has a CE quality assurance mark. This means that – provided you use it correctly – the kit should work properly and be safe.
Your health questions answered
If my sperm count is normal, do I need more tests?
“Sperm counts can vary significantly because of things like general health and how often you have sex, so each test you have done will analyse a number of things. However, if your sperm analysis is initially found to be normal, your doctor will likely recommend thorough testing of your female partner before conducting any more male infertility tests. If you’ve used a self-test kit to check your sperm count, your doctor may recommend another test at the local hospital laboratory to check it again.”
– Answered by Dr Roger Henderson
Key takeaways
- infertility is when a couple is unable to get pregnant, despite having regular unprotected sex for a year or more
- this can be due to male or female fertility problems
- the usual test for male fertility is an analysis of your semen (cum)
- laboratory tests of your semen that can be arranged on the NHS by your doctor have advantages over self-test home kits
- if you have any concerns about your fertility, discuss these with your doctor
