Diagnosis of Male Infertility

Difficulty conceiving may be related to female, male, or combined factors. For this reason, we recommend that both partners are assessed in parallel and approach male fertility evaluation with medical precision, discretion, and understanding.

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Semen Analysis Is the Starting Point, Not the Entire Diagnosis

What Does Male Infertility Diagnosis Include?

Diagnosis is a step-by-step process that combines reproductive history, semen analysis, andrological examination, and additional tests when clinically indicated. A semen analysis result is not an assessment of masculinity or sexual function. It provides medical information that we always interpret in a broader clinical context.

Evaluation usually begins after 12 months of regular unprotected intercourse without conception, or after 6 months when the female partner is aged 35 or over. Earlier assessment may be appropriate in cases of previous surgery, undescended testes, cancer treatment, trauma, infection, sexual dysfunction, or another condition that may affect fertility.

Initial Assessment

The initial evaluation includes a detailed medical history, semen analysis, and, when abnormalities or other medical indications are present, an andrological examination. For many men, these steps are sufficient to determine whether further testing is needed.

Targeted Diagnostic Assessment

Hormonal, genetic, microbiological, and imaging tests are recommended according to the findings from the initial assessment. We do not perform every possible test routinely; instead, we select investigations that may help clarify the cause and influence the treatment plan.

Male Infertility Can Arise at Different Levels

Causes of Male Infertility

Spermatogenesis may be affected by congenital conditions, undescended testes, trauma, testicular torsion, previous inflammation, chemotherapy, or radiotherapy. This may result in a reduced sperm count or a complete absence of sperm in the ejaculate.
A varicocele is an enlargement of the veins around the testicle. In some men, it may alter temperature regulation and affect sperm production and quality. Not every varicocele causes infertility, and not every case requires treatment.
The hypothalamus, pituitary gland, and testes function as part of an interconnected hormonal system. Disorders affecting this system may impair testosterone and sperm production and may sometimes be associated with reduced libido, fatigue, or erectile dysfunction.
Sperm may be produced normally but fail to reach the ejaculate because of congenital absence or obstruction of the vas deferens. Previous surgery, infection, retrograde ejaculation, or another disorder affecting semen release may also be responsible.
Chromosomal abnormalities, Y-chromosome microdeletions, and mutations in the CFTR gene may be associated with severely impaired spermatogenesis or obstructive azoospermia. Genetic testing is recommended only when there are specific indications and is accompanied by appropriate counselling.
Infections of the urogenital tract may affect the patency of the reproductive ducts and the quality of the ejaculate. Microbiological testing is recommended when there are symptoms, an increased number of leukocytes, or other signs of inflammation, rather than routinely with every semen analysis.
Exogenous testosterone, anabolic steroids, certain medications, and toxic exposures may suppress spermatogenesis. Smoking, excess body weight, excessive alcohol consumption, frequent heat exposure, and certain occupational exposures may also affect male fertility.

Steps in the Diagnosis of Male Infertility

Which Tests Provide the Information We Need?

Precise Laboratory Assessment

What Does Semen Analysis Tell Us?

The accuracy of semen analysis depends on correct sample collection and processing, a standardised laboratory protocol, and the expertise of the specialist performing the assessment.

In our andrology laboratory, we evaluate semen samples in accordance with current World Health Organization recommendations and apply strict internal quality control procedures. Automated methods can support the analysis, but they do not replace expert microscopic assessment and clinical interpretation.

Imaging in Male Infertility

When Does Ultrasound Complement the Clinical Examination?

Imaging is not required for every patient. Scrotal Doppler ultrasound can provide information about the testes, epididymides, blood flow, and the presence of varicocele.

When obstruction of the ejaculatory ducts is suspected, transrectal ultrasound or another appropriate imaging examination may be considered.

Questions

Frequently Asked Questions

A single normal result is often sufficient for an initial assessment. If abnormalities are identified, the sample was incomplete, or the test was performed during an illness, we recommend repeating the analysis after an appropriate interval.
No. Reference values do not represent an absolute boundary between fertility and infertility. The type, severity, and combination of abnormalities are important, as is the reproductive health of the female partner.
A period of two to seven days of sexual abstinence is usually recommended. The entire sample should be collected in the sterile container provided.

It is important to inform us about any recent high fever, illness, medication use, or loss of part of the sample during collection.
Yes. Standard semen analysis does not assess every aspect of sperm function or genetic integrity. Additional tests are recommended only when the reproductive history or previous treatment provides a clear medical indication.
Hormonal testing may be recommended in cases of reduced sperm count or absence of sperm, low testicular volume, reduced libido, or other signs of an endocrine disorder.

Genetic testing is most commonly considered in cases of azoospermia, severe oligozoospermia, or congenital abnormalities of the vas deferens.
Sperm DNA fragmentation testing may be considered in cases of recurrent miscarriage, unsuccessful IVF treatment, or unexplained infertility. It does not replace semen analysis and is not required as an initial test for every patient.
In many cases, it may be possible, depending on the underlying cause. In obstructive azoospermia, sperm can often be retrieved from the epididymis or testis.

In non-obstructive azoospermia, the likelihood of finding sperm is assessed individually and cannot be guaranteed in advance.
Exogenous testosterone and anabolic steroids suppress the hormonal signals to the testes and may significantly reduce or temporarily stop sperm production.

If you are planning to have a child, do not start or stop hormonal treatment without consulting a specialist.

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I am one of the many people who received care, professionalism and reassurance at this clinic. I underwent several attempts there and always felt that things would work out... and I was right!

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