Male Infertility Causes and Tests: What Goes Wrong and How It Is Diagnosed

Roughly half of all fertility struggles involve a male factor, yet the man is often the last to be checked. The encouraging part is that identifying the exact reason is usually straightforward, and once the cause is clear, a significant share of cases can be effectively treated. This guide explains what can go wrong and, just as importantly, the tests doctors use to pinpoint it.

If you have already been diagnosed and want to understand your options, our main male infertility treatment guide covers those. Here, the focus is on causes and the diagnostic workup that identifies them.

Understanding the Sperm Terms

A semen report often uses medical labels. In plain terms, oligospermia means a low sperm count, asthenospermia means weak sperm movement, teratospermia means too many abnormally shaped sperm, and azoospermia means no sperm in the semen at all. When low count, poor motility, and poor shape appear together, it is called OAT, the single most common pattern seen in infertile men.

Male Infertility Tests: How the Cause Is Found

Diagnosis works from the simplest test outward, and most answers come from the very first one, combined with a careful history.

Semen Analysis

The semen analysis is the cornerstone of male fertility testing. It measures the number of sperm, their motility, shape, and the volume and acidity of the sample. To get a reliable result, abstain from ejaculation for two to five days beforehand, and provide the sample at the laboratory so it can be examined fresh.

At Delhi IVF, samples are assessed against the latest WHO 2021 (sixth edition) standards. The lower reference limits are shown below.

Parameter WHO 2021 lower reference limit

A result below these limits does not automatically mean infertility, and a result above them does not always guarantee fertility, which is why the report is always read alongside your history and your partner's assessment.

Why a Repeat Test Matters

Sperm takes about 74 days to develop, and a sample can be thrown off by a recent fever, stress, or heat. For that reason, a single abnormal result is never the final word. A second analysis, a few weeks later, confirms whether the finding is genuine or a one-off.

Hormone Profile

A blood test measuring testosterone, prolactin, thyroid function, and the pituitary hormones FSH and LH reveals whether a hormonal imbalance is behind the problem. The pattern is informative on its own. A high FSH usually points to the testes failing to produce sperm, whereas a low FSH suggests the signal from the brain is the issue.

Scrotal Ultrasound

An ultrasound of the scrotum looks for a varicocele, cysts, structural abnormalities, and signs of blockage. It is painless and quick, and it often confirms what a physical examination first suggests.

Genetic Testing

For men with a very low count or no sperm at all, genetic tests such as karyotyping, Y-chromosome microdeletion analysis, and screening for the cystic fibrosis gene are advised. These identify inherited causes and flag conditions that could be passed to a child, which is why genetic counselling goes hand in hand with the results.

Sperm DNA Fragmentation Test

This specialised test looks at how intact the sperm's DNA actually is. A man can have a perfectly normal semen analysis yet carry high DNA damage, which can quietly cause failed fertilisation, weak embryos, or repeated miscarriage. It is particularly useful for couples facing unexplained IVF failure or pregnancy loss.

Post-Ejaculatory Urine Test

When semen volume is very low or absent, a urine sample taken straight after ejaculation is checked for sperm. Finding sperm there confirms retrograde ejaculation, where semen travels into the bladder instead of leaving the body.

Cause and Test at a Glance

Suspected cause Common clue Test that confirms it

When Should a Man Get Tested?

A couple is generally advised to seek testing after twelve months of trying without success, or after six months if the female partner is over 35. Anyone with a known risk, such as a previous groin injury, an undescended testicle, cancer treatment, or a swelling in the scrotum, should be checked sooner rather than later. Because a male and female factor often coexist, testing both partners together is always the wiser route.

Why Choose Delhi IVF for Male Infertility Diagnosis

A precise diagnosis depends on a laboratory that can do more than count sperm. Delhi IVF and Fertility Research Centre operates a dedicated andrology laboratory that adheres to WHO 2021 standards, offering advanced tests such as DNA fragmentation and genetic screening under one roof.

1. Semen analysis and andrology testing to the current WHO criteria
2. Hormonal, ultrasound, genetic, and DNA fragmentation testing in one place
3. Genetic counselling where an inherited cause is found
4. Assessment of both partners together, so nothing is missed
5. Guidance led by Dr. Anoop Gupta, Director and IVF Specialist

Frequently Asked Questions

Q1: How should I prepare for a semen analysis test?

Abstain from ejaculation for two to five days before the test, avoid alcohol beforehand, and collect the sample at the laboratory. Following these steps gives the most accurate and reliable semen analysis result.

Q2: What are the normal semen analysis values under WHO 2021?

According to the WHO 2021 criteria, the lower reference limits are a volume of 1.4 mL, a concentration of 16 million per mL, 42% total motility, 30% progressive motility, and 4% normal shape.

Q3: Can a man be infertile with a normal semen analysis?

Yes. A normal semen analysis can still hide problems like high sperm DNA fragmentation, which a standard test does not detect. This is why unexplained IVF failure or miscarriage warrants further specialised testing.

Q4: What does a high FSH level mean in male infertility?

A raised FSH level usually signals that the testes are struggling to produce sperm, pointing toward a testicular cause. A low FSH instead suggests the problem lies in hormonal signalling from the brain.

Q5: Which test detects a varicocele?

A scrotal ultrasound is the main test used to detect a varicocele, the enlarged scrotal veins that can impair sperm production. A physical examination by the doctor often raises the first suspicion.

Q6: When is genetic testing recommended for male infertility?

Genetic testing is advised for men with severe low sperm count or azoospermia. Tests like karyotyping and Y-chromosome microdeletion analysis check for inherited conditions that could affect sperm production or be passed to children.

Q7: What test diagnoses retrograde ejaculation?

Retrograde ejaculation is diagnosed with a post-ejaculatory urine test. If sperm appear in the urine sample after orgasm, it confirms that semen is flowing backward into the bladder instead of outward.

Q8: How do doctors tell obstructive from non-obstructive azoospermia?

Doctors use hormone levels, testicular size, and ultrasound to tell them apart. Normal FSH with normal testes suggests a blockage, while raised FSH with small testes points to a sperm production failure.

Q9: Why does a semen test need to be repeated?

Sperm production runs on a roughly 74-day cycle, and results swing with illness, stress, and heat. So a single abnormal semen analysis is repeated a few weeks later to confirm the finding.

Q10: When should a couple get male fertility testing done?

A couple should seek male fertility testing after twelve months of trying without success, or after six months if the female partner is over 35. Known risk factors justify testing sooner.