How is male infertility diagnosed?

Male infertility is diagnosed through a combination of medical history, physical examination, semen analysis, and additional tests when needed. Depending on the initial findings, a urologist or andrologist may recommend hormone testing, scrotal ultrasound, genetic tests, or other investigations to identify the underlying cause of fertility problems.

A proper male fertility evaluation is important because infertility can result from problems with sperm production, sperm quality, sperm transport, hormones, or sexual function.

The evaluation generally begins with a detailed medical and reproductive history.

1. Medical and Reproductive History

Your doctor may ask about:

• How long you have been trying to conceive.
• Previous pregnancies or fertility problems.
• Previous testicular or reproductive surgery.
• History of infections or injuries.
• Medications and supplements.
• Lifestyle factors.
• Sexual and ejaculation problems.
• Previous chemotherapy or radiation exposure.

2. Physical Examination

A urologist or andrologist may examine the testicles and reproductive system to look for conditions such as:

• Varicocele.
• Testicular abnormalities.
• Signs of hormonal problems.
• Other reproductive conditions.

3. Semen Analysis

Semen analysis is one of the most important initial tests for male fertility.

It can evaluate parameters such as:

• Sperm concentration.
• Sperm motility.
• Sperm morphology.
• Semen volume.
• Presence or absence of sperm.

If the result is abnormal, your doctor may recommend repeating the test because semen parameters can vary between samples.

4. Hormone Testing

Blood tests may be recommended when sperm production appears abnormal or when symptoms suggest a hormonal problem.

Depending on the clinical situation, tests may include:

• Testosterone.
• FSH.
• LH.
• Prolactin.
• Other hormones when clinically indicated.

5. Scrotal Ultrasound

A scrotal ultrasound may be recommended when your doctor needs to evaluate the testicles or surrounding structures. It can help identify conditions such as varicocele or other structural abnormalities.

6. Genetic Testing

Genetic testing may be considered in selected men, particularly those with very low sperm counts or azoospermia, to investigate possible genetic causes affecting sperm production.

What happens if no sperm are found?

If a semen analysis shows azoospermia (zero sperm in the semen), further evaluation is required to determine whether the cause is:

• Obstructive azoospermia — sperm production may be present but sperm cannot reach the semen because of a blockage.
• Non-obstructive azoospermia — sperm production within the testicles is significantly impaired.

The distinction is important because treatment options can be very different.

SCI International Hospital

At SCI International Hospital, New Delhi, Dr. Vishal Dutt Gour, Senior Consultant Urologist and Andrologist, provides comprehensive male infertility evaluation, including assessment of semen parameters, hormonal factors, testicular conditions, varicocele, and azoospermia. Based on the findings, he recommends appropriate diagnostic investigations and develops an individualized treatment plan.