Male Fertility Testing

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Explore How Male Infertility Is Diagnosed

When a couple is having difficulty conceiving, both partners need to be evaluated, and that means starting with a thorough male fertility assessment. Male factor infertility is a contributing cause in approximately half of all infertility cases, yet it is frequently underdiagnosed or evaluated only after significant time has passed. The reality is that male fertility testing is accessible, largely non-invasive, and can deliver meaningful answers quickly.

Early evaluation matters because it expands options. When a male factor is identified promptly, the care team can develop a targeted plan, whether that involves lifestyle changes, medical management, surgical intervention, or assisted reproductive technology. At NYU Langone Fertility Center in New York City, we take a proactive, evidence-based approach to male fertility evaluation, integrating reproductive urology and reproductive endocrinology to provide comprehensive diagnostic and treatment care under one system, giving couples the best possible chance of success. 

What are the signs of male infertility, and when should I get tested?

Most causes of male infertility produce no noticeable symptoms. A man can feel entirely healthy, maintain normal sexual function, and still have sperm parameters that are significantly affecting a couple’s ability to conceive. This is why waiting for a symptom before seeking evaluation is rarely the right approach – by the time a problem becomes apparent without testing, valuable time may have been lost.

Clinically, a male fertility evaluation is recommended when a couple has not conceived after 12 months of regular, unprotected intercourse, or after 6 months if the female partner is over 35. Earlier testing is warranted for men with a history of testicular injury, orchiopexy (surgery for undescended testicle), hernia repair, mumps orchitis, sexually transmitted infections, or a known genetic condition that may affect reproductive function. Men who have used anabolic steroids or testosterone therapy, or who have been exposed to chemotherapy, radiation, or significant occupational chemical exposure, should also seek evaluation before actively trying to conceive. A semen analysis is a straightforward, low-barrier first step that provides immediate, actionable data. 

Potential Causes of Male Infertility

Male infertility can result from disruptions to sperm production, sperm function, sperm delivery, or the hormonal systems that regulate these processes. Common causes and contributing factors include:

  • Varicocele: An enlargement of the veins within the scrotum that elevates testicular temperature and impairs sperm production and quality. It is one of the most prevalent and surgically correctable causes of male infertility.
  • Azoospermia (obstructive or non-obstructive): The complete absence of sperm in the ejaculate. Obstructive azoospermia results from a blockage somewhere in the reproductive tract; non-obstructive azoospermia results from impaired sperm production within the testes themselves.
  • Low sperm count (oligospermia): A sperm concentration below the established reference threshold that reduces the probability of natural fertilization.
  • Poor sperm motility or morphology: Sperm that move poorly (asthenospermia) or have an abnormal shape and structure (teratospermia) may be unable to reach or fertilize an egg, even when count is adequate.
  • Hormonal imbalances (e.g., low testosterone): Disruptions to the hormonal axis governing sperm production – involving testosterone, FSH, LH, and other hormones – can significantly impair spermatogenesis.
  • Genetic or chromosomal conditions: Conditions such as Klinefelter syndrome, Y-chromosome microdeletions, or cystic fibrosis gene mutations can directly affect sperm production or the structural integrity of the reproductive tract.
  • Infections or structural blockages: Prior infections, including sexually transmitted infections or epididymitis, can cause scarring that obstructs sperm transport. 
  • Lifestyle or environmental factors: Tobacco use, excessive alcohol consumption, anabolic steroid or testosterone use, obesity, heat exposure, and certain occupational or environmental chemical exposures are all associated with reduced sperm quality.
  • Unexplained infertility: In some cases, standard semen analysis results appear normal yet conception does not occur. Advanced diagnostics such as sperm DNA fragmentation testing may identify issues not captured by routine parameters.

What is a semen analysis and why does it matter?

The semen analysis is the cornerstone of male fertility evaluation. It is a non-invasive test that provides a comprehensive assessment of sperm health across multiple parameters and is almost universally the first diagnostic step when male factor infertility is being evaluated.

A standard semen analysis measures:

  • Sperm count (concentration): The number of sperm per milliliter of ejaculate. The WHO reference value is 16 million/mL or higher; values below this threshold are classified as oligospermia.
  • Total motility: The percentage of sperm that are moving. Progressive motility, or sperm moving in a consistent forward direction, is the parameter most directly associated with fertilization potential.
  • Morphology: The percentage of sperm with a structurally normal form. Even in healthy, fertile men, the majority of sperm in a given sample have some structural abnormality; the clinical threshold is based on the percentage with normal morphology.
  • Semen volume: The total fluid produced per ejaculate. Both very low and very high volumes can have clinical significance.
  • Additional parameters: pH, liquefaction time, viscosity, and the presence of white blood cells may also be evaluated to provide a fuller diagnostic picture.

Results are interpreted against WHO reference ranges, and it is important to note that a single semen analysis is a starting point, not a definitive diagnosis. Sperm parameters naturally vary between samples, and a follow-up analysis is typically recommended two to four weeks after an abnormal result to confirm findings before a clinical conclusion is drawn.

Preparing for a semen analysis is simple. You will be asked to abstain from ejaculation for 2 to 5 days before providing a sample to ensure adequate sperm replenishment without quality decline from prolonged abstinence. Samples are collected in a private room at our facility; in some cases, home collection with prompt delivery to the lab is acceptable. Avoid alcohol and do not begin any new medications or supplements in the days prior to the test. Inform your provider of all current prescriptions, including any testosterone or hormone therapy.

What other male fertility tests might be recommended?

Depending on the findings of your semen analysis and your overall clinical history, your specialist may recommend one or more additional evaluations to identify the underlying cause of any abnormalities and determine the most appropriate treatment approach.

Medical History and Physical Examination

A detailed medical history is always part of a comprehensive male fertility evaluation. Your provider will ask about your reproductive and general health history, including prior pregnancies with any partner, past surgeries or injuries, any history of infections, current and past medications, and relevant lifestyle factors. This history helps identify risk factors that may not be detectable through laboratory testing alone.

A physical examination, performed by a reproductive urologist, allows direct assessment of testicular size and consistency, the epididymis, and the vas deferens. Varicoceles, one of the most common and treatable causes of male infertility, are often identifiable on physical exam, particularly with the aid of scrotal ultrasound. The combination of a thorough history and hands-on examination provides essential context for interpreting all subsequent diagnostic results.

Microsurgical Testicular Sperm Extraction (microTESE)

For men diagnosed with non-obstructive azoospermia – where no sperm are present in the ejaculate due to impaired testicular production rather than a blockage – microsurgical testicular sperm extraction (microTESE) may offer a path to biological fatherhood. This highly specialized procedure uses an operating microscope to identify and retrieve sperm directly from within the testicular tissue, targeting areas where active sperm production may still be occurring even when none is detectable in the ejaculate.

microTESE is performed by a fellowship-trained reproductive urologist in a surgical setting and is typically coordinated with an IVF cycle so that any retrieved sperm can be used immediately for intracytoplasmic sperm injection (ICSI). Not every man with non-obstructive azoospermia will have retrievable sperm, but microTESE offers the highest sperm retrieval rates of any surgical extraction method currently available. Candidacy is determined based on the underlying cause of azoospermia, hormone levels, and in many cases genetic testing. NYU Langone Fertility Center’s integrated urology and reproductive endocrinology team is experienced in evaluating and performing this procedure.

Hormone Testing

The hormonal axis that regulates sperm production involves a coordinated interaction between the hypothalamus, pituitary gland, and testes. Disruptions at any point in this system can impair spermatogenesis, and a hormonal blood panel is commonly ordered when semen analysis results are abnormal or when a hormonal etiology is suspected.

Key hormones evaluated include:

  • Testosterone: The primary male sex hormone, essential for driving sperm production and maintaining overall reproductive function. Both low and, in some contexts, high testosterone can affect fertility.
  • Follicle-Stimulating Hormone (FSH): Stimulates spermatogenesis within the testes. Elevated FSH often indicates primary testicular failure; very low FSH suggests a pituitary or hypothalamic cause of impaired sperm production.
  • Luteinizing Hormone (LH): Works with FSH to regulate testosterone secretion and support spermatogenesis. Abnormal LH levels can reflect dysfunction at the pituitary level.
  • Prolactin: Elevated prolactin can suppress testosterone and impair fertility. 
  • Estradiol: Excess estrogen in men – often seen in obesity or certain liver conditions – can suppress the hormonal axis needed for sperm production.

Hormone testing requires only a blood draw and can provide critical diagnostic clarity, particularly in cases of significant sperm production impairment or when a medically correctable cause is suspected.

Genetic Testing

Genetic evaluation is an important component of the male fertility workup in specific clinical scenarios. It is most commonly recommended for men with azoospermia, severely low sperm counts, or a history of recurrent IVF failure that lacks an obvious explanation.

Testing may include karyotype analysis to detect chromosomal abnormalities such as Klinefelter syndrome, Y-chromosome microdeletion testing to identify deletions in the Y chromosome that are essential for sperm production, and cystic fibrosis gene mutation screening. Genetic results directly inform counseling, treatment planning, and the likelihood of successful sperm retrieval in surgical procedures such as microTESE. Genetic counseling is available to help patients and their partners understand results and their implications for family building.

How much does male fertility testing cost?

The cost of male fertility testing at NYU Langone Fertility Center varies depending on which evaluations are clinically indicated and your individual insurance coverage. A semen analysis is among the more accessible fertility diagnostics, while hormone panels, sperm DNA fragmentation testing, genetic testing, and surgical procedures such as microTESE involve additional costs that vary by complexity.

New York State has fertility insurance coverage requirements that may provide meaningful benefits for eligible patients, and many health plans cover diagnostic testing – including semen analysis and hormone bloodwork – when ordered for a documented medical indication. We recommend verifying your coverage with your insurer before testing begins. Our financial counselors are available to review your plan, clarify what is covered, estimate out-of-pocket costs, and discuss financing options so that financial considerations do not delay your evaluation.

Male Fertility Testing FAQ

  • A semen analysis is a laboratory evaluation of the quantity and quality of sperm in an ejaculate sample. It measures sperm count (concentration per milliliter), total and progressive motility (the percentage and forward movement of sperm), morphology (the proportion with a structurally normal form), and semen volume. Results are compared to World Health Organization reference ranges to identify parameters that may be contributing to fertility challenges. A semen analysis is typically the first test ordered in a male fertility evaluation and provides a strong diagnostic foundation for determining next steps.

  • You will be asked to abstain from ejaculation for 2 to 5 days before your appointment. This window allows sperm to adequately replenish without the quality decline that can occur with very prolonged abstinence. In the days before the test, avoid alcohol and do not start any new medications or supplements. Inform your provider of all current prescriptions, particularly any hormonal medications. Samples are most commonly collected on-site in a private room. In some circumstances, home collection with prompt delivery to the lab within 30 to 60 minutes is acceptable.

  • A low sperm count, clinically called oligospermia, means sperm concentration in the ejaculate is below the WHO reference value of 16 million per milliliter. A low count reduces the statistical probability of natural fertilization but does not eliminate it – many men with oligospermia father children naturally or with minimal assistance. The clinical significance depends on how low the count is, as well as the motility and morphology of the sperm present. Your specialist will interpret semen analysis results in the context of your full history to determine whether further evaluation or treatment is warranted.

  • Yes, many causes of male infertility are treatable. Varicocele can be surgically repaired, hormonal imbalances can often be corrected medically, and lifestyle modifications such as stopping tobacco use, reducing alcohol, or addressing obesity can meaningfully improve sperm parameters. For men with more significant impairment, assisted reproductive technologies such as IUI or IVF with ICSI can effectively bypass many sperm-related barriers to conception. Even men with azoospermia may have sperm retrieved surgically through procedures such as microTESE. Early evaluation opens the door to the broadest range of treatment options.

  • Yes, though the decline is more gradual than the age-related decline in female fertility. As men age, sperm count, motility, and morphology tend to decline, and sperm DNA fragmentation – which can affect embryo quality and increase miscarriage risk – tends to increase. Research has also associated advanced paternal age with a modestly higher risk of certain genetic conditions in offspring. While men can remain fertile well into older age, those over 40 who are experiencing difficulty conceiving may benefit from a fertility evaluation and, in some cases, sperm DNA fragmentation testing.

  • Abnormal motility (asthenospermia) or morphology (teratospermia) can result from a range of causes including varicocele, genital tract infections, hormonal imbalances, heat exposure, oxidative stress, genetic factors, and certain medications. Lifestyle factors, including tobacco use, excessive alcohol, recreational drug use, and obesity, are also associated with reduced sperm quality. In some cases, the cause is idiopathic and cannot be precisely identified despite thorough evaluation. Your specialist will assess contributing factors and recommend targeted interventions where a correctable cause is found.

  • Yes. Several medications and supplements are known to impair sperm production or function. Anabolic steroids and exogenous testosterone suppress the body’s natural signaling for sperm production and can cause azoospermia, which is often reversible after discontinuation, but sometimes requires months to years for recovery. Certain antidepressants, antihypertensives, alpha-blockers, and chemotherapy agents can also affect fertility. Some supplements may interfere as well. Always provide your fertility specialist with a complete and accurate list of everything you are currently taking before your evaluation begins, including over-the-counter products and herbal supplements.

  • Most semen analysis results are available within 24 to 48 hours of sample collection, though specific turnaround times vary by laboratory. Results are typically reviewed with you at a scheduled follow-up appointment or communicated through a patient portal, with your provider explaining what each parameter means and whether any additional evaluation is recommended. If results are outside the normal range, a repeat semen analysis is commonly ordered two to four weeks later to confirm findings, as natural variation between samples is well established and a second result is needed before a definitive clinical conclusion is drawn.

  • No, many cases of male infertility are temporary or correctable. Lifestyle-related impairment, hormonal imbalances, and surgically correctable conditions such as varicocele are often responsive to treatment. Men who have suppressed sperm production through testosterone or anabolic steroid use may recover fertility after discontinuing, though the timeline varies and full recovery is not guaranteed. More severe conditions, such as non-obstructive azoospermia due to primary testicular failure, may not be reversible in a traditional sense, but assisted reproductive options – including surgical sperm retrieval and IVF with ICSI – can still provide a path to biological parenthood.

Comprehensive Male Fertility Testing in New York City

If you are ready to get answers about your reproductive health, whether you have been trying to conceive for some time or simply want to better understand your fertility, NYU Langone Fertility Center is here to help. Our team brings together reproductive endocrinologists and reproductive urologists to provide integrated, expert male fertility evaluation and care in New York City, Manhattan, Westchester, Mount Vernon, and White Plains.

A thorough evaluation is the most direct path to clarity. Reach out today to schedule a male fertility consultation with our team.