When are special sperm tests needed?
In some cases, standard semen analysis is not enough.
Additional sperm tests may be recommended if there is unexplained infertility, repeated IVF or ICSI failure, recurrent miscarriage, severe oligozoospermia, poor sperm motility, abnormal morphology, older paternal age, varicocele, smoking, oxidative stress risk or previous infection.
Special tests may include:
- sperm DNA fragmentation testing
- oxidative stress assessment
- antisperm antibody testing
- semen culture when infection is suspected
- advanced morphology assessment
- sperm function-related tests before assisted reproduction
Sperm DNA fragmentation testing can be especially useful when the semen parameters are only mildly abnormal but pregnancy does not occur, or when embryo development or implantation has been repeatedly unsuccessful.
Hormonal and ultrasound evaluation
Male fertility is closely connected to hormonal and testicular function.
The evaluation may include testosterone, free testosterone, SHBG, FSH, LH, prolactin, oestradiol and thyroid-related parameters when needed.
Testicular ultrasound can help assess testicular volume, structure, varicocele, epididymal abnormalities or other anatomical factors that may affect fertility.
In selected severe cases, genetic testing may also be required before assisted reproduction.
Treatment options
Treatment depends on the underlying cause.
Possible treatment options include lifestyle optimisation, weight reduction, smoking cessation, antioxidant therapy, treatment of infection or inflammation, hormonal treatment in selected cases, varicocele treatment when clinically relevant, and correction of reversible risk factors.
If sperm production is severely reduced, the aim is to determine whether medical treatment can improve sperm quality or whether assisted reproduction should be planned.
Assisted reproduction planning
A key part of male fertility evaluation is deciding which reproductive method is realistic.
Depending on the semen result, the couple may be suitable for natural conception, intrauterine insemination, IVF or ICSI.
In some men, the semen quality is still suitable for IUI. In more severe cases, IVF or ICSI may be the more effective option.
The andrological assessment helps avoid unnecessary delay and helps choose the most appropriate fertility strategy.
