Fertility Testing in Men – Why testing is important

Take-home points

• Fertility problems were historically focused on women, but male fertility issues are prevalent and impactful.
• Sperm quality globally is decreasing, with around 40% of fertility problems attributed to men.
• Couples often receive limited testing and information, leading to unaddressed male fertility concerns.
• Comprehensive education, early and advanced testing, and proper specialist referrals are vital for improved male fertility care and successful treatment paths.

Fertility issues in heterosexual couples have long been predominantly associated with women, perpetuated by societal norms that hinder progress for both men and women alike.

Sperm quality is decreasing

Over the past few decades, there has been a significant decline in sperm quality worldwide. Approximately 40% of fertility problems are attributed to men, and male factor infertility often plays a role in recurrent miscarriage and failed IVF.¹

Despite these statistics, men are rarely made aware of their potential fertility issues and seldom offered the necessary testing that could significantly improve their chances of conceiving.

Conception is a two-way street: Male and Female fertility matters

When a couple seeking to conceive approaches their general practitioner (GP), the standard set of tests typically focuses on the woman. She undergoes scans, blood tests, and is referred to a gynaecologist. However, for the man, the only test offered is a basic semen analysis, a procedure that has remained essentially unchanged for decades. At this point, the couple is often steered towards IVF without further investigating the reasons behind the suboptimal semen analysis. Consequently, the man receives little additional information or testing to determine why his sperm quality is subpar, and the couple proceeds with treatment without addressing potential male factors.

While IVF may result in success for some couples, many remain heartbroken and perplexed by their inability to conceive, often receiving the dreaded diagnosis of "unexplained infertility." These difficulties take a toll not only on women but also on men, who commonly experience depression, low mood, and loss of libido, profoundly affecting their well-being and relationships.

At this stage, couples may have already invested several years in their journey to parenthood, spending significant sums of money, all without receiving answers as to why they cannot conceive. Yet, one of the most crucial factors—sperm quality and male fertility—has been largely overlooked since their first visit to the GP. It is typically only considered once all tests on the woman have been completed, usually after several failed IVF cycles, and even then, it is not routinely conducted.

It is illogical to embark on an invasive, expensive, and emotionally charged process like IVF without thoroughly investigating both partners from the beginning. However, this scenario repeats itself time and time again.

The importance of education on fertility

Comprehensive education on fertility is crucial for both men and women. Women often have a reasonable understanding of their own fertility, thanks to increased media coverage. Unfortunately, men have access to very limited information.

It is time to provide men with a better understanding of their fertility and the options available to them. Improved education and more thorough testing are necessary.

Offering men more comprehensive tests from the outset could change the treatment path for many couples. Advanced tests, such as oxidative stress assessment, DNA fragmentation testing, and a comprehensive hormone profile, would provide men with a more accurate understanding of their fertility than a semen analysis alone.²

However, it is equally important to guide individuals towards appropriate medical professionals if issues are detected. Many couples end up consulting gynaecologists during their fertility investigations. While gynaecologists are specialists in female reproductive health, they are not experts in male reproductive health.

The importance of seeking professional guidance

If a man is facing fertility challenges, he should be referred to an Andrologist—a specialist in male reproductive health. An Andrologist can conduct further tests and examinations and provide clear guidance on potential treatments to help the man achieve fatherhood. However, the UK currently faces a shortage of Andrologists, and there is no clear referral pathway within the NHS unless a man experiences pain or lacks sperm in his ejaculate.

Men are left uninformed, without education, information, or clear treatment options, which significantly disadvantages couples seeking fertility treatment.

Now is the time for couples and men to demand additional support and clear guidance on testing. Policy changes are needed to improve male fertility care, ensuring that both men and women receive thorough investigations to address their fertility concerns.

TRTed is not financially supported or benefiting from Testhim in any capacity. Testhim have a number of resources on their website to support men with infertility. If you have any questions, please don't hesitate to reach out to us at info@trted.org.  

References

1. Kumar N, Singh AK. J Hum Reprod Sci 2015;8(4):191–196.
2. Dorostghoal M, et al. Andrologia 2017;10(49):e12762.