The first step in diagnosing male infertility is to evaluate a sperm sample, provided either through masturbation, electric stimulation, or by undergoing urological surgical procedures (MESA, PESA, or TESE). The semen sample is analyzed for sperm count, sperm motility (amount of movement), and sperm morphology (general health of the sperm). If the sperm are found to be abnormal, or if the patient has low sperm production, then information from the sample can also help determine the best infertility treatment (such as IUI or ICSI with IVF).
A postcoital test checks to see if the man’s sperm are present and moving normally in a woman’s cervical mucus after intercourse. This test is performed when a woman is not able to become pregnant and other tests have not found the cause. Since other fertility testing can usually find the cause of infertility, however, postcoital tests are not performed very often.
The timing of a postcoital test is one to two days before the woman is supposed to ovulate – this is when the cervical mucus is thin and flexible, allowing the sperm to move easily through the mucus into the uterus. The couple is instructed to have intercourse two to eight hours before the test is scheduled.
A man may be tested for elevated levels of the prolactin hormone, which can be the cause of a lack of sexual desire and erectile dysfunction and therefore impacts a couple’s ability to get pregnant. Prolactin hormone may also be tested if the patient’s testosterone levels are low.
Elevated prolactin levels can also indicate a tumor in the pituitary gland, leading to other problems including infertility.