9. Perform advanced tests on the man: Some men will require more advanced investigations to establish a correct diagnosis and prognosis.
Hormonal problems can cause or be associated with severe male factor infertility. Blood tests for the measurement of gonadotropins, testosterone and prolactin can assist in the diagnosis in males with poor semen analysis. (ASRM, 2012b; NICE, 2012; ASRM, 2008)
In men with azoospermia or severe oligospermia, genetic testing may be offered to identify men with Kleinfelter’s syndrome and other genetic defects. In rare cases, ultrasonographic evaluation and/or semen culture may assist in identifying pathology in the male genital tract that requires treatment irrespective of its potential impact on male fertility.
A variety of tests for sperm function, anti-sperm antibodies and sperm DNA fragmentation exist, but they play a limited role in the practical management of the infertile couple.
The interpretation of advanced tests in an infertile male patient requires special expertise (Tomlinson, 2013).