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Men's fertility testing guide · 2026
A male factor contributes in roughly half of couples, and the first test is cheap, quick and frequently skipped for a year.
Male fertility testing starts with a semen analysis, not a hormone panel. Two samples are usually collected at least a few weeks apart, after 2 to 7 days of abstinence, because normal variation between samples is substantial. Hormones — morning total testosterone, LH, FSH and prolactin — are added when the semen analysis is abnormal, when testosterone deficiency is clinically suspected, or where sperm concentration is very low. A single abnormal semen analysis is common and is not a diagnosis on its own.
| First test | Semen analysis, repeated at least once for confirmation |
|---|---|
| Abstinence | 2 to 7 days before each sample; keep it consistent between samples |
| Hormones | Morning total testosterone, LH, FSH, prolactin, SHBG |
| Genetic tests | Karyotype and Y-chromosome microdeletion where counts are very low |
| Price | Listed on the MedEx lab test catalogue — same price nationwide |
| Interpretation | Doctor consultation or specialist teleconsultation to review the report |
Results vary considerably between samples from the same person, which is why one abnormal result rarely means much. Preparation matters:
The report covers volume, concentration, total count, motility, progressive motility and morphology. Laboratories compare against WHO reference values, which describe a reference population rather than a fertility threshold — a value slightly below reference does not mean conception is impossible.
A hormone panel is indicated when the semen analysis is abnormal, when there are symptoms of testosterone deficiency, or where sperm concentration is very low or absent. It normally includes morning total testosterone, LH, FSH and prolactin, with SHBG where the testosterone is borderline.
| Low testosterone, high LH/FSH | Primary testicular failure |
|---|---|
| Low testosterone, low or normal LH/FSH | Pituitary or hypothalamic cause — check prolactin, iron studies, medicines |
| Normal FSH with no sperm in the ejaculate | Raises the possibility of obstruction, a different pathway with different options |
| Suppressed LH/FSH with high testosterone | Strongly suggests exogenous androgen or anabolic steroid use |
That last row is common and often unmentioned. Anabolic steroid use suppresses sperm production, sometimes for many months after stopping. Disclosing it changes the plan entirely and is worth raising in a confidential doctor consultation.
Book a semen analysis and a morning hormone draw in the same week.
Where sperm concentration is very low or absent, guidelines recommend genetic assessment: a karyotype, Y-chromosome microdeletion testing, and CFTR (cystic fibrosis gene) testing where congenital absence of the vas deferens is suspected. These change both prognosis and the counselling given before assisted reproduction.
A scrotal examination and ultrasound assess for varicocele, testicular volume and structural abnormalities. Genetic testing is available through the MedEx genetic testing service.
Several contributors are modifiable and act over the same two to three month window as a sperm production cycle, so changes made now show up in a repeat sample:
Two to seven days, and keep the same interval before a repeat sample so the two are comparable. Longer or shorter intervals change the result.
No. Variation between samples from the same person is substantial, so at least one repeat is standard before drawing conclusions. Recent fever, illness or an unusual abstinence interval are common explanations.
Not always. Hormones are added when the semen analysis is abnormal, when symptoms suggest testosterone deficiency, or when sperm concentration is very low or absent.
No, the opposite. Exogenous testosterone suppresses the pituitary signals that drive sperm production and can cause prolonged infertility. Tell your clinician if you are using or have used it, including anabolic steroids.
A sperm production cycle takes roughly two to three months, so a repeat analysis around three months after making changes is more meaningful than an earlier one.
Where sperm concentration is very low or absent. A karyotype, Y-chromosome microdeletion testing and CFTR testing are the usual assessments.
One abnormal result is not a diagnosis. Get it interpreted properly.
Medical disclaimer: This article is general health information and does not replace medical advice, diagnosis or treatment. Laboratory reference ranges differ between laboratories and results must be interpreted alongside your symptoms, medicines and medical history. Speak with a qualified clinician before starting, stopping or changing any treatment. Service details, inclusions and prices can change — confirm them with MedEx before booking.
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