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The aforementioned tests are highly sophisticated and are not easily available. Another drawback is that these tests are often not standardized adequately, so that interpreting their results can be quite difficult.
The ultimate sperm function test is IVF, since this directly assesses whether or not the husband's" sperm can fertilize the wife's eggs. The best way to perform this test is to culture some of the eggs with the husband's sperm and the others with donor sperm of proven fertility, at the same time. If the donor sperm can fertilize the eggs, and the husband's sperm fail to do so, then the diagnosis of sperm inability to fertilize the eggs is confirmed. However, even this test is not infallible since it has been shown that about 5% of sperm samples which fail to fertilize an egg in the first IVF attempt, can do so in a second attempt at IVF. In any case, it is obviously not practicable or feasible to use IVF as a test for sperm function in clinical practice.
The serum FSH (follicle-stimulating hormone) level test is a very useful one for assessing testicular function. If the reason for the azoospermia or severe oligospermia is testicular failure, then this is reflected in a raised FSH level. This is because, in these patients, the testis also fails to produce a hormone called inhibin (which normally suppresses FSH levels to their normal range). A high FSH level is usually diagnostic of testicular failure. This test is done by a radioimmunoassay or ELISA test, and since it is a laboratary sophisticated test, it is best done in a specialized. Abnormal test results should be repeated and rechecked for confirmation. The other reason for a high FSH level in some men is the consumption of clomiphene (a medicine often prescribed for the empiric treatment of oligospermia). This is why the test should be done only when no medication is being taken. While a high FSH level is diagnostic of testicular failure, a normal FSH level provides no useful information. Rarely, the FSH level may be low. A low FSH level is found in patients with hypogonadotropic hypogonadism.
This is an uncommon (but treatable!) cause of azoospermia. Along with an FSH level test, most doctors also do an replacement therapy (in the form of injections or tablets). LH (luteinizing hormone) level test, which provides mostly the same information.
A testosterone level test provides information on whether or not the testes are producing adequate amounts of the male hormone, namely, testosterone. Most infertile men have normal testosterone levels, because the compartment for testosterone production is separate from the compartment which produces sperm, and is usually intact in infertile men. A low testosterone level causes a decreased libido and this can be treated by testosterone. Of course, this therapy will not increase the sperm count.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
