Trying to Conceive Without Success: What a Man Can Have Tested

Month after month you see the same single line, and slowly the question creeps in whether it might be you. A fair question, and an important one: when conception does not work, the cause lies entirely or partly with the man in about half of cases. Yet in practice it is mostly the woman who gets investigated first.

My take: as a man, get investigated in parallel, not only once she has been through everything. It saves time, and with a wish to conceive, time matters.

What can a man have tested?

Roughly two tracks that complement each other. A semen analysis assesses the number of sperm cells, their motility and their shape. A blood test looks at the hormones that steer sperm production. To be honest about scope: a blood test maps the hormonal side, while the semen analysis itself usually runs through your GP or a fertility clinic. Together they give a fuller picture than either alone.

In practical terms, a semen analysis asks for a few days of abstinence beforehand and a fresh sample, often requested through the GP. Because a single result can disappoint due to, say, fever or stress, an abnormal result is usually repeated after some time before conclusions are drawn. Keep that in mind in terms of expectations and time.

Which hormones play a role?

FSH and LH steer your testicles from the brain, and testosterone is needed locally for sperm production. A raised prolactin can disrupt that steering. It is the pattern between these values that can help your doctor look for the cause, not a single number. Also see sperm quality and hormones.

Which track fits which situation?

Use this as a reading guide for the conversation with your GP, not as a diagnosis.

How do you read the pattern?

A single value says little, the pattern says more. Two examples, purely as illustration and explicitly not a diagnosis. A raised FSH and LH together with a low testosterone can fit a problem in the testicles themselves. A low FSH and LH with a low testosterone points more towards the steering from the brain, the pituitary. Which direction your result points in, and what that means, is for your doctor to determine in the context of your story and any semen analysis. The goal of a blood test is not to conclude yourself, but to sharpen the conversation.

What can you do yourself for your odds?

Several lifestyle factors are in your own hands. Quitting smoking, going easy on alcohol, working towards a healthy weight and limiting stress can favourably affect sperm quality and hormone balance. Here too: because sperm cells mature over months, you only see effects later. None of these steps is a guarantee of pregnancy, but they are dials you have a grip on while any investigation runs its course.

The STI factor that is often forgotten

A past, untreated STI can play a role. Soa Aids Nederland notes that chlamydia in men can lead to inflammation in the epididymis, which can affect fertility, and that many STIs run without clear symptoms. An STI test when in doubt is therefore a logical, quick step you can take together with your GP.

When is investigation reasonable?

If it does not work after about a year of unprotected trying, investigation in both partners is reasonable; with known risk factors it can be earlier. This aligns with the line of the NHG guideline on subfertility and with what the RIVM describes about factors that can affect fertility, such as age, smoking and excess weight. Discuss your situation with your GP; a blood test supports the conversation but does not replace it. Also see male fertility: what every man needs to know.

The side you do not measure

A wish to conceive that does not come true straight away also does something to your head and to your relationship. Shame, guilt and the feeling that you are failing are more often the rule than the exception, especially among men who say little about it. An abnormal result sometimes feels like a personal shortcoming, but it is not: it is information, not a verdict. Talk about it with your partner and, if it keeps nagging, with your GP. The numbers tell the story of your hormones, not the whole story of the two of you.

Getting started

The Hormones Man panel brings FSH, LH, testosterone and prolactin together as the hormonal side of the story. If you want a broader look at your overall health, the Complete Mens Health Panel may fit. Bring your result to your GP; together with your story and any semen analysis, that gives the fullest picture. Always interpret a result in consultation with a doctor; this article provides general information and is not a diagnosis.