Diagnosis begins with a semen assessment and often hormone testing (including FSH, LH, testosterone and prolactin). Other diagnostic steps include but are not limited to:
- Ultrasound: of the prostate and seminal glands
- Semen assessment: a front line test to evaluate the main parameters of concentration (sperm numbers), motility and morphology (sperm shape) from an ejaculate.
Normal ejaculate as defined by WHO reference values
Sperm concentration less than WHO reference values
Sperm motility less than WHO reference values
Sperm morphology less than WHO reference values
- Oligoasthenoteratozoospermia (OAT):
Disturbance of all three variables (combinations of only two prefixes may also be used)
Complete absence of sperm within the ejaculate
Few spermatozoa recovered after centrifugation
- Biochemical and urine analysis
- Immunological testing, including detection of antisperm antibodies.
- Tests on the interaction of sperm and cervical mucus, including for example the postcoital test according to Sims-Huhner, or the SCMC (sperm cervical mucus contact) contact test.
- Testicular biopsy
- Function tests in erectile dysfunction
- Microsurgery TESE, MESA
- Microsurgery for men includes MESA/TESE
(microsurgical epididymal sperm aspiration / testicular sperm extraction). Both procedures are performed under general anaesthetic and are used to obtain sperm, which is then processed for ICSI.
MESA is used effectively for obstructive azoospermia and usually yields high sperm counts for IVF, with the goal of obtaining enough sperm for subsequent IVF cycles.
TESE is used for sperm extraction and is an open biopsy procedure. It is often used when no sperm are found in the epididymis; however, it yields fewer sperm than MESA.