What is the single most important hormone level to be tested in the evaluation of infertile men?

FSH is the most important hormone level. FSH indirectly relates to sperm concentration and therefore can be helpful in determining whether lack of sperm production or obstruction is responsible for a low sperm concentration.

What hormones should be tested in males? When should hormonal testing be performed? Why?

Hormonal testing for infertile males consists of testosterone and FSH. However men with sperm counts greater than 10 million/mL rarely have significant hormonal abnormalities and Testosterone levels are unlikely to be of any benefit. FSH values can be predictive for the outcome of any type of fertility treatment, including hormonal manipulation and/or varicocele repair. Therefore, FSH determinations may be beneficial in all men before undergoing any therapy, but testosterone determination probably should be reserved for men who have severe oligoasthenospermia and/or signs of hypogonadism including small testicular size. In the case of a low testosterone level, it is important to look at other hormones that may affect testosterone production, including prolactin, estradiol, LH and FSH. These hormones are typically best measured early in the morning.

My doctor believes that I might have an immune disorder that is causing my infertility. What are the most common tests to diagnose this problem?

  • Antithyroglobulin Antibodies (ATA) can cause problems with the function of your thyroid. These antibodies can disrupt other hormone levels, thus affecting egg production. Treatment for high ATA levels may consist of steroids.
  • Antisperm Antibodies (ASA) can be found in both males and females. Males who have had vasectomy reversal or have injured their testicles can produce ASA (semen specimen) Female (blood test) ASA are found in the cervical mucus as well as in blood. The ASA attaches to the head of the sperm and make it hard for the sperm to penetrate an egg. IVF with ICSI treatment is recommended for couples with ASA.
  • The Anti Phospholipids Antibody (APA) test is conducted if you have had multiple miscarriages. APA can interfere with the embryo implanting. APA disrupts the normal clotting of blood and the adhesion of the embryo to the uterus. APA tests for a number of different antibodies. If your test results show that two or more are positive treatment is either by baby aspirin or heparin.
  • Antinuclear Antibodies (ANA) can increase your risk of miscarriage when the result is a low positive with a speckled pattern. If your result highly positive you may have a disease called systemic lupus erythematosus (SLE). A positive ANA level may be treated with low-dose steroids.
  • Antiovarian Antibodies (AOA). This test is ordered when early menopause or premature ovarian failure are possible diagnoses.
  • Natural killer (NK) cells of white blood cells that attack and destroy anything that is a foreign substance in the body. If the NK cell count is high these cells may be aggressive and attack a growing embryo. Treatment for NK cells is intravenous immunoglobulin therapy (IVIG). This can be very expensive procedure and controversial among infertility specialists. A drug called Enbrel can also be used to treat NK cells.

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