Scrotal ultrasound. This test uses high-frequency sound waves to look at the testicles and supporting structures.

Transrectal ultrasound. A small lubricated wand is inserted into your rectum to check your prostate, and for blockages of the tubes that carry semen (ejaculatory ducts and seminal vesicles). Hormone testing. Your doctor may recommend a blood test to determine the level of hormones produced by the pituitary, hypothalamus and testicles, which play a key role in sexual development and sperm production. Post-ejaculation urinalysis. Sperm in your urine can indicate your sperm are traveling backward into the bladder instead of out your penis during ejaculation (retrograde ejaculation). Genetic tests. When sperm concentration is extremely low, genetic causes could be involved. A blood test can reveal whether there are subtle changes in the Y chromosome signs of a genetic abnormality. Genetic testing may also be ordered to diagnose various congenital or inherited syndromes. Testicular biopsy. This test involves removing samples from the testicle with a needle. It may be used if your semen analysis shows no sperm at all. The results of the testicular biopsy will tell if sperm production is normal. If it is, your problem is likely caused by a blockage or another problem with sperm transport.

Anti-sperm antibody tests. These tests are used to check for immune cells (antibodies) that attack sperm and affect their ability to function. Specialized sperm function tests. A number of tests can be used to evaluate how well your sperm survive after ejaculation, how well they can penetrate an egg and whether there's any problem attaching to the egg. If you do have a low sperm count, having healthy sperm can be an important factor in male fertility. Hormone evaluation--measures blood levels of the hormones involved in sperm production, abnormal hormonal levels are indicative of the hormonal problems described that cause infertility. Semen culture--checks for bacteria in the semen which either cause or indicate a genital infection

that may cause infertility. Biochemical analysis of semen--measures various chemical in semen; a chemical imbalance may impair fertility. Post-coital/cervical mucus test--checks the compatibility of a mans sperm with the mucus of his partners cervix. If the sperm and mucus are incompatible, the sperm is unable to pass through the mucus into the fallopian tubes and fertilize the egg. Sperm penetration assay (Hamster test)--measures sperm-egg membrane fusion using hamster eggs a mans sperm: tests the capability of the sperm to penetrate the egg during IVF. A thorough physical examination and history can diagnose physical problems such as varicocoeles, Klinefelters Syndrome, retrograde ejaculation, erectile disfunction, and premature ejaculation. An absence of sperm in the semen sample is indicative of ejaculatory incompetence, retrograde ejaculation, or one of the conditions that block the spermatic ducts.