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Male Fertility Testing Through Your GP: What to Expect

Male Fertility Testing Through Your GP: What to Expect
Authored by
Francesca Steyn

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If you are worried about your fertility, your GP can provide an initial assessment and usually arrange or refer you for a semen analysis. This checks the number of sperm in your sample, how they move and their shape. Further examinations, hormone tests, scans or genetic tests may be considered if repeated semen analyses show a problem.

When should you see your GP about fertility?

The NHS advises speaking to your GP if you and your partner have not conceived after one year of regular unprotected sex. You should seek help sooner if your partner is aged 36 or over, either of you has a known or suspected fertility problem, or there is a relevant medical history such as cancer treatment.

You do not have to wait for a year if you already have a reason to be concerned. This might include:

  • Previous chemotherapy or radiotherapy
  • A history of undescended testicles, testicular injury or surgery
  • Previous testicular infection or a sexually transmitted infection
  • A varicocele or another testicular problem
  • Problems with erections or ejaculation
  • Use of testosterone or anabolic steroids
  • Previous abnormal semen-analysis results

Where possible, attend the first appointment together. Fertility problems can affect either or both partners, and investigating both people at the same time can reduce unnecessary delay.

What will your GP ask you?

Your GP will normally begin by asking about your medical, sexual and reproductive history. This can include:

  • How long you have been trying to conceive
  • How often you have sex and whether there are any difficulties with sex or ejaculation
  • Previous pregnancies, fertility tests or treatment
  • Operations, infections and long-term health conditions
  • Prescription medicines, supplements and non-prescription drugs
  • Smoking, alcohol, weight, exercise and occupational exposures
  • Testosterone treatment or anabolic-steroid use

Depending on your history, the GP may examine your testicles and penis or arrange further assessment. Be honest about medication and drug use. Testosterone and anabolic steroids can suppress sperm production, so this information may materially change the advice you receive.

What is the main male fertility test?

Semen analysis

A laboratory semen analysis is the usual first-line test for male fertility. It can assess:

  • Semen volume: the amount of fluid in the sample
  • Sperm concentration: how many sperm are present in each millilitre
  • Total sperm number: the total number in the complete sample
  • Motility: the proportion of sperm that move, including those moving progressively forwards
  • Morphology: the proportion of sperm with a typical shape
  • Vitality: the proportion of sperm that are alive, when this measurement is required

These results are assessed together. A single number does not provide a simple fertile or infertile verdict, and being below a reference value does not mean that natural conception is impossible.

Your clinic or andrology laboratory will give you instructions for producing and delivering the sample. Follow those instructions closely because the period since your last ejaculation, whether the full sample is collected and the time before analysis can all affect the result.

For a more detailed explanation, read Semen Analysis Explained with Andrologist Stuart Dawe-Long and How Abstinence Timing Affects Male Fertility Testing.

What happens if the semen-analysis result is abnormal?

One abnormal result is not normally treated as a final diagnosis because semen quality can vary between samples.

The 2026 NICE fertility guideline recommends a repeat confirmatory semen analysis when the first result is abnormal. This should ideally be performed about three months later, allowing for the sperm-production cycle. If the result shows azoospermia, meaning no sperm were seen, or severe oligozoospermia, the repeat should be arranged as soon as possible rather than waiting three months.

After two or more abnormal semen analyses, NICE recommends a physical examination of the scrotum and testicles. Testosterone and gonadotrophin blood tests may also be considered.

What other male fertility tests might be arranged?

Further tests depend on your history, examination and semen-analysis results. They are not all routinely needed.

Hormone blood tests

Blood tests may include testosterone and gonadotrophins such as follicle-stimulating hormone (FSH) and luteinising hormone (LH). These can help a specialist understand whether an abnormal semen result may be connected to sperm production or hormonal signalling.

Physical examination and ultrasound

A clinician may examine the testicles and surrounding structures for possible causes such as a varicocele, differences in testicular size or an absent vas deferens. An ultrasound may be requested when the history or examination suggests it would be useful, but it is not automatically required for everyone.

Genetic tests

Genetic tests are generally reserved for particular findings, especially azoospermia or a very low sperm concentration. The 2026 NICE guideline recommends:

  • Y-chromosome microdeletion testing for unexplained azoospermia or a sperm concentration below 1 million per millilitre
  • CFTR testing where obstructive azoospermia or an abnormality of the vas deferens is suspected
  • Karyotype testing for unexplained azoospermia, with testing also considered for a persistently low concentration below 5 million per millilitre

Genetic counselling should be offered when a relevant genetic condition is identified.

Chlamydia and other tests

A urine test for chlamydia may be included because infection can affect fertility. Other investigations will depend on your symptoms and clinical history.

Will your GP arrange a sperm DNA-fragmentation test?

Not routinely. The NICE guideline published in March 2026 recommends that sperm DNA-integrity or fragmentation testing should not be carried out as part of the standard investigation of fertility problems. If a private clinic suggests this test, ask how the result would change your treatment and what evidence supports its use in your circumstances.

What happens after the results?

Your GP or fertility team should explain the results in context rather than focusing on one isolated figure. The next step may be:

  • Repeating the semen analysis
  • Reviewing medication, testosterone or anabolic-steroid use
  • Addressing a possible infection or other health problem
  • Referral to a fertility clinic, andrology service, urologist or male-fertility specialist
  • Further hormone, imaging or genetic investigations
  • Discussing natural conception, IVF, ICSI, surgical sperm retrieval or donor conception, depending on the findings

An abnormal result does not automatically mean IVF or ICSI is the only option. It is reasonable to ask whether a potentially treatable cause has been properly considered and who will assess the male partner.

Questions to take to your GP appointment

  • Can you arrange a laboratory semen analysis or refer me to the appropriate service?
  • Should both partners be investigated at the same time?
  • Is there anything in my medical history or medication that could affect sperm production?
  • If the result is abnormal, when will it be repeated?
  • At what point would I be referred to a male-fertility specialist or urologist?
  • Who will explain the complete result, rather than only telling me whether it is normal or abnormal?

The most important thing to remember

Male fertility testing should not be an afterthought. A semen analysis is the usual starting point, but abnormal results may need confirmation and proper investigation. Asking for a clear explanation, an appropriate repeat test and specialist assessment where indicated can help you understand what is happening and make better-informed decisions about what comes next.

If the process is affecting your mental health or relationship, you can also join The Male Fertility Hub community to connect with other men and couples going through similar experiences.

Sources

This article provides general information and does not replace individual medical advice. Speak to your GP or fertility specialist about your circumstances.

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