Male Fertility Tests in London: Semen Analysis, Hormones and What Results Mean
Updated: 4 hours ago
Male fertility assessment usually begins with a medical and reproductive history, a physical examination and a semen analysis. Hormone, genetic and imaging tests are selected according to the clinical findings and semen results; they are not automatically required for everyone. A single semen analysis cannot, by itself, prove that a man is fertile or infertile.
If you and your partner have not conceived after 12 months of regular unprotected sex, both partners should usually be assessed at the same time. Earlier advice may be appropriate when the female partner is aged 36 or over, either partner has a known fertility risk, or there has been cancer treatment, a genital operation, testicular injury, undescended testes, an infection or exposure to anabolic steroids.
This guide explains the usual steps in a male fertility assessment, how to prepare for semen analysis and how results are interpreted in context.
What happens at a male fertility consultation?
A consultation is intended to identify potentially reversible causes, select the right investigations and understand the couple’s reproductive goals. It may cover:
how long you have been trying to conceive and the timing of intercourse;
previous pregnancies, fertility treatment or semen tests;
childhood and adult illnesses, undescended testes, infections, injury or surgery;
erections, ejaculation, libido and testicular symptoms;
current medicines, supplements, testosterone or anabolic-steroid use;
smoking, alcohol, recreational drugs, occupational heat or chemical exposure;
family history of infertility or relevant genetic conditions; and
the health and fertility assessment of the other partner.
The physical examination may include the testes, epididymides and spermatic cords and may look for findings such as a varicocele or an absent vas deferens. The need for any examination or test should be explained, and consent and privacy maintained throughout.
Semen analysis: the first laboratory test
Semen analysis measures characteristics of semen and sperm, commonly including:
semen volume;
sperm concentration and total sperm number;
progressive and total motility;
morphology, or the proportion of sperm with a reference shape;
vitality when clinically appropriate; and
other laboratory observations relevant to the sample.
Current UK guidance compares results with World Health Organization reference values when the sample has been collected and analysed using the corresponding WHO method. These values are lower reference limits derived from men whose partners conceived; they are not a pass-or-fail fertility test. Results above a reference limit do not guarantee conception, and results below it do not mean that natural conception is impossible.
How should I prepare for semen analysis?
Follow the instructions from the laboratory performing the test, because collection and transport requirements can differ. Laboratories commonly request a defined period without ejaculation before collection. The WHO reference method uses an abstinence interval of 2 to 7 days, but the laboratory’s instructions take priority.
Tell the clinician or laboratory if the sample was incomplete, collection was difficult, you were recently unwell with a fever, or the sample could not be delivered within the requested time. These factors can affect interpretation. Do not stop prescribed medicines solely for a semen test unless the prescribing clinician has advised you to do so.
What if the first semen result is outside the reference range?
Semen parameters vary naturally, and illness or collection factors can influence a sample. NICE recommends a repeat confirmatory test when the first analysis is abnormal, ideally after about three months to allow a cycle of sperm formation. When azoospermia or severe oligozoospermia is detected, repeat testing should be arranged sooner.
The European Association of Urology similarly recommends at least two consecutive analyses when the baseline result is abnormal. A clinician should interpret the pattern rather than a single number and decide whether further investigation is needed.
If no sperm are seen, the laboratory may examine a centrifuged sample to confirm azoospermia. This finding requires specialist assessment; it does not identify the cause on its own.
When are hormone blood tests useful?
Hormone tests help distinguish problems in sperm production from disorders affecting hormonal signalling. Tests may include total testosterone, follicle-stimulating hormone and luteinising hormone, with prolactin or other tests when indicated.
NICE advises considering testosterone and gonadotrophin measurements after two or more abnormal semen analyses. EAU guidance recommends hormonal evaluation in oligozoospermia and azoospermia. The appropriate panel still depends on symptoms, examination and the semen pattern.
External testosterone is particularly important to disclose. Testosterone replacement and anabolic-androgenic steroids can suppress the pituitary signals needed for sperm production and may markedly reduce or stop sperm production. Anyone trying to conceive should obtain specialist advice before starting testosterone and should not start, stop or change prescribed treatment without their clinician.
Prof Castiglione co-authored a recent study examining recovery after short-term anabolic-androgenic steroid use in recreational bodybuilders. It is relevant to specialist assessment of steroid-related reproductive suppression, but it should not be used as a self-treatment protocol.
When are genetic tests or ultrasound appropriate?
Genetic testing is not a routine test for every man. It may be recommended with azoospermia, severe oligozoospermia, absent vas deferens or another finding that suggests a genetic cause. Depending on the situation, testing may include a karyotype, Y-chromosome microdeletion analysis or CFTR testing. Genetic counselling is important when a potentially inherited finding is identified and before assisted reproduction where relevant.
Imaging is also selected according to the clinical question. Scrotal ultrasound can assess the testes and surrounding structures; transrectal ultrasound may be used when an ejaculatory-duct obstruction is suspected. Imaging should complement—not replace—history, examination and laboratory assessment.
Are advanced sperm tests always needed?
No. Additional tests should be ordered only when the result is likely to answer a defined clinical question or change management.
Guidelines do not fully agree on every advanced test. NICE 2026 advises against sperm DNA fragmentation testing because the evidence did not show a convincing treatment benefit. EAU guidance recommends it in selected situations, including recurrent pregnancy loss, failure of assisted reproductive treatment or unexplained male infertility. This difference makes individual discussion particularly important; testing should not be marketed as a universal screening test.
Routine antisperm-antibody testing is not recommended by NICE. EAU guidance advises against routine reactive oxygen species testing in the diagnostic work-up.
What happens after the assessment?
The next step depends on the cause, the other partner’s assessment and the couple’s priorities. It may include:
treating a defined medical or hormonal disorder;
reviewing a medicine or exposure that may impair sperm production;
evidence-based lifestyle support, including smoking cessation and weight management where relevant;
discussing surgery for a clinically significant structural problem in selected cases;
fertility preservation or sperm retrieval when indicated; or
coordinated referral for assisted reproduction.
Not every abnormal semen result has a correctable cause, and no ethical clinician can promise pregnancy. A useful plan explains what is known, what remains uncertain and how each option may affect time, cost, fertility and general health.
Frequently asked questions
Does a normal semen analysis guarantee fertility?
No. Semen analysis provides important information, but it cannot distinguish every fertile man from every infertile man. Conception also depends on the other partner, timing and factors that are not captured by routine semen measurements.
Should an abnormal semen analysis be repeated?
Usually, yes. NICE recommends a repeat confirmatory test after an abnormal first result, ideally around three months later, or sooner for azoospermia or severe oligozoospermia. The clinician and laboratory will advise the appropriate timing.
How long should I abstain before providing a semen sample?
Follow the laboratory’s instructions. WHO-based testing commonly uses 2 to 7 days without ejaculation. Using the same interval for repeat samples can also help comparison.
Are hormone tests needed for every man?
No. Hormone tests are selected using the semen results, symptoms and examination. They are especially important in oligozoospermia or azoospermia and when a hormonal disorder is suspected.
Can testosterone treatment improve male fertility?
External testosterone can suppress sperm production and should not be used to treat male infertility. Men who want children should discuss fertility before any testosterone prescription. Do not stop prescribed treatment without medical advice.
When should testicular symptoms be assessed urgently?
Sudden severe testicular pain requires urgent medical assessment. A new lump, swelling or persistent change should also be examined promptly. Fertility testing should not delay assessment of a possible acute or testicular condition.
Male fertility assessment in London
A consultant-led assessment can review both reproductive and general health, interpret semen results in context and select further tests only when they are likely to be useful. To enquire about a confidential consultation with Holistic Andrology in London, use the online booking page or email info@holisticandrology.com.
If you are beginning with a general question, read How to Know if a Man Is Fertile: Signs, Tests and When to Seek Help.
This article provides general educational information and does not replace an individual medical assessment, diagnosis or treatment plan.
About the author
Prof Fabio Castiglione, MD, PhD, FECSM, FEBU Professor of Urology (Italy); Consultant Urologist and Andrologist, King’s College Hospital NHS Foundation Trust; Honorary Reader, King’s College London; Academic Lead of Urology; GMC No. 7542824; Director and Founder, Holistic Andrology.
PubMed publications: https://pubmed.ncbi.nlm.nih.gov/?term=fabio+castiglione+&sort=date
King’s College Hospital consultant profile: https://www.kch.nhs.uk/services/consultants-a-to-z/dr-fabio-castiglione/
Updated: 17 September 2026
Last clinical review: 17 September 2026
Medical sources
NICE. Fertility problems: assessment and treatment (NG257), investigation of male factor fertility problems, published 31 March 2026. https://www.nice.org.uk/guidance/NG257/chapter/investigation-of-fertility-problems-and-management-strategies
European Association of Urology. Sexual and Reproductive Health Guidelines: Male Infertility, current web edition accessed 10 September 2026. https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-infertility
NHS. Diagnosis of infertility. https://www.nhs.uk/conditions/infertility/diagnosis/
NHS. Low sperm count. https://www.nhs.uk/conditions/low-sperm-count/
İbis MA, et al. Post-cycle therapy after short-term anabolic-androgenic steroid use: comparative outcomes in recreational bodybuilders. PubMed PMID 41147237. https://pubmed.ncbi.nlm.nih.gov/41147237/
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