Male Factor Infertility: Causes, Testing and Treatment

Male factors are involved in a substantial proportion of infertility cases, either alone or alongside female factors, and men usually have no symptoms. That combination is why a semen analysis belongs early in any investigation rather than after the female partner has been worked up. It is the least invasive and least expensive test available. Most causes have something that can be done about them, ranging from treating an infection or a varicocele through to ICSI or surgical sperm retrieval.

What are the common male fertility problems?

Low sperm count

One of the most common findings. Conception is less likely, not impossible, and treatment options exist. Reference values come from the WHO laboratory manual for the examination and processing of human semen, now in its sixth edition; the current sixth edition sets the lower reference limit for sperm concentration at 16 million per mL, replacing the 15 million figure used in the previous edition. Our article on low sperm count covers this.

Poor motility

Sperm that do not move well are less likely to reach an egg. Causes include infection, heat exposure, varicocele and lifestyle factors.

Abnormal morphology

A high proportion of abnormally shaped sperm can impair fertilization. The percentage considered normal is much lower than most people expect, so this result is frequently misread as worse than it is.

Hormonal problems

Testosterone, FSH and LH drive sperm production, and disorders such as hypogonadism can impair it. This is worth identifying because it is one of the causes with a specific medical treatment.

Varicocele

An enlargement of the veins within the scrotum, comparable to varicose veins in the leg. It can affect sperm production and quality, and it can be treated surgically. It is one of the more common correctable causes, which is why it is worth looking for.

Genetic causes

Chromosomal and genetic conditions can affect sperm production. Genetic testing is generally offered where no sperm is found in the semen, or where there is a relevant family history.

Infection and lifestyle

Infections of the reproductive tract can damage sperm or cause obstruction. Smoking, alcohol, recreational drugs and sustained heat exposure all affect semen quality. See our articles on smoking and fertility and diet and sperm.

How is male infertility investigated?

A semen analysis comes first, measuring count, concentration, motility, morphology and vitality. Because results vary considerably between samples, an abnormal result is usually repeated before conclusions are drawn.

Depending on what it shows, further investigation may include hormone profiling, physical examination, imaging, and genetic testing where no sperm is present.

What are the treatment options?

• Treating an identified cause, such as an infection, a hormonal disorder, or a varicocele.
• Lifestyle change, which works over months rather than weeks because a cycle of sperm production takes roughly two to three months. It can improve a borderline result but will not resolve a structural, genetic or obstructive cause.
• Medication, where a specific hormonal abnormality has been identified. This must be prescribed and monitored by a specialist. Testosterone in particular is worth understanding: taking testosterone suppresses sperm production rather than improving it, so it is not a fertility treatment, and men taking it for other reasons should raise that with their doctor.
• Surgery, to repair a varicocele or relieve an obstruction.
• Assisted reproduction. IUI where there are enough motile sperm, IVF, or ICSI where sperm quality is significantly impaired. Where there is no sperm in the ejaculate it can often be retrieved surgically through TESA, PESA or TESE.

We at Millennium IVF Clinic investigate both partners. You can arrange a consultation with our team.

Frequently asked questions

Does male infertility have symptoms?

Usually not. This is precisely why testing matters: there is nothing to notice, so it is found only by looking.

Will taking testosterone improve my fertility?

No. Testosterone therapy suppresses the body's own sperm production. If you are taking it, tell your fertility specialist.

Can male infertility be cured?

Some causes can be treated directly, such as infection, hormonal disorders and varicocele. Others are managed with assisted reproduction rather than cured. Which applies depends on the cause, which is why identifying it comes first.

How long before lifestyle changes show up on a test?

At least two to three months, since that is roughly the length of a cycle of sperm production.