Male infertility is an important factor when a couple experiences difficulty achieving a pregnancy and may occur alone or alongside female fertility factors. It can be related to problems with sperm production, sperm count, movement or shape, as well as conditions that affect the transport or ejaculation of sperm. In many cases, there may be no obvious symptoms apart from difficulty conceiving.
For this reason, fertility assessment should involve both partners from the beginning. The initial evaluation of male fertility usually includes a detailed medical and reproductive history together with a semen analysis, which provides important information about sperm concentration, motility and morphology.
Depending on the results, further investigations may be recommended to identify the underlying cause. Today, a range of treatments is available for male infertility, from medical or surgical management to assisted reproductive techniques such as IUI, IVF and ICSI.
Male infertility is more common than many people realise. Male factors are involved, either alone or together with female factors, in approximately half of couples experiencing infertility. This is why fertility assessment should not focus only on the female partner, but should evaluate both partners from the beginning.
Male fertility can be affected by different abnormalities in the semen, including:
- low sperm concentration or sperm count,
- reduced sperm motility,
- abnormal sperm morphology,
- complete absence of sperm in the ejaculate, known as azoospermia.
A man may have no noticeable symptoms and may only discover a fertility problem after experiencing difficulty conceiving with his partner. For this reason, a semen analysis is one of the most important initial tests when investigating possible male factor infertility.
What Are the Main Causes of Male Infertility?
Male infertility can have many different causes. Some affect the production or quality of sperm, while others interfere with the transport or ejaculation of sperm. In certain cases, more than one factor may be present, while in others the exact cause may remain unclear.
Varicocele
A varicocele is an enlargement of the veins within the scrotum and is one of the conditions that may affect male fertility. In some men, it can be associated with impaired sperm production or abnormal semen parameters.
Problems With Sperm Production and Azoospermia
Some men produce a reduced number of sperm, while others may have azoospermia, meaning that no sperm are detected in the ejaculate. Azoospermia may result either from an obstruction that prevents sperm from reaching the semen or from impaired sperm production within the testes.
Obstruction and Ejaculatory Problems
Blockages within the male reproductive tract can prevent sperm from being released normally. Erectile dysfunction, ejaculation disorders and certain previous surgeries may also interfere with natural conception.
Genetic, Medical and Other Causes
Male fertility may also be affected by:
- genetic or chromosomal abnormalities,
- hormonal disorders,
- infections, including some sexually transmitted infections,
- previous chemotherapy or radiotherapy,
- trauma or injury to the testes,
- certain medications or medical conditions.
Identifying the underlying cause is important because some conditions may be treated directly, while others may require assisted reproductive techniques to achieve pregnancy.
How Is Male Infertility Diagnosed?
The diagnosis of male infertility begins with a detailed medical and reproductive history and a semen analysis. The aim is not only to identify abnormalities in sperm, but also to investigate whether there is an underlying condition that may be affecting fertility.
Medical and Reproductive History
During the initial consultation, the doctor may ask about previous pregnancies, medical conditions, medications, previous surgery, infections, sexual function and any history of trauma or treatment such as chemotherapy or radiotherapy. A physical examination may also be recommended when indicated.
Semen Analysis
A semen analysis is one of the most important tests in the evaluation of male fertility. It provides information about several semen parameters, including:
- sperm concentration and count,
- sperm motility,
- sperm morphology,
- semen volume.
An abnormal result does not always establish infertility on its own. Semen parameters can vary between samples, and in some cases the test may need to be repeated.
Additional Male Fertility Tests
Depending on the semen analysis and medical history, further investigations may include hormonal blood tests, genetic testing or imaging. Men with azoospermia or severely reduced sperm production may require a more detailed assessment to determine whether the problem is caused by an obstruction or impaired sperm production.
The results of the complete fertility assessment help determine the most appropriate treatment for each couple.
How Is Male Infertility Treated?
The treatment of male infertility depends on its underlying cause, the severity of the sperm abnormality and the fertility assessment of both partners. Some conditions can be treated medically or surgically, while others may require assisted reproductive techniques such as IUI, IVF or ICSI.
Medical and Surgical Treatment
When a specific cause is identified, treatment may be directed towards the underlying problem. This can include treatment of certain hormonal disorders, infections or selected cases of varicocele. In men with an obstruction of the reproductive tract, surgical treatment may sometimes restore the passage of sperm.
IUI for Male Infertility
Intrauterine insemination (IUI) may be considered in selected cases of mild male factor infertility. During IUI, a semen sample is prepared in the laboratory and concentrated motile sperm are placed directly into the uterus around the time of ovulation.
IVF and ICSI
For more significant male factor infertility, IVF with ICSI may be recommended. During ICSI, a single selected sperm is injected directly into an egg to assist fertilisation. This technique can be particularly useful when sperm concentration, motility or morphology is significantly reduced.
Surgical Sperm Retrieval for Azoospermia
In some men with azoospermia, sperm may still be retrieved directly from the epididymis or testes. The appropriate technique depends on whether azoospermia is caused by an obstruction or reduced sperm production. Retrieved sperm can then be used during IVF with ICSI.
Donor Sperm
When sperm from the male partner cannot be obtained or used successfully, donor sperm may be considered. Depending on the fertility needs of the woman or couple, donor sperm can be used with IUI or IVF.
Treatment is always individualised following a complete fertility assessment, with the aim of selecting the most appropriate approach for each couple.
Frequently Asked Questions About Male Infertility
What is the most common cause of male infertility?
Male infertility can result from several factors, including low sperm production, reduced sperm motility, abnormal sperm morphology, obstruction of the reproductive tract, hormonal disorders and testicular problems. In some men, more than one factor may be involved, while in others no specific cause is identified.
What are the signs of infertility in men?
Male infertility often causes no obvious symptoms. In many cases, the first indication is difficulty achieving a pregnancy. Some men may also experience symptoms related to an underlying condition, such as sexual dysfunction, hormonal problems, testicular discomfort or changes in the testicles.
How is male infertility tested?
The initial investigation usually includes a medical and reproductive history together with a semen analysis. Depending on the results, additional tests such as hormonal blood tests, genetic testing, physical examination or imaging may be recommended.
Can male infertility be treated?
Yes, many causes of male infertility can be treated or managed. The appropriate treatment depends on the underlying cause and may include medical treatment, surgery or assisted reproductive techniques such as IUI, IVF or ICSI.
Can a man with azoospermia have a biological child?
In some cases, yes. Azoospermia means that no sperm are detected in the ejaculate, but sperm may sometimes still be produced within the testes or epididymis. Depending on the type and cause of azoospermia, surgical sperm retrieval followed by IVF with ICSI may be an option.
Is IVF or ICSI better for male infertility?
The most appropriate technique depends on the severity and type of male fertility problem. Conventional IVF may be suitable in some cases, while ICSI is frequently considered when there is significant male factor infertility or when surgically retrieved sperm are used. The final decision is made after evaluating both partners and their individual fertility needs.
