Male infertility contributes to about half of infertility cases, either on its own or alongside a female fertility factor. Because sperm-related issues can influence which treatment options are recommended, a semen analysis is usually one of the first tests included in a fertility evaluation. Reviewing both partners at the same time gives your fertility specialist a clearer basis for deciding what should come next.
What Is Male Infertility?
Male infertility refers to a problem with sperm production, sperm function, or the delivery of sperm through the reproductive tract. It may involve a low sperm count, reduced sperm motility, abnormal sperm morphology, or no sperm in the semen, known as azoospermia.
Some men instead have a blockage involving the vas deferens or ejaculatory duct, while others experience problems such as retrograde ejaculation. These issues may occur on their own or alongside factors identified during the female partner’s fertility evaluation.
Many men with male infertility have no noticeable symptoms. Sexual function can be normal even when sperm production or sperm quality is affected. Erectile dysfunction or another form of sexual dysfunction may point to an issue that warrants further evaluation, but many sperm abnormalities occur without either.
How Is Infertility Diagnosed in Males With a Semen Analysis?
A semen analysis, sometimes called a sperm analysis, is the main test used during the initial male infertility evaluation. The laboratory examines a semen sample for several characteristics:
- Sperm concentration and sperm count: the number of sperm cells in the sample
- Sperm motility: how many sperm move and how well they move
- Sperm morphology: the proportion of sperm with typical shape and structure
- Semen volume: the amount of fluid in the sample
These results of the analysis help your physician understand whether sperm health may be affecting fertility, but no single number can confirm infertility. A low sperm count does not automatically mean pregnancy is impossible, just as a result within the expected range does not guarantee fertility.
Because semen results can vary from one sample to another, your physician may recommend repeating an initial semen analysis if the first result is abnormal. Repeat testing can help confirm whether concerns such as a low sperm count, reduced sperm motility, or abnormal sperm morphology are persistent.
What Causes Male Infertility?
The cause of male infertility may involve the testicles, hormones, genetics, the reproductive tract, or environmental and health factors, and sometimes testing does not identify one specific cause.
Common causes and contributing factors include:
- Varicocele: Enlarged veins around the testicle may affect sperm production and quality. Varicoceles occur in about 15% of adult men and approximately 40% of men evaluated for infertility.
- Hormonal abnormalities: Problems involving the pituitary gland, testosterone, follicle stimulating hormone (FSH), luteinizing hormone, or prolactin can interfere with spermatogenesis.
- Genetic abnormalities: Klinefelter syndrome, Y-chromosome changes, and some cystic fibrosis gene mutations can affect male fertility. Klinefelter syndrome usually involves an extra X chromosome, 47,XXY.
- Testicular conditions: Cryptorchidism, or an undescended testicle, increases infertility risk. Testicular injury, testicular cancer, chemotherapy, radiation, and some infections may also affect sperm production.
- Obstruction or ejaculation problems: Obstructive azoospermia may result from absence or blockage of the vas deferens, ejaculatory duct obstruction, surgery, infection, or another structural problem.
- Lifestyle and environmental factors: Smoking, heavy alcohol or drug use, obesity, anabolic steroids, testosterone exposure, certain medications, frequent high heat, and some environmental toxins may affect sperm quality.
- Infections: Sexually transmitted infections and other infections of the male reproductive tract can affect sperm production or cause inflammation and scarring. In some cases, that scarring can create a blockage that prevents sperm from moving normally through the reproductive tract.
Because these factors can affect sperm in different ways, identifying the likely cause guides which tests or treatments are considered next.
What Testing Comes After an Abnormal Semen Analysis?
Further male fertility testing depends on the semen analysis results, medical history, and any symptoms or prior diagnoses. Follow-up testing may include:
- Hormone blood tests: These may include testosterone and FSH, with luteinizing hormone (LH) and prolactin added when needed. Elevated FSH can point to impaired sperm production, while other hormone abnormalities may suggest a problem with the signals involved in sperm production.
- Genetic testing: This may be recommended for men with azoospermia or severe oligospermia, especially when testing suggests a problem with sperm production. Men who are born without the vas deferens or have certain forms of obstructive azoospermia may also need testing related to cystic fibrosis.
- Ultrasound imaging: A scrotal ultrasound may be used when your physician needs a closer look at the testicles or surrounding structures. A transrectal ultrasound may be considered when findings suggest a blockage in the ejaculatory ducts.
- Sperm DNA fragmentation testing: This is not part of every initial fertility evaluation, but it may be considered in specific situations, including some cases of recurrent pregnancy loss.
- Testicular biopsy: This is used much less often. In certain cases, it may help determine whether the testicles are producing sperm when doctors suspect a blockage but the cause is still unclear.
The purpose of follow-up testing is to understand whether the issue involves sperm production, hormones, genetics, or a blockage so treatment can be based on the underlying problem.
When Should You Pursue Male Infertility Testing?
For couples without a known fertility concern, an infertility evaluation generally begins after 12 months of regular unprotected sexual intercourse when the female partner is under 35, or after six months when she is 35 or older. Earlier testing is recommended when either partner has a known fertility risk.
Male fertility testing should also be discussed sooner after:
- a previous abnormal semen analysis or very low sperm count
- undescended testes, testicular surgery, injury, or cancer treatment
- erectile dysfunction, retrograde ejaculation, or another ejaculatory concern
- previous surgery involving the vas deferens or reproductive tract
- a known hormonal or genetic condition
- testosterone replacement therapy, anabolic steroid use, or medications that may affect sperm
These factors can change when testing starts and which tests your fertility specialist recommends.
What Are the Treatment Options for Male Infertility?
Male infertility treatment options depend on the diagnosis, semen analysis results, the female partner’s fertility, age, and any previous treatment. Depending on the cause, treatment may include the following:
- Treating an underlying condition: A specialist may recommend treatment for a hormonal disorder, varicocele, blockage, or ejaculatory problem.
- Lifestyle changes: Reaching a healthy weight, exercising regularly, avoiding tobacco and anabolic steroids, and reviewing medications or environmental exposures may support sperm health.
- Hormonal medication: Some men may be prescribed medications such as hCG, aromatase inhibitors, or clomiphene citrate to improve hormone signaling involved in testosterone and sperm production.
- Assisted reproductive treatment: Intrauterine Insemination (IUI), IVF with Intracytoplasmic Sperm Injection (ICSI), sperm retrieval, or donor sperm may be considered depending on the semen analysis and the couple’s fertility evaluation.
Testosterone replacement therapy requires special consideration because external testosterone can suppress sperm production. Men who want to conceive should discuss testosterone treatment with a fertility or reproductive specialist.
How Are IUI and IVF Used for Male Factor Infertility?
Treatment depends on the severity of the sperm abnormality, the female partner’s evaluation, and whether other approaches have already been tried. For some couples, that may mean IUI. Others may need IVF with ICSI or sperm retrieval.
Intrauterine Insemination (IUI)
Intrauterine Insemination (IUI) may be considered for mild male factor infertility or unexplained infertility. The laboratory prepares the semen sample, concentrates the motile sperm, and places them directly into the uterus around ovulation.
The total motile sperm count after the semen sample is prepared helps determine whether IUI is likely to be a reasonable option. When the number of motile sperm is very low, IUI success rates decrease and IVF may be discussed instead.
IVF With ICSI
In Vitro Fertilization (IVF) may be recommended when male factor infertility is more significant, IUI has not worked, or the sperm findings make fertilization less likely with other approaches.
With Intracytoplasmic Sperm Injection (ICSI), an embryologist selects a single sperm cell and injects it directly into a mature egg. IVF with ICSI may be used when there is a very low sperm count, reduced sperm motility, abnormal sperm morphology, or another finding that could make fertilization more difficult.
Donor sperm is another option when using the male partner’s sperm is not possible or is not the preferred treatment approach.
Understanding Male Infertility and Your Treatment Options
When sperm health is affecting fertility, identifying the issue can clarify which treatment options you have. Fertility & Endocrine Associates evaluates infertility in Louisville and offers treatment options including IUI and IVF based on both partners’ test results and medical history.
If you and your partner have been trying to get pregnant without success, or already know sperm health may be affecting fertility, request a fertility consultation to discuss male fertility testing and your treatment options.
Frequently Asked Questions About Male Infertility
Can You Still Get Pregnant With a Low Sperm Count?
Yes. A low sperm count can make conception more difficult, but pregnancy is still possible depending on sperm motility, morphology, and other fertility factors.
Can Male Infertility Develop Even If You Have Had a Child Before?
Yes. Changes in health, hormones, medications, age, or sperm production can affect fertility even after a previous pregnancy.
Can Lifestyle Changes Improve Male Fertility?
They may improve sperm health in some men. Maintaining a healthy weight, avoiding tobacco and anabolic steroids, limiting heavy alcohol use, and reducing excessive heat exposure are common recommendations.
Does Male Infertility Always Require IVF?
No. Treatment depends on the cause and may include medication, treatment for a blockage or varicocele, IUI, IVF with ICSI, or sperm retrieval.
