Male factor infertility contributes to approximately 40-50% of all infertility cases, yet it remains significantly under-discussed and under-investigated. Too often, fertility investigations focus primarily on the female partner while male assessment is delayed or overlooked. At PTA Fertility Centre, we investigate both partners from the very first consultation.
Understanding Male Fertility
Male fertility depends on the production of sufficient quantities of normal, motile sperm capable of reaching and fertilising an egg. This requires:
- Functioning testes producing adequate sperm (spermatogenesis)
- Patent ducts to transport sperm from the testes
- Adequate sperm count, motility, and normal morphology
- Functioning accessory glands (prostate, seminal vesicles)
- Normal ejaculatory function
Common Causes of Male Infertility
Varicocele
A varicocele is a dilation of the veins around the testicle (similar to varicose veins). Present in about 15% of men and up to 40% of infertile men, varicoceles can raise testicular temperature and impair sperm production. Surgical correction may improve sperm parameters in some cases.
Hormonal Imbalances
Low testosterone, elevated prolactin, or thyroid disorders can impair sperm production. Importantly, external testosterone use (whether prescribed TRT or bodybuilding steroids) suppresses the body's own testosterone production in the testes and can cause severe oligospermia or azoospermia.
Obstructive Causes
Blockages in the reproductive tract — from previous infection (STIs, epididymitis), surgery (vasectomy, hernia repair), or congenital absence of the vas deferens (associated with cystic fibrosis carrier status) — can prevent sperm from reaching the ejaculate.
Genetic Factors
Klinefelter syndrome (47,XXY), Y-chromosome microdeletions, and other genetic conditions can cause severely impaired sperm production. Genetic testing is recommended for men with very low sperm counts.
Lifestyle Factors
- Smoking — Reduces sperm count, motility, and increases DNA damage
- Excessive alcohol — Impairs testosterone production and sperm quality
- Obesity — Hormonal disruption and elevated scrotal temperature
- Heat exposure — Saunas, hot baths, laptop use on lap, tight underwear
- Recreational drugs — Cannabis, cocaine, and anabolic steroids all impair fertility
- Stress — Chronic stress can affect hormonal balance and sperm parameters
Diagnosis: The Semen Analysis
The cornerstone of male fertility investigation is the semen analysis. Normal parameters (WHO 2021 criteria):
- Volume: ≥1.4 ml
- Concentration: ≥16 million sperm/ml
- Total motility: ≥42%
- Progressive motility: ≥30%
- Normal morphology: ≥4% (strict criteria)
A single abnormal result should always be repeated after 2-3 months, as sperm parameters can fluctuate. If abnormalities persist, further investigation is warranted.
Treatment Options
Lifestyle Modifications
For mild abnormalities, lifestyle changes can make a meaningful difference: stopping smoking, reducing alcohol, losing weight, avoiding heat exposure, and discontinuing any testosterone or steroid use. Improvements typically take 3 months (one full sperm production cycle).
Medical Treatment
Hormonal treatments (clomiphene citrate, gonadotropins) may stimulate sperm production in men with hormonal imbalances. Antibiotics treat active infections. Antioxidant supplements (Vitamin C, E, zinc, selenium, CoQ10) may improve sperm quality in some cases.
Surgical Treatment
Varicocele repair, vasectomy reversal, or surgical sperm retrieval (TESA, micro-TESE) for obstructive azoospermia.
Assisted Reproduction
- IUI — For mild male factor (count >10 million motile sperm after wash)
- IVF with ICSI — For moderate-severe male factor. A single sperm is injected directly into each egg, bypassing all barriers to fertilisation
- Surgical sperm retrieval + ICSI — For azoospermia (no sperm in ejaculate)
- Donor sperm — When no viable sperm can be obtained
A Message to Men
We understand that male fertility investigations can feel uncomfortable or emasculating. But infertility is a medical condition — not a reflection of masculinity or virility. Seeking help is a sign of strength, and in many cases, male factor issues are highly treatable.
If you and your partner are struggling to conceive, please don't delay your investigation. A simple semen analysis — which costs far less than months of unsuccessful trying — can provide answers and direction.