Male factor contributes to 40% of infertility cases. Both partners must be evaluated for complete assessment.
Why Male Testing Is Essential
The Statistics
Male factor infertility:
- Contributes to 40% of cases
- Sole cause in 20% of cases
- Combined with female factors in 20%
- Only 40% of cases are female-only
This means nearly half of infertility involves male issues.
Common Misconceptions
Myths that delay testing:
- “He’s healthy, so his sperm must be fine”
- “He’s fathered children before, so no problem”
- “Men don’t have fertility issues like women”
- “It’s probably me, so test me first”
Reality:
- Health doesn’t guarantee sperm quality
- Previous fertility doesn’t mean current fertility
- Men have fertility issues just as often
- Both partners need testing simultaneously
Don’t waste time and money treating only the woman if the issue is male factor!
Routine Semen Analysis
The primary male fertility test
What It Measures
Three main parameters:
1. Sperm Count (Concentration)
- Number of sperm per milliliter
- Total number in entire sample
- Indicates production capability
2. Motility (Movement)
- Percentage of moving sperm
- Quality of movement (progressive vs. non-progressive)
- Ability to reach and fertilize egg
3. Morphology (Shape)
- Percentage with normal shape
- Head, midpiece, and tail structure
- Affects ability to penetrate egg
Plus other factors:
- Volume of ejaculate
- pH level
- White blood cells (infection indicator)
- Liquefaction time
- Viscosity
Normal Parameters (WHO 2021)
Reference values:
Volume: 1.4 mL or more
Sperm concentration: 16 million/mL or more
Total sperm count: 39 million or more per ejaculate
Motility: 42% or more moving (total motility)
Progressive motility: 30% or more
Normal morphology: 4% or more (Kruger strict criteria)
These are minimum thresholds, not ideal. Higher is better.
How to Prepare
For accurate results:
Abstinence period:
- 2-5 days (no longer, no shorter)
- Too long or too short affects results
Avoid:
- Hot tubs, saunas (3 months before)
- Tight underwear or pants
- Laptop on lap
- Excessive alcohol
- Smoking, drugs
- Fever or illness (wait 3 months after)
Collection:
- Masturbation into sterile cup
- Can collect at home if brought to lab within 1 hour
- Keep at body temperature during transport
- Most men prefer clinic private room
Understanding Results
Normal results:
- All parameters above minimum thresholds
- Good fertility potential
- Natural conception likely
Abnormal results:
Oligospermia: Low sperm count (under 15 million/mL)
Asthenospermia: Poor motility (under 40%)
Teratospermia: Abnormal morphology (under 4% normal)
Oligoasthenoteratospermia (OAT): All three parameters low
Azoospermia: No sperm in ejaculate
- Obstructive (blockage)
- Non-obstructive (production problem)
Severe male factor:
- Count under 5 million/mL
- Motility under 20%
- May need ICSI with IVF
Variability in Results
Sperm production varies:
- Results can change cycle to cycle
- Recent illness affects production
- Medications impact quality
- Environmental exposures matter
If abnormal result:
- Repeat test in 2-3 months
- Two samples more accurate than one
- Confirm before proceeding to treatment
If consistently abnormal:
- See urologist specializing in male fertility
- Further testing needed
- Treatment options available
Infectious Disease Screening
Required for both partners before fertility treatment
Tests Included
Standard panel:
- HIV (Human Immunodeficiency Virus)
- Hepatitis B Surface Antigen (HBsAg)
- Hepatitis C Antibody (Anti-HCV)
- Syphilis (RPR or VDRL)
- Sometimes others based on location
Why Testing Is Required
Safety reasons:
- Lab safety (handling sperm/eggs)
- Clinic protocols
- Legal requirements
- Partner protection
- Baby protection
Many clinics won’t proceed without negative results or documented treatment plan.
If Positive Result
Don’t panic:
- Many infections are treatable
- Some don’t prevent fertility treatment
- Special protocols exist
- Consultation with infectious disease specialist
Treatment before conception:
- HIV: antiretroviral therapy
- Hepatitis B/C: treatment or monitoring
- Syphilis: antibiotic treatment
Fertility treatment still possible with proper precautions.
When Additional Tests Are Needed
Hormone Testing for Men
If semen analysis very abnormal:
Tests may include:
- Testosterone
- FSH (Follicle Stimulating Hormone)
- LH (Luteinizing Hormone)
- Prolactin
What they indicate:
- Low testosterone: production issues
- High FSH: testicular failure
- High prolactin: pituitary tumor
- Hormonal causes treatable in some cases
Genetic Testing
Recommended if:
- Very low or zero sperm count
- Family history of genetic conditions
- Recurrent miscarriages
Tests include:
- Karyotype (chromosome analysis)
- Y-chromosome microdeletions
- Cystic fibrosis carrier screening
Why it matters:
- Some genetic issues passed to children
- Affects treatment recommendations
- Genetic counseling may be needed
Testicular Biopsy
When azoospermia (no sperm):
- Determines if sperm being produced
- Can extract sperm for IVF/ICSI
- Differentiates obstructive vs. non-obstructive
Types:
- TESE (Testicular Sperm Extraction)
- Micro-TESE (microsurgical)
- PESA (Percutaneous Epididymal Sperm Aspiration)
Specialized Sperm Tests
If standard analysis normal but not conceiving:
DNA fragmentation testing:
- Measures DNA damage in sperm
- High levels reduce fertility and increase miscarriage
- May explain unexplained infertility
Antisperm antibodies:
- Immune system attacking own sperm
- Can reduce motility and fertilization
Penetration tests:
- Ability to penetrate egg
- Less commonly done
Causes of Male Infertility
Varicocele
Most common correctable cause:
- Enlarged veins in scrotum
- Raises testicular temperature
- Reduces sperm production and quality
- Affects 15% of men, 40% of infertile men
Treatment:
- Surgical repair (varicocelectomy)
- May improve sperm parameters
- 3-6 months to see improvement
- Not always necessary (can do IVF/ICSI instead)
Lifestyle Factors
Modifiable causes:
- Smoking (reduces count and motility)
- Excessive alcohol
- Drug use (especially marijuana, steroids)
- Obesity
- Heat exposure (hot tubs, saunas, laptops)
- Stress
Improvement possible with lifestyle changes in 3-6 months.
Medical Conditions
Affecting fertility:
- Diabetes
- Thyroid disorders
- Infections (past or present)
- Undescended testicles (history)
- Testicular injury or surgery
- Cancer treatment (chemo/radiation)
Medications
Can impact sperm:
- Testosterone replacement (shuts down production!)
- Steroids
- Some blood pressure medications
- Antidepressants
- Others
Review all medications with fertility doctor.
Obstructions
Blockages preventing sperm release:
- Vasectomy (intentional)
- Injury or infection
- Congenital absence of vas deferens (CAVD)
- Ejaculatory duct obstruction
Treatment:
- Surgical repair sometimes possible
- Sperm extraction for IVF
- Reversal (for vasectomy)
Unknown Causes
Idiopathic (unexplained):
- No identifiable reason
- Still treatable with IVF/ICSI
- Success still possible
Treatment Options for Male Factor
Lifestyle Modifications
First-line approach:
- Quit smoking
- Limit alcohol
- Lose excess weight
- Exercise regularly (moderate)
- Avoid heat
- Reduce stress
- Eat healthy diet
- Take supplements (see below)
Improvement takes 3 months (sperm production cycle length).
Supplements
May improve sperm parameters:
- Coenzyme Q10 (CoQ10)
- L-carnitine
- Vitamin E and C (antioxidants)
- Zinc
- Folic acid
- Selenium
Discuss with doctor before starting.
Medication
For specific causes:
- Clomid (improves hormones)
- Letrozole
- hCG injections
- Antibiotics (if infection)
Not always effective, but worth trying in some cases.
Surgery
Varicocele repair:
- May improve parameters
- Not guaranteed
- Alternative: IVF/ICSI
Vasectomy reversal:
- Success depends on time since vasectomy
- Alternative: sperm extraction + IVF
Obstruction repair:
- Sometimes successful
Assisted Reproductive Technology
When natural conception unlikely:
IUI (Intrauterine Insemination):
- For mild male factor
- Count at least 5-10 million after wash
- Motility at least 30%
IVF with ICSI:
- For moderate to severe male factor
- Even very low counts can work
- Single sperm injected into each egg
- High success rates
Sperm extraction with IVF:
- For azoospermia (no sperm in ejaculate)
- TESE, Micro-TESE
- As long as some sperm produced, ICSI possible
Donor sperm:
- When no sperm production
- Failed treatments
- Genetic concerns
- Success rates excellent
Supporting Your Partner
Emotional Impact on Men
Male infertility is emotionally difficult:
- Feels like failure of masculinity
- Society equates virility with fertility
- Less discussed than female infertility
- May feel isolated
Common feelings:
- Guilt (letting partner down)
- Inadequacy
- Anger
- Depression
- Loss of self-esteem
These feelings are normal and valid.
How Partners Can Help
What helps:
- Reassure him it’s medical, not personal failure
- Emphasize you’re in this together
- Acknowledge his feelings
- Don’t blame or shame
- Focus on solutions, not fault
- Encourage him to talk (to you or counselor)
- Attend appointments together
What doesn’t help:
- Blaming
- Comparing to other men
- Making it about masculinity
- Pushing him to talk if he’s not ready
- Taking it personally
Moving Forward
Male factor is NOT the end of your journey:
- Very treatable in most cases
- ICSI overcomes nearly all male factor issues
- Even severe cases have good prognosis
- Success rates excellent with modern technology
Action steps:
✓ Get tested early (don’t wait)
✓ Make lifestyle changes immediately
✓ See specialist if abnormal results
✓ Consider all treatment options
✓ Seek emotional support
✓ Work as a team with your partner
Remember
Male fertility testing is essential, not optional. Nearly half of infertility cases involve male factors.
Testing is simple and non-invasive. There’s no reason to delay.
Even severe male factor is highly treatable with modern technology.
This isn’t about masculinity or virility – it’s about biology and medicine.
You’re a team. Face this together.