Where the evaluation starts
Two semen analyses done correctly, a few weeks apart, after two to five days of abstinence. A single poor report means very little — counts fluctuate with fever, illness and even the collection method. Examination for a varicocele, testicular size and the vas deferens follows, along with FSH, LH, testosterone and prolactin.
Common and correctable causes
Several of the commonest contributors respond well to treatment, and many are not obvious to the patient.
- Varicocele — treatable surgically, with improvement in parameters in many men
- Hormonal deficiency, thyroid disorder or high prolactin
- Infection of the genital tract
- Heat, smoking, alcohol, anabolic steroids and some medications
- Obstruction of the vas or ejaculatory ducts
- Genetic causes such as Y-chromosome microdeletion or Klinefelter syndrome
When no sperm are found
Azoospermia needs careful separation into obstructive and non-obstructive causes, because the treatments are completely different. Obstruction can often be bypassed or reconstructed. Where production is the problem, surgical sperm retrieval (TESA, micro-TESE) with ICSI gives many couples a biological child.
Treatment is coordinated with your IVF team so that retrieval and the female partner's cycle are planned together rather than in sequence.
Male Infertility Treatment — common questions
How long should we try before getting tested?
Twelve months of unprotected intercourse, or six months if the female partner is over 35 or there is a known problem. There is no benefit in waiting longer.
Can low sperm count be improved?
Often yes — by treating a varicocele, correcting hormonal problems, stopping steroids or smoking, and managing weight and infections.
Is a varicocele operation worth doing for fertility?
In men with a clinically palpable varicocele and abnormal semen parameters, repair improves counts and motility in a substantial proportion.
What is ICSI?
A single sperm is injected directly into an egg during IVF. It allows fatherhood even with very few sperm, including sperm retrieved surgically.
Reviewed by Dr. Kinjal Banerjee, MBBS, MS (General Surgery), DNB (Urology) — Urologist, Renal Transplant & Robotic Surgeon, Faridabad. This page explains male infertility treatment in general terms; your own treatment plan depends on your reports and examination.