Male-factor infertility

Male-factor infertility is when something to do with sperm is part of the reason a couple is having trouble conceiving. It is common, playing a role in roughly half of all cases, either on its own or alongside a female-factor cause. That is why testing both partners early matters: it avoids months spent looking in only one direction.

Common causes

The usual issues are a low sperm count, poor movement (motility), or a high share of abnormally shaped sperm (morphology). Behind these can sit a range of causes, including a varicocele, hormonal imbalances, blockages, infections, and lifestyle factors such as smoking, heavy drinking, heat, and being significantly overweight. In some cases there is no measurable sperm in the semen (azoospermia).

How it is diagnosed

The main test is a semen analysis, which measures count, movement, and shape against reference limits. Because results vary between samples, a single low result is usually repeated before any conclusion is drawn. Sometimes hormone blood tests or a scan are added.

Treatment options

Many causes are treatable, and the right approach depends on the cause and how significant it is.

• Lifestyle changes can improve sperm quality over a few months.
• Treating an underlying cause, such as a hormonal problem or in some cases a varicocele, can help.
• IUI can work for mild issues, by concentrating the best sperm.
• IVF with ICSI is the usual route for more significant male-factor problems, since a single sperm is injected into each egg. Even where there is no sperm in the semen, it can sometimes be retrieved directly.