Male infertility
Understanding Male Infertility
Male infertility means that a male factor is contributing to difficulty achieving pregnancy. In many couples, fertility issues involve male factors, female factors, or both, so assessing both partners often gives the clearest plan.
When should you seek help?
Consider an assessment if:
You’ve been trying for 12 months without pregnancy, or 6 months if the female partner is 35 or older
You have known risk factors (previous testicular surgery, undescended testis, chemotherapy/radiotherapy, anabolic steroid/testosterone use)
You have symptoms such as scrotal swelling, testicular pain, reduced libido, or ejaculatory issues
Common causes of male infertility
Male infertility usually relates to one (or more) of these areas:
1) Sperm production problems
Low sperm count, reduced motility (movement), abnormal morphology (shape), or azoospermia (no sperm)
2) Varicocele
Enlarged scrotal veins that may affect sperm production/quality
3) Hormonal causes
Hormone imbalances can reduce sperm production
4) Blockage (obstruction)
Sperm may be produced but cannot travel into the semen
5) Genetics
Sometimes recommended testing based on semen results and exam findings
6) Lifestyle and health factors
Smoking/vaping, excess alcohol, obesity, heat exposure, anabolic steroids/testosterone, some medications, chronic illness
How male infertility is tested
Most assessments include:
Semen analysis (often repeated)
Hormone blood tests (when indicated)
Examination (testis size, varicocele, signs of obstruction)
Ultrasound or genetic testing (selected cases)
Treatment options
Treatment depends on the cause and your goals (natural conception vs IVF/ICSI):
Lifestyle optimisation (often recommended for most men)
Targeted medical treatment (if hormonal/inflammatory contributors)
Surgery (e.g., varicocele treatment in selected cases)
Sperm retrieval procedures and IVF/ICSI pathways when needed
Next step
If you’re trying to conceive, a structured evaluation can clarify why pregnancy hasn’t happened yet and which pathway is most efficient.
Semen Analysis Explained
A semen analysis is the key first test for male fertility. It assesses semen volume and multiple sperm parameters that influence the chance of conception.
What does a semen analysis measure?
Common parameters include:
Volume (how much semen is produced)
Sperm concentration / count
Motility (how well sperm move)
Morphology (sperm shape)
Sometimes: vitality, pH, white blood cells, and other lab-specific measures
How to prepare
Labs differ slightly, but typical guidance includes:
Abstinence window (often a few days) before the test
Avoid fever/illness where possible (recent high fever can affect results)
Avoid ejaculation too close to the test
Follow your lab’s collection and transport instructions carefully
Why do we often repeat the test?
Semen parameters can vary due to:
Timing/abstinence period
Illness, stress, sleep, alcohol
Collection factors
For that reason, two semen analyses are commonly recommended before making big decisions.
What if the semen analysis is abnormal?
Common patterns include:
Low count: may relate to testicular production, hormones, varicocele, lifestyle, medications
Low motility: can be influenced by infection/inflammation, lifestyle, heat exposure, lab factors
Low morphology: can occur with many causes; interpretation depends on the full picture
Low volume: can suggest collection issues, ejaculation problems, or (less commonly) obstruction
What you can do while awaiting results
Evidence-based “big rocks”:
Stop smoking/vaping
Avoid anabolic steroids/testosterone
Reduce alcohol
Optimise weight, sleep and exercise
Minimise prolonged heat exposure to the testes
When to book a review
Book a consult if:
Results are abnormal
You’ve been trying >12 months (or >6 months if female partner ≥35)
You have symptoms (pain/swelling), prior surgery, chemo/radiotherapy, or steroid/testosterone use
Male Fertility Evaluation: What to Expect
A male fertility evaluation aims to identify:
the most likely cause(s), and
the most efficient pathway to pregnancy.
Your first appointment usually covers
1) Time trying and conception history
How long you’ve been trying
Intercourse timing and frequency
Any prior pregnancies (with current or previous partners)
2) Medical and surgical history
Undescended testis, torsion, infections, trauma
Prior hernia/scrotal/pelvic surgery
Chemotherapy/radiotherapy
Chronic illnesses (e.g., diabetes), medications
3) Lifestyle review
Smoking/vaping, alcohol, recreational drugs
Testosterone therapy/anabolic steroids (very important)
Sleep, stress, weight, heat exposure
4) Sexual and ejaculatory function
Erections, ejaculation, pain, libido
Any concerns that make timed intercourse difficult
Physical examination
A focused exam can identify clues such as:
Testicular size and consistency
Varicocele
Signs of obstruction
Hormonal indicators
Tests commonly ordered
Semen analysis (often repeated)
Hormone blood tests (when indicated)
Ultrasound (selected cases, based on exam/results)
Genetic testing (selected cases with severe abnormalities/azoospermia)
How a plan is made
Your clinician will typically map results into one of several pathways:
Optimise lifestyle and repeat testing
Treat a specific reversible cause (e.g., varicocele in selected cases, hormonal contributors)
Move toward assisted reproduction (IUI/IVF/ICSI) if that offers the best chance
Consider sperm retrieval options if sperm are absent or extremely low
What to bring
Any prior semen analyses or blood results
Medication and supplement list
Surgical history and letters (if available)
Varicocele and Fertility
A varicocele is enlarged veins around the testicle (often described as a “bag of worms”). It is common and can be associated with reduced sperm quality in some men.
How can a varicocele affect fertility?
A varicocele may affect:
Sperm count, motility, and/or morphology
Testicular function over time
Not every varicocele causes infertility—treatment decisions depend on the overall clinical picture.
Symptoms
Many men have no symptoms. Others notice:
Dull ache or heaviness, often worse after standing/exercise
Visible or palpable enlarged veins
Fertility difficulties discovered during investigation
How it’s diagnosed
Diagnosis is usually based on:
Clinical examination (standing exam is important)
Ultrasound (often used to confirm findings or assess anatomy)
When is treatment considered?
Treatment is typically considered when there is a combination of:
A clinically significant varicocele
Abnormal semen parameters
A couple trying to conceive (or fertility plans in the near future)
Your clinician will also consider female partner factors and timeline.
Treatment options
Options depend on anatomy and your goals and may include:
Observation with lifestyle optimisation and repeat semen analysis
Procedural or surgical management in selected cases
What to expect after treatment
Follow-up often includes:
Repeat semen analysis after a suitable interval
Ongoing fertility planning (natural conception vs IVF/ICSI depending on results and timeline)
What is azoospermia?
Azoospermia means no sperm are seen in the semen analysis. This can happen for two broad reasons:
sperm are being produced but blocked from reaching the semen (obstructive azoospermia), or
sperm production in the testes is severely reduced or absent (non-obstructive azoospermia).
Obstructive azoospermia (OA)
In OA, the testes may produce sperm normally, but a blockage prevents sperm entering semen. Causes can include:
Congenital or acquired blockage
Prior infections/inflammation
Prior surgery affecting the reproductive tract
Specific structural causes
Non-obstructive azoospermia (NOA)
In NOA, sperm production is significantly impaired. Possible contributors include:
Hormonal causes
Genetic factors
Prior chemotherapy/radiotherapy
Testicular injury, undescended testis, severe varicocele in some cases
Medications or anabolic steroid/testosterone use
How azoospermia is assessed
Evaluation often includes:
Repeat semen analysis (to confirm)
Hormone blood tests (FSH/LH/testosterone ± others)
Examination (testis size, vas deferens presence, signs of obstruction)
Ultrasound in selected cases
Genetic testing in selected cases (especially NOA patterns)
Treatment pathways
Treatment depends on whether it is OA or NOA:
In selected obstructive cases: options may include procedures addressing obstruction or sperm retrieval for IVF/ICSI
In NOA: focus may include addressing reversible contributors (if present) and discussing sperm retrieval options (e.g., microTESE in selected men) and IVF/ICSI pathways
Common questions
Does azoospermia mean no chance of pregnancy?
Not necessarily. Many men have pathways forward, especially once the type and cause are identified.
Should I stop testosterone if I’m trying to conceive?
Testosterone therapy and anabolic steroids can suppress sperm production. Do not stop prescribed medication abruptly—seek medical advice and a fertility-specific plan.
Treatment options for male infertility
Treatment is tailored to:
The cause(s) found on testing
Time trying and age-related factors
Your preferences (natural conception vs assisted reproduction)
Partner factors and IVF planning
1) Lifestyle optimisation (high impact for many men)
Often recommended regardless of cause:
Stop smoking/vaping
Avoid anabolic steroids/testosterone while trying to conceive (seek medical guidance)
Reduce alcohol
Improve sleep and manage stress
Aim for a healthy weight and regular exercise
Minimise prolonged heat exposure to the testes
2) Medical treatment (when indicated)
May be considered for:
Hormonal contributors
Infection/inflammation when identified
Managing comorbidities that can affect sexual function and fertility
3) Surgical/procedural options (selected cases)
Depending on findings:
Varicocele treatment when likely to help
Management options for obstruction in selected cases
4) Sperm retrieval procedures (for IVF/ICSI pathways)
Sperm retrieval may be recommended when sperm are absent from semen or extremely low. Techniques vary based on the clinical situation and may include:
Needle-based retrieval approaches
Testicular tissue sampling techniques
Microdissection approaches in selected non-obstructive azoospermia cases
Retrieved sperm are typically used with IVF/ICSI (intracytoplasmic sperm injection), where a single sperm is injected into an egg.
5) How IVF/ICSI fits in
IVF/ICSI can be considered when:
Semen parameters are significantly reduced
There is azoospermia with a plan for sperm retrieval
Time factors mean a faster pathway is preferred
Female partner factors also indicate IVF may be beneficial