Treatment options for male factor infertility

Several treatments are available for male factor infertility. We use approaches with proven results and avoid methods that aren’t backed by scientific evidence.

Male infertility can weigh heavily on men and put real strain on a couple. No one should suffer in silence, because effective treatments are available.

Lifestyle and medical treatment

Losing weight, not smoking, drinking less alcohol and other lifestyle changes can be very helpful.

Most men don’t benefit from medications such as clomiphene (Clomid), tamoxifen (Nolvadex), anastrozole (Arimidex), hCG (human chorionic gonadotropin) or testosterone, and supplements have no proven benefit. In particular, the chance of pregnancy and live birth doesn’t increase for the partners of men who take these medications. Testosterone and other anabolic steroids actually suppress sperm production.

Medical treatment does help a small minority of men:

• In men with pituitary gland problems, such as Kallmann syndrome, injectable medications that stimulate sperm production may improve sperm count.
• In men with low libido caused by high prolactin, lowering that hormone with medication may increase the frequency of intercourse.

Surgery

• Blockages. For men with a prior vasectomy or another obstruction, surgery can be used to open the blockage. Alternatively, sperm can be retrieved and used for IVF with ICSI.
• Varicocele. Surgical repair of a varicocele doesn’t appear to increase the chance of conception and live birth for the female partner.

Assisted reproduction

Assisted reproduction options are tailored to the initial sperm analysis and to whether there’s a blockage, retrograde ejaculation or decreased sperm production. IVF should be considered for men with 10 million moving sperm or fewer, and for men with multiple sperm abnormalities in count, movement and shape. Learn more about IVF and ICSI.

Sperm retrieval

If not enough sperm are ejaculated, sperm can be obtained by:

• Freezing several sperm samples before treatment, when only a few sperm are released
• Using vibratory devices for men who can’t maintain an erection
• Collecting sperm from the bladder after ejaculation, for retrograde ejaculation
• Electroejaculation (EEJ) for men with spinal cord injury
• Needle aspiration
• Retrieving sperm directly from the duct of the testis (MESA) or from the testis itself (TESE), using microdissection under a microscope or multiple biopsies to find an area where sperm are being produced

ICSI and IMSI

Intracytoplasmic sperm injection (ICSI)

A single sperm is selected and injected directly into the egg. ICSI is used when the number or quality of sperm is low or when sperm are expected to have trouble fertilizing the egg. It’s also recommended for couples with prior fertilization failure.

Intracytoplasmic morphologically selected sperm injection (IMSI)

IMSI is a variation of ICSI that uses high magnification to choose sperm based on their detailed shape and structure before injection into the egg. It’s sometimes helpful in cases of severe male factor.

Donor sperm

If using donor sperm feels right for you, it can be an option when repeated sperm retrieval hasn’t worked, in some genetic conditions, and after repeated fertilization failure. Learn more about donor sperm and third-party reproduction.

This article is general information, not medical advice. Every situation is different, so talk with your doctor about yours.