Male factor infertility
Male factor plays a role in many couples' infertility. Learn how it's evaluated and how mild, severe and absent sperm counts are approached.
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Male factor infertility is present in about 40% of infertility cases. The good news is that fertility treatment for male factor can be effective even when there are very few sperm, whether ejaculated or surgically retrieved.
How male factor is evaluated
Initial testing starts with a sperm analysis, which looks at the volume of the ejaculate, the number of sperm, how many are moving and how many are normally shaped, measured against standard laboratory reference criteria.
Seeing a reproductive endocrinologist, in addition to a urologist, is very helpful. A reproductive endocrinologist can also evaluate female factors and suggest simple steps, such as freezing a sperm sample, that can preserve your ability to have children in the future. The right intervention for the male partner often changes because of female factors, such as blocked tubes or low egg reserve.
In general, supplements, medical treatment and most varicocele repairs lead to lower success and a longer wait to conception than assisted reproduction.
Mild to severe male factor
Mild male factor
For men with 10 million or more moving sperm, fertility can be improved by preparing the sperm and placing it directly in the uterus (intrauterine insemination, or IUI).
Moderate to severe male factor
For men with fewer than 10 million moving sperm, IVF offers better pregnancy rates. When there are combined problems with sperm number, movement and shape, intracytoplasmic sperm injection (ICSI), in which a single sperm is placed into each egg, results in higher fertilization rates.
Azospermia: no sperm in the ejaculate
Azospermia means no sperm appear in the ejaculate, either because of a blockage in the ducts that carry sperm or because sperm production is markedly reduced.
Obstructive azospermia
A blockage can be genetic, such as congenital bilateral absence of the vas deferens, or acquired, such as after a vasectomy. Options include retrieving sperm from the testes for IVF, or surgery to correct the blockage. Surgical sperm retrieval with IVF appears to be more successful. If you choose surgery to relieve the blockage, it’s important to retrieve and freeze some sperm at the same time in case the surgery doesn’t work.
Non-obstructive azospermia
Reduced sperm production can be genetic, as in Klinefelter syndrome, Kallmann syndrome or abnormalities of the Y chromosome, or acquired, for example after chemotherapy. First, semen samples are searched carefully for sperm. If none are found, sperm can be retrieved directly from the testes in an outpatient procedure (TESE).
Genetic evaluation
Men with severe male factor may carry genetic risks that should be investigated before fertility treatment. These can include chromosome abnormalities such as Klinefelter syndrome, changes in the Y chromosome, and cystic fibrosis gene mutations (associated with absence of the vas deferens). We look into these carefully during the initial workup. Learn more about genetics and PGT.
Other causes and how they’re addressed
Erectile dysfunction
Men who have difficulty maintaining an erection or ejaculating can be helped with noninvasive methods of obtaining sperm, which can then be frozen or used fresh to achieve a pregnancy.
Retrograde ejaculation
In some men, for example men with diabetes, sperm flows backward into the bladder. Sperm can be retrieved from a urine sample or directly from the testes.
Vasectomy
A vasectomy is a form of obstructive azospermia. Men who’ve had a vasectomy and want to father children can have a vasectomy reversal. Alternatives to reversal include:
- Using sperm frozen before the vasectomy, if any is available
- Retrieving sperm from the testes and using it for IVF, while leaving the vasectomy in place for long-term contraception
The choice of treatment should take female factors into account. Even if you plan a vasectomy reversal, sperm should be retrieved during the procedure and frozen in case the reversal isn’t successful.
Varicocele
A varicocele is a group of enlarged veins around the testes. Although some varicoceles are associated with abnormal sperm results, there’s no strong evidence that repairing a varicocele improves the chance of pregnancy for the female partner.
For a closer look at medical, surgical and assisted reproduction options, read treatment options for male factor infertility.
This article is general information, not medical advice. Every situation is different, so talk with your doctor about yours.
