Male Infertility: Causes, Diagnosis & Treatment
Semen analysis, oligospermia, azoospermia — a complete guide to male fertility evaluation
Semen Analysis: The First Step
A semen analysis is the basic test for male fertility evaluation, typically the first step in infertility workup. It measures:
Sperm Count
Normal ≥ 16 million/mL
Motility
Normal ≥ 40% moving
Morphology
Normal ≥ 4% normal forms
Volume
Normal 1.5–5 mL
Male Infertility Treatment Options
IUI
For mild sperm issues — concentrated sperm placed into the uterus
IVF + ICSI
Most effective for severe sperm problems — a single sperm injected into each egg
Surgical Sperm Retrieval (TESE/PESA)
For azoospermia — surgically retrieving sperm from testicles or epididymis
Donor Sperm
When own sperm cannot be obtained or genetic disease is a concern
Frequently Asked Questions
Does an abnormal semen analysis mean I cannot father children?
No. Semen analysis is a reference indicator, not an absolute judgment. Even with low sperm count or poor motility, IVF + ICSI requires only a very small number of motile sperm to achieve fertilization. The key is identifying the root cause — whether treatable (e.g., varicocele repair) or addressable through assisted reproduction.
Do lifestyle habits affect sperm quality?
Yes. Smoking and excess alcohol reduce sperm count and DNA integrity. Laptops on the lap, tight underwear, or hot baths raise scrotal temperature. Obesity and chronic stress are also linked to lower sperm quality. Lifestyle improvements take about 3 months to appear in semen analysis results (sperm production cycle is ~74 days).
If I have azoospermia (no sperm), can I still have biological children?
Possibly. Obstructive azoospermia — sperm is produced but blocked — can be treated with PESA/MESA surgery to retrieve sperm from the epididymis for IVF + ICSI. Non-obstructive azoospermia — reduced testicular production — still yields retrievable sperm via microTESE in about 50-60% of cases.
Does male age affect fertility?
Yes, but the effect is smaller and starts later than in women. Male fertility begins to decline noticeably after age 45 — sperm count decreases and DNA fragmentation rates rise. Men in their 50s and 60s can still father children, though with lower success rates.