- Male infertility causes account for roughly half of all cases of infertility in couples, and must always be investigated at the same time as the female partner’s fertility
- Semen analysis is the cornerstone of male infertility investigations and involves the evaluation of sperm count, sperm concentration, sperm motility, normal sperm morphology, and total sperm count
- Varicocele, hormonal imbalances affecting the pituitary gland, blockages in the male and female tracts, genetics, sexually transmitted infections, and lifestyle factors such as anabolic steroids and emotional stress are causes of male infertility
- Surgical sperm retrieval for intracytoplasmic sperm injection is also possible through percutaneous epididymal sperm aspiration and testicular biopsy for males without sperm in their ejaculate
- Intracytoplasmic sperm injection and in vitro fertilization are the most effective ART for severe male factor infertility
- Lifestyle modifications, such as healthy weight, smoking, alcohol, and heat protection, also improve sperm quality in addition to all other treatments for male infertility
When a couple struggles to conceive, male factor infertility shows up in about half the cases, but it is rarely checked because most fertility checks start with the woman. A man is considered infertile if he can’t help his partner get pregnant after 12 months of unprotected sex, and this includes issues with sperm count, movement, function, or overall reproductive health. At Zemya IVF & Fertility Clinics, a top IVF center in South Delhi, men are assessed and treated just like women; a full understanding of both sides is needed for real results.
Understanding Male Infertility
Male infertility is said to occur when the semen analysis tests conducted on the individual show abnormal semen parameters such as low sperm count, poor sperm motility, abnormal sperm morphology, or a combination of the aforementioned conditions. Male infertility is also said to occur in the absence of sperm in the semen. A normal sperm count is said to be fifteen million or more per milliliter of semen, and the total sperm count, sperm concentration, and motility of the sperm cells are also analyzed.
Male infertility stems from many sources. Hormonal issues can mess with the pituitary gland’s signal to the testes. Structural flaws, like blockages in the vas deferens, the ejaculatory duct, or the seminal vesicles, can stop sperm from moving properly. Genetic disorders such as cystic fibrosis, chromosomal changes, or sickle cell disease play a role, too. Varicocele – swollen veins in the scrotum, raise testicular heat, and harm sperm production. Undescended testicles are another factor. Old STIs may leave scars in reproductive pathways. Anti-sperm antibodies can attack and destroy healthy sperm. Lifestyle choices matter: steroid use, smoking, heavy drinking, stress, and weight gain all contribute. Some men just don’t take care of their bodies enough.
Conditions such as erectile dysfunction, premature ejaculation, and retrograde ejaculation, where the sperm travels backwards into the bladder instead of forwards during ejaculation, also lead to male infertility because the sperm cannot reach the female reproductive system during intercourse.
Male Infertility Tests
Before the treatment for male infertility can be carried out, it is important to diagnose the problem. The main test for male infertility is semen analysis, which is the complete analysis of the semen sample, including the number, density, motility, percentage of normally formed sperm, total sperm density, volume, and consistency of the semen. Abnormal semen parameters detected during semen analysis form the basis for the entire investigation and treatment for male infertility.
Other potential male infertility examinations can be blood tests to check hormone levels such as testosterone, follicle-stimulating hormone, and luteinising hormone, figuring out how well the pituitary gland is controlling sperm generation, along with thyroid function and prolactin. Ultrasound of the scrotum and testicles helps detect structural problems, varicocele, or testicular cancers that might be limiting sperm production. A testicular biopsy may be done when no sperm are present in the semen in order to find out if the reason is low sperm production or a blockage in the reproductive tract. If retrograde ejaculation is suspected, post-ejaculatory urinalysis is done to find out if there are any sperm cells are present in the urine. Genetic testing is advised for men who have very low sperm production or no sperm.
Medical Treatments for Male Infertility
Hormonal Therapy
In cases of male infertility resulting from hormonal imbalances related to the pituitary gland, such as those resulting from inadequate brain signals causing low sperm counts, hormonal therapy has a high success rate. Gonadotropin injections work by stimulating the testicles to produce sperm, thereby replacing the hormones that are supposed to be produced by the pituitary gland. This therapy has a significant impact on increasing sperm count and quality over a period of a few months in patients suffering from hypogonadotropic hypogonadism.
It must also be mentioned that testosterone replacement therapy, which may be used to treat men with low levels of the male sex hormone, actually inhibits sperm production and should never be used as a treatment for male infertility if the patient wants to have children. Men who have been taking anabolic steroids or testosterone replacement therapy are at high risk of being unable to produce sperm due to the effects of these drugs, which can last many months.
Treating Ejaculatory Disorders
Some men have trouble sending sperm forward during orgasm. Medications can help close the bladder neck better, so sperm move the right way. Sperm sometimes end up in urine after ejaculation. Scientists collect it and prepare it in a lab for use in IVF or IUI. If drugs don’t work, treatment focuses on helping the body deliver sperm through sex. For those with ED or premature ejaculation, doctors prescribe PDE5 inhibitors to support an erection. These treatments are paired with fertility plans when necessary. The process depends on how well the body responds to therapy and how much sperm is available after ejaculation.
Varicocele Repair
Varicocele is a condition of swollen veins in the scrotum and is one of the most common and most treatable causes of male infertility. Abnormal blood flow due to varicocele increases testicular temperature and causes oxidative stress to the testes, resulting in decreased sperm count, motility, and normal forms of the sperm. Surgical repair of varicocele and radiological embolization correct the abnormal blood flow pattern. Many studies have proven that successful treatment of varicocele leads to improvements in semen parameters and to conception in the months following the procedure. Surgical Treatment for Blockages
If low sperm count or no sperm at all in the ejaculated semen is due to a blockage in the reproductive system- the vas deferens, ejaculatory duct, or epididymis- and not due to rarely functioning sperm producing cells in the testes, then an operation can restore normal sperm flow. Vasectomy reversal means the vas deferens, which were disconnected during vasectomy, are reconnected. Besides that, other microsurgical techniques correct blockages brought about by previous infections, injuries, or congenital absence of the vas deferens, like cystic fibrosis.
Surgical Sperm Retrieval
In cases when no sperm are present in the ejaculated fluid and surgical intervention is not possible or is not successful, sperm can be aspirated directly from the male reproductive system through various methods. Percutaneous epididymal sperm aspiration (PESA) is a procedure wherein a needle is used to aspirate sperm directly from the epididymis for men who have obstructive reasons for the absence of sperm in their ejaculated fluid. Testicular sperm extraction (TESE) is a procedure wherein a small incision is made to aspirate sperm from testicular tissue, while micro-dissection testicular sperm extraction is a highly advanced procedure wherein the areas of testicular tissue most likely to contain sperm are identified in cases of severely impaired sperm production.
Assisted Reproductive Techniques
Intrauterine Insemination
In case the man has minor fertility issues like a slightly decreased sperm count or sperm motility, intrauterine insemination (IUI) is an efficient first-line assisted reproductive treatment. IUI involves the introduction of sperm directly into the female uterus at the time of ovulation. The sperm are “washed” so that only the healthiest ones are concentrated to enhance the quality of the sperm that will be in direct contact with the egg.
Intracytoplasmic Sperm Injection
Intracytoplasmic Sperm Injection, or ICSI, is the most significant advance in the treatment of male infertility since the inception of reproductive medicine. In ICSI, a healthy sperm, whether obtained from the ejaculate or through surgical sperm retrieval, is injected directly into a mature egg as part of an in vitro fertilization cycle, circumventing all barriers to fertilization. ICSI has revolutionized the prognosis for infertile male patients with severely low sperm counts, dysfunctional sperm, abnormal semen parameters, or no sperm obtained through testicular biopsy or percutaneous epididymal sperm aspiration. Indeed, men with only a handful of sperm within their testicles have been able to father biological offspring through ICSI and in vitro fertilization.
Donor Sperm
If no sperm is retrievable after all efforts or if genetic issues make the male partner’s sperm unsafe, donor sperm from a registered bank offers a practical solution. It seems hard to ignore that the child conceived with donor sperm through IVF or IUI is legally recognized as the biological child of the intended parents. Zemya IVF & Fertility Clinics supports couples dealing with this path with clear guidance and emotional care.
Lifestyle Factors and Male Fertility
Along with clinical and surgical treatments, the management of modifiable lifestyle factors is also of importance in the management of sperm quality and male fertility. A healthy weight is essential in minimizing the impact of excess body fat on hormones. Giving up smoking, minimizing the intake of alcohol, and abstaining from the intake of anabolic steroids and drugs, as well as minimizing stress and heat to the testicles from hot baths, saunas, and tight clothing, also contribute to the improvement of sperm quality. This takes about two to three months to manifest in the semen analysis, as it is the time required for the entire cycle of sperm production.
