Male Infertility: Causes, Diagnosis & Modern Treatments
Male-factor infertility accounts for nearly half of all infertility cases, yet it remains under-discussed.
For decades, infertility was treated as primarily a "women's issue." The reality, supported by research, is very different: male-factor infertility is a sole or contributing cause in approximately 40–50% of all cases. Yet men are far less likely to seek evaluation — often waiting years before getting a simple semen analysis that could provide answers within 48 hours. At Progeny Fertility Hospital, we evaluate both partners from the very first consultation.
Understanding Semen Analysis — The Starting Point
A semen analysis evaluates three key parameters:
- Sperm concentration: Normal is 16 million/mL or more
- Sperm motility: At least 42% moving, 30% with progressive forward motion
- Sperm morphology: At least 4% with normal shape (Kruger strict criteria)
- Semen volume: 1.4–7.6 mL per ejaculate
Common Causes of Male Infertility
Varicocele
An enlargement of veins within the scrotum — the most identifiable and surgically correctable cause of male infertility, present in up to 35–40% of men seen in infertility clinics. Varicoceles raise scrotal temperature and impair sperm production and DNA integrity. Surgical treatment (varicocelectomy) often significantly improves parameters.
Hormonal Imbalances
Disruptions to the testosterone-producing hormonal cascade (due to obesity, tumours, or anabolic steroid use) can suppress sperm production. Blood tests measuring FSH, LH, testosterone, and prolactin help diagnose these conditions.
Obstructive Azoospermia
Some men produce healthy sperm but have a blockage preventing release — due to previous infections, vasectomy, or congenital absence of the vas deferens. Surgical sperm retrieval (TESA or PESA) can obtain sperm for use in ICSI.
Lifestyle Factors
- Smoking: reduces count, motility, and DNA integrity
- Alcohol: reduces testosterone and sperm quality
