For many years, infertility was understood primarily as a female problem. The statistics tell a different story. Male factor infertility is identified in approximately 40–50% of all cases where a couple cannot conceive, either as the sole cause or as a contributing factor. Despite this, men frequently receive less thorough investigation than their partners, and subspecialist andrological assessment remains underutilised.
Understanding male factor infertility — its causes, how it is properly diagnosed, and what treatments are available — is the first step toward an accurate diagnosis and a realistic treatment plan.
What Is Male Factor Infertility?
Male factor infertility refers to any condition in the male partner that reduces the likelihood of natural conception. It encompasses a wide spectrum of problems, ranging from mild reductions in sperm quality to the complete absence of sperm in the ejaculate.
A couple is generally considered to have a fertility problem if they have not conceived after 12 months of regular unprotected intercourse (or 6 months if the female partner is over 35). Investigation should include both partners from the outset.
Causes of Male Factor Infertility
Male infertility can arise from problems at multiple levels of the reproductive system.
Sperm production problems (testicular failure) — the testes produce insufficient numbers of sperm, or sperm of inadequate quality. Causes include varicocele, genetic conditions, hormonal disorders, prior infection (including mumps orchitis), cryptorchidism, and the effects of medications, chemotherapy, or radiotherapy.
Sperm transport problems (obstructive causes) — sperm are produced normally but cannot reach the ejaculate because of a blockage. This may follow vasectomy, infection, or congenital absence of the vas deferens.
Hormonal problems — the hormonal signals from the brain (hypothalamus and pituitary gland) that stimulate sperm production may be deficient or dysregulated, resulting in hypogonadism and impaired spermatogenesis.
Genetic causes — chromosomal abnormalities (most commonly Klinefelter syndrome, 47XXY) and Y chromosome microdeletions are found in a significant proportion of men with severe male factor infertility. Genetic counselling is an important part of the assessment in these cases.
Ejaculatory problems — retrograde ejaculation (sperm entering the bladder rather than being expelled) or anejaculation can prevent sperm from reaching the partner, despite normal production.
DNA integrity problems — high sperm DNA fragmentation can cause infertility even when conventional sperm parameters appear normal.
How Is Male Infertility Diagnosed?
A thorough male fertility assessment at London Andrology includes:
Semen analysis — at least two samples, ideally from a specialist andrology laboratory rather than a general pathology service. Parameters assessed include concentration, total count, progressive motility, morphology, and volume.
Sperm DNA fragmentation testing — routinely offered for couples with unexplained infertility, failed IVF, or recurrent miscarriage.
Hormonal blood tests — FSH, LH, testosterone, prolactin, inhibin B, thyroid function where indicated.
Scrotal ultrasound — to identify varicocele, epididymal abnormalities, and testicular volume.
Genetic testing — karyotype and Y chromosome microdeletion screen for men with severe oligospermia or azoospermia; CFTR mutation analysis for men with obstructive azoospermia and absent vas deferens.
Physical examination — an experienced andrologist can identify varicocele, epididymal abnormalities, and other findings that are not detectable on ultrasound alone.
Treatment Options
Treatment is matched to the underlying cause. This is why accurate diagnosis is the most important investment a couple can make in their fertility journey.
For men with correctable causes — varicocele, hormonal disorders, obstructive azoospermia amenable to reversal — targeted treatment can restore or significantly improve natural fertility or IVF outcomes. For men with non-correctable causes, surgical sperm retrieval for IVF/ICSI offers the possibility of biological parenthood.
We do not recommend proceeding directly to IVF before a thorough male assessment has been completed. Treating a correctable male factor first is almost always more effective and less costly than repeated IVF cycles.
Book a Consultation
If you and your partner have been trying to conceive without success, or if you have already been told that IVF is your only option without a full male assessment having been carried out, we strongly encourage you to seek a subspecialist andrological opinion. Contact London Andrology to arrange an appointment with Professor Minhas or Professor Yap.
