If you and your partner have been trying to conceive without success, you are not alone — and the reason may not always lie with the woman. Male factor infertility is responsible for approximately 40–50% of all infertility cases worldwide. Yet it remains one of the most underdiagnosed and under-discussed aspects of fertility care.
At SHEIVF, we believe that understanding the problem is the first step toward solving it. This guide walks you through everything you need to know about male infertility — what causes it, how it is diagnosed, and the full range of treatments available today.
What is male factor infertility?
Male factor infertility refers to any condition in a man that reduces the chances of his partner becoming pregnant. It is typically identified through abnormalities in sperm — including low sperm count, poor sperm motility (movement), abnormal sperm shape (morphology), or a complete absence of sperm in the semen (azoospermia).
In some cases, male infertility may also be caused by structural or hormonal problems that prevent sperm from being produced or delivered effectively.
How common is it?
Studies show that male factor infertility contributes to roughly 1 in 3 cases of couples struggling to conceive. Despite this, men are far less likely to seek evaluation than women. This delay in diagnosis can cost couples months or even years of unnecessary treatment.
The encouraging news: the vast majority of male infertility conditions are treatable, and modern assisted reproduction techniques — particularly ICSI — have made it possible for men with very low or no sperm counts to father biological children.
What causes male infertility?
Male infertility can arise from a wide range of causes, which broadly fall into three categories:
1. Sperm production problems
- Varicocele: Enlarged veins in the scrotum that raise testicular temperature and impair sperm production. It is the most common correctable cause of male infertility.
- Hormonal imbalances: Low testosterone, FSH, or LH levels can disrupt sperm production.
- Genetic conditions: Klinefelter syndrome, Y-chromosome microdeletions, and other genetic disorders can severely affect sperm production.
- Undescended testicles (cryptorchidism): If not corrected early, this can permanently reduce sperm production.
- Infections: Mumps orchitis, STIs such as chlamydia, and epididymitis can damage sperm-producing tissue.
2. Sperm delivery problems
- Blockages (obstructive azoospermia): Blockages in the vas deferens or epididymis — caused by infection, injury, or previous vasectomy — prevent sperm from reaching semen.
- Retrograde ejaculation: Sperm travels backward into the bladder instead of being ejaculated.
- Ejaculatory duct obstruction: A blockage within the ejaculatory ducts reduces or eliminates sperm in semen.
3. Lifestyle and environmental factors
- Excessive heat exposure (laptops, saunas, tight clothing)
- Smoking, alcohol, and recreational drug use
- Obesity and poor diet
- Chronic stress
- Exposure to pesticides, heavy metals, or radiation
- Anabolic steroid use (suppresses natural testosterone and sperm production)
Signs and symptoms to watch for
Male infertility rarely has obvious symptoms. Most men feel and look completely healthy. However, some signs may suggest an underlying issue:
- Pain, swelling, or a lump in the testicle area
- Low sex drive or difficulty maintaining an erection
- Reduced facial or body hair (possible hormonal issue)
- A history of testicular injury or surgery
- Previous STI or urinary tract infection
If you have been trying to conceive for 12 months (or 6 months if your partner is over 35) without success, both partners should be evaluated — simultaneously.
How is male infertility diagnosed?
Diagnosis at SHEIVF begins with a thorough evaluation that typically includes:
Semen analysis
This is the first and most important test. It measures sperm count, motility, morphology, volume, and pH. Two samples taken 2–4 weeks apart are usually recommended for accuracy.
Hormone blood tests
Levels of testosterone, FSH, LH, and prolactin are assessed to determine if a hormonal cause is involved.
Scrotal ultrasound
Imaging that detects varicoceles, blockages, or structural abnormalities in the testes and epididymis.
Genetic testing
A karyotype test and Y-chromosome microdeletion analysis may be recommended for men with very low or absent sperm counts to identify genetic causes.
Post-ejaculation urinalysis
Checks for sperm in urine, which would confirm retrograde ejaculation.
Testicular biopsy
In cases of azoospermia (no sperm in semen), a biopsy can determine if sperm are being produced in the testes but are unable to reach the semen.
Treatment options
Treatment depends entirely on the underlying cause. At SHEIVF, our male fertility specialists design a personalised plan after a thorough evaluation.
Medical treatment
- Hormone therapy: If hormonal imbalances are detected, medications such as gonadotropins or clomiphene can stimulate sperm production.
- Antibiotics: For infections affecting sperm quality or the reproductive tract.
- Lifestyle changes: Stopping smoking, reducing alcohol, losing weight, and avoiding heat exposure can meaningfully improve sperm parameters within 3 months.
Surgical treatment
- Varicocelectomy: Surgical repair of varicoceles, which can significantly improve sperm count and motility in many men.
- Vasovasostomy / vasoepididymostomy: Surgical reversal of vasectomy or repair of blockages in the vas deferens or epididymis.
- Sperm retrieval procedures (TESA / PESA / micro-TESE): For men with azoospermia, sperm can often be retrieved directly from the testes or epididymis under local anaesthesia and used in IVF.
Assisted reproduction (ART)
- Intrauterine insemination (IUI): Suitable for mild male factor infertility. Washed, concentrated sperm is placed directly into the uterus around ovulation.
- IVF with ICSI (intracytoplasmic sperm injection): A single healthy sperm is injected directly into an egg. ICSI has transformed outcomes for men with severe male factor infertility — even those with very few sperm. It is SHEIVF's most successful approach for this condition.
- Donor sperm: Where no sperm can be retrieved and no other option is viable, donor sperm from a screened, anonymous donor can be used.
When to see a fertility specialist
Do not wait for a year if any of the following apply to you:
- You have a known history of testicular problems, injury, or surgery
- You have previously been treated for cancer (chemotherapy affects sperm)
- You have diabetes, thyroid issues, or other chronic conditions
- Your partner is 35 or older
At SHEIVF, your first consultation is completely free and confidential. Our male fertility specialists — including Dr. Nidhi Sharma and Dr. Pallavi Singh — approach every case with clinical precision and complete sensitivity.
If you have been quietly wondering whether the problem might be on your side, the most powerful thing you can do is find out. Early diagnosis changes outcomes.