Understanding Male Infertility: Common Causes and Treatment Options

By Dr. Anshika Lekhi | MBBS, DGO, Fellowship in Reproductive Medicine, The Fertilife, Gurgaon

Male infertility gets talked about less than almost anything else in fertility care in India, and it plays a part in close to half of all cases where a couple struggles to conceive. At The Fertilife we assess both partners as a matter of routine before recommending anything, because treating the female partner alone where a significant male factor is sitting there gets you avoidable delays and failed cycles. Male factors are now responsible for 40 to 50% of infertility cases in India, a figure that has climbed as sperm quality has fallen off, under environmental pollutants, sedentary lifestyles and chronic stress.

What Does Male Infertility Actually Mean?

Male infertility covers any condition in the male partner that brings down the likelihood of a pregnancy. It usually gets picked up on a semen analysis, which measures sperm count, motility, meaning movement, morphology, meaning shape, and volume. A standard semen analysis does not catch everything, though. Sperm DNA fragmentation, hormonal status and structural anatomy all feed into male fertility, and none of them necessarily show up on a basic semen report.

What Are the Most Common Causes?

Sperm Production Problems

• Oligospermia: low sperm count, meaning fewer than 15 million sperm per millilitre

• Azoospermia: no sperm at all in the ejaculate, which may be obstructive, so a blockage, or non-obstructive, so a production failure

• Asthenospermia: poor sperm motility, which tells on the ability of sperm to reach an egg and get into it

• Teratospermia: a high proportion of abnormally shaped sperm, which brings fertilisation potential down

Sperm DNA Damage

Raised sperm DNA fragmentation is a cause of male infertility that slips past a standard semen analysis regularly. High DNA fragmentation can turn into fertilisation failure, poor embryo development, recurrent implantation failure and recurrent pregnancy loss, and it does that even where sperm count and motility look perfectly normal. It gets read through a dedicated DNA fragmentation index test, which we run as part of our Male Fertility Assessment in the cases that call for it.

Hormonal Causes

Low testosterone, FSH or LH will disrupt sperm production. Hormonal imbalances may come off conditions affecting the pituitary gland or the hypothalamus, or off external factors, anabolic steroid use among them, which suppresses sperm production directly.

Structural Issues

• Varicocele: enlarged veins in the scrotum that push testicular temperature up and impair sperm production, and the most surgically correctable cause of male infertility there is

• Obstruction: blockages in the vas deferens or the epididymis, which can be left behind by past infections, injury or a previous vasectomy

• Retrograde ejaculation: sperm going into the bladder instead of out, which may mean sperm retrieval for use in IVF

How Is Male Infertility Diagnosed at The Fertilife?

Our Male Infertility assessment opens with a comprehensive semen analysis, and additional testing follows off what that turns up:

What Are the Treatment Options?

Lifestyle Optimisation

Where sperm parameter abnormalities are mild, structured lifestyle changes will improve semen quality over 2 to 3 months. Weight management, cutting alcohol, stopping smoking, keeping heat exposure down, antioxidant supplementation.

Surgical Intervention

Varicocele repair, or varicocelectomy, improves sperm parameters in selected cases. For obstructive azoospermia, surgical sperm retrieval, so TESA or PESA, takes sperm straight from the testis or the epididymis for use in IVF.

ICSI Treatment

ICSI Treatment, intracytoplasmic sperm injection, is the most effective assisted reproduction technique going for significant male-factor infertility. One healthy sperm gets selected and injected straight into a mature egg, so the sperm never has to penetrate the egg naturally. It runs alongside IVF and it is the standard approach at The Fertilife where there is low sperm count, poor motility, abnormal morphology or raised DNA fragmentation.

Why Early Investigation Matters

The longer male-factor infertility goes undiagnosed, the more treatment cycles get attempted without anybody touching the underlying problem. Our Male Infertility program and Male Fertility Assessment are built to identify every contributing male factor before treatment starts, so the IVF or ICSI Treatment protocol we design rests on a complete picture of both partners. Visit thefertilife.in to arrange a full fertility assessment.

This article is for general educational purposes and is not a substitute for personalised medical advice from your fertility specialist or embryologist.