Male infertility: what causes it, and how it's treated
Male infertility is involved in roughly a third of couples struggling to conceive, and it is investigated with the same seriousness as female infertility — not treated as an afterthought. Most causes are identifiable on testing, and most have a treatment option, ranging from simple lifestyle changes through medication to surgical sperm retrieval where none is present in the ejaculate.
What causes male infertility
The causes generally fall into a few groups. A low sperm count, or sperm with reduced motility or abnormal shape (morphology), is the most common finding and can result from hormonal imbalance, infection, heat exposure, smoking, or no clear cause at all. A varicocele — enlarged veins in the scrotum, similar to varicose veins — is a common and often treatable cause, sometimes correctable surgically. Blockages in the tubes that carry sperm, whether from a past infection, injury, or surgery, can mean sperm is being produced normally but cannot reach the ejaculate. Hormonal problems affecting the pituitary or testes can reduce or stop sperm production altogether. Previous surgery, mumps in adulthood, certain long-term illnesses, and some medications can also play a part.
How it's investigated
Semen analysis
This is the first and most important test, looking at sperm count, motility and morphology. It is simple, quick, and tells us which direction the rest of the work-up should take. A single abnormal result is often repeated after a few weeks before conclusions are drawn, since results can vary.
Hormone blood tests
Used where the semen analysis suggests a hormonal cause, or where sperm production itself appears to be affected rather than just sperm quality.
Physical examination and scrotal ultrasound
Checks for a varicocele, undescended testes, or other structural findings that a semen analysis alone would not show.
Further tests where needed
Depending on the initial findings, this can include tests to look for a blockage or to check for genetic factors, so treatment is targeted rather than guessed at.
Treatment options
Treatment depends entirely on what the investigation finds. Where lifestyle factors are contributing — smoking, excess alcohol, being significantly overweight, or heat exposure from tight clothing or frequent hot baths — addressing these is usually the first step, alongside general health measures. Where a varicocele is found and judged significant, it can often be corrected surgically. Hormonal causes may respond to medication that supports sperm production. Where an obstruction is blocking sperm from reaching the ejaculate, or where the count is too low for IUI to be a realistic option, IVF with ICSI — where a single sperm is injected directly into an egg in the laboratory — is often the next step, and is covered in more detail on the fertility and IVF page.
When no sperm is found: micro-TESE
In some men, no sperm at all is found in the ejaculate — a condition called azoospermia. This does not necessarily mean sperm is not being produced; in many cases it is present in the testicular tissue itself but not reaching the ejaculate, or production is reduced but still occurring in small pockets. Micro-TESE (microdissection testicular sperm extraction) is a surgical procedure to search the testicular tissue directly and retrieve sperm for use with ICSI. It is carried out here in the hospital's own operating theatre, by Dr. Mayur Pai, so a couple does not need to be referred elsewhere between diagnosis and the procedure itself.
Why investigating the man matters from the start
It is common for a couple to assume infertility is a female issue and to start testing there. A semen analysis is inexpensive, quick and non-invasive, and doing it early avoids months of investigating only one partner while the other cause goes unlooked-for. At Pai Hospital, both partners are typically investigated from the first consultation for exactly this reason.
Getting started
Call or WhatsApp us to arrange a semen analysis and a first consultation. If you already have a previous semen analysis or hormone report, bring it along — it often shortens the path to a plan. For what a full fertility work-up and treatment cycle involves, including IVF and ICSI, see the fertility and IVF page.
Is male infertility as common as female infertility?
Roughly a third of infertility cases trace to the man, a third to the woman, and the rest to a combination of both or no clear cause found on testing — so investigating both partners together is the usual starting point.
What is the first test for male infertility?
A semen analysis, checking sperm count, motility and shape. It is simple and usually the starting point for everything that follows.
Can male infertility be treated without surgery?
Often, yes. Lifestyle changes, treating an underlying hormonal cause, or medication can be enough in many cases. Surgery, including micro-TESE, is kept for situations where it is specifically needed.
What is micro-TESE?
A surgical procedure to search testicular tissue directly for sperm, used when none is found in the ejaculate. It is carried out here in the hospital's own operating theatre.
This page is for general education and is not personal medical advice. Treatment depends on your own examination and reports, so please speak to a doctor about your situation. We do not carry out or offer sex determination of any kind.