Male Factor Infertility and IVF

Our approach to male-factor infertility

Male evaluation begins with a WHO-2021-criteria semen analysis. Abnormal findings trigger a second sample to rule out lab or sampling variability. Where abnormalities persist, deeper testing — DNA fragmentation, hormonal panel, scrotal ultrasound, urology referral — is added selectively. The clinical decision is informed by the female workup in parallel; the cycle plan calibrates ICSI vs IVF and additional techniques (IMSI, PICSI, MACS) based on the combined picture.

Sperm DNA fragmentation

Standard semen analysis measures concentration, motility, and morphology — but two samples with identical parameters can have very different DNA integrity. DNA fragmentation testing is added where there is recurrent miscarriage, prior unexplained IVF failure, advanced paternal age, or known lifestyle risk factors. High fragmentation may direct toward antioxidant therapy, varicocoele evaluation, or surgical sperm retrieval.

Surgical sperm retrieval — TESA / PESA

For azoospermia (absence of sperm in ejaculate), TESA (testicular sperm aspiration) or PESA (percutaneous epididymal sperm aspiration) retrieve viable sperm for ICSI. The technique selection depends on whether the cause is obstructive or non-obstructive. Where indicated, urology collaboration is integrated.

Male-factor topics

Guidelines we follow

• WHO Laboratory Manual for the Examination of Human Semen (2021)
• ESHRE Andrology Guidelines
• EAU Guidelines on Male Infertility
• AUA-ASRM joint guidelines on male infertility

Where this fits

Male evaluation runs in parallel with female evaluation and informs cycle planning. For laboratory techniques designed for male factor, see lab techniques.