Male Infertility — Evaluation and Treatment

Male factor is the sole cause of infertility in approximately 20 percent of couples and contributes in another 30 to 40 percent. This is why both partners are evaluated when a couple presents with infertility, never just the woman.

Improvements in semen analysis methodology (WHO 2021 Manual, sixth edition) and downstream diagnostic tools have transformed male infertility evaluation from a basic count and motility check into a sophisticated assessment of sperm quality, function, and DNA integrity.

• Detailed history — childhood illnesses (mumps orchitis), surgeries (varicocelectomy, hernia repair), medications, occupational exposures, lifestyle factors
• Physical examination — testicular volume, varicocele detection, secondary sexual characteristics
• Semen analysis × 2 — minimum two analyses spaced 2-4 weeks apart, per WHO 2021 reference values
• Hormonal profile — FSH, LH, testosterone, prolactin where indicated
• Scrotal ultrasound — for varicocele, testicular pathology, ductal obstruction
• Genetic testing — karyotype, Y-chromosome microdeletion, CFTR for severe oligospermia or azoospermia

For borderline or unexplained findings:

• Sperm DNA fragmentation index (DFI) — important when standard parameters are normal but recurrent pregnancy loss or failed IVF cycles occur
• Oxidative stress markers — research-grade in selected cases
• Acrosomal integrity — for unexplained fertilisation failure with IVF
• Antisperm antibodies — post-vasectomy, varicocele, or trauma history

We order these tests selectively based on the clinical scenario, not as routine complete panels.

Lifestyle and medical optimisation — weight loss, smoking cessation, alcohol moderation, heat avoidance, and treatment of underlying conditions like diabetes or hypogonadism can improve sperm parameters within three months.

Varicocele repair — microsurgical varicocelectomy benefits selected men with clinical varicocele and abnormal semen parameters.

IUI — for mild male factor with adequate post-wash count and patent female tubes.

IVF with ICSI — overcomes most semen abnormalities. ICSI achieves fertilisation rates above 70 percent across a range of male factor severities.

Surgical sperm retrieval (TESA/PESA/Micro-TESE) — for obstructive and non-obstructive azoospermia. Performed in collaboration with reproductive urology.