Infertility is a condition that is often attributed to women, but the truth is not exactly what is thought. Studies have shown that in 30% of infertile couples, the male is the cause. 1 Like female-induced infertility, male-induced infertility has an extremely complex nature. Infertility can occur in men for many different reasons.
In order to better understand the occurrence of male-induced infertility, it is important to have basic information about how the pregnancy occurs.
In order for fertilization to occur, couples need to have unprotected sexual intercourse during the process of ovulation of women. Egg quality is extremely important, as is the progression of released eggs to the fallopian tubes. However, in order for the egg and sperm to meet and for the sperm to enter into the egg cell, the sperm cells must also meet various conditions.
In its simplest form, these requirements, which can be summed up as sperm quality, can be listed as ideal sperm count, the suitability of sperm morphology (sperm shape) and the presence of a forward mobility. Let's look at the journey from the production of sperm cells and their journey into the egg.
Male factor infertility is a clinical condition in which factors related to the male partner play a role in the inability to achieve pregnancy. The AUA/ASRM male infertility guideline reports that male factors may be present either alone or as a contributing element in approximately half of infertile couples.
As part of the male infertility evaluation in İzmir, semen analysis, and when necessary, hormonal tests and genetic evaluations are planned. Doç. Dr. Funda Göde evaluates the couple’s overall reproductive profile in IVF and infertility processes where both male and female factors are considered together.
“When a male factor is identified, we evaluate it within the couple’s overall reproductive profile. Semen analysis, hormonal tests, and when necessary, genetic evaluations guide us in determining the treatment pathway.”
Male factor infertility, commonly known as male infertility, refers to situations in which a male-related factor contributes to the inability to achieve pregnancy. The AUA/ASRM guideline addresses male infertility within the framework of semen quality, sperm function, anatomical, endocrine (hormonal), genetic, and sexual function-related conditions.
In men, sperm production begins in the testes. This process is called spermatogenesis; in simpler terms, sperm cells are formed and prepared for maturation. The sperm cells then mature in the ducts called the epididymis and are expelled together with semen during ejaculation. For pregnancy to occur, sperm must be present in sufficient numbers, be able to move properly, and be structurally capable of reaching the egg.
For this reason, sperm count, sperm motility, and sperm morphology are evaluated together during assessment. A problem in one of these parameters does not always provide a definitive conclusion on its own; the overall picture is evaluated together with examination findings and, when necessary, additional tests.
Male factor infertility often does not present with an obvious complaint. In many couples, the first sign is the inability to achieve pregnancy despite regular unprotected intercourse.
Situations that may be observed or identified during evaluation within the scope of male infertility symptoms can be listed as follows:
Inability to achieve pregnancy: This is the most commonly recognized situation in male infertility. The man may not have any obvious pain, discharge, or sexual problems.
Low sperm count: This is not a symptom the individual can notice on his own. It is identified through semen analysis (spermiogram).
Impaired sperm motility or sperm morphology: Sperm motility refers to the sperm’s ability to move forward. Sperm morphology refers to the shape of the sperm. These findings also cannot be seen externally and are identified through laboratory evaluation.
Testicular pain, swelling, or palpable differences: These findings should not be interpreted directly as symptoms of male infertility. They may require urological evaluation and are also addressed during infertility assessment.
Findings suggesting hormonal abnormalities: Situations such as small testes, decreased sexual desire, or erectile dysfunction may lead to hormonal testing.
The AUA/ASRM guideline states that FSH and testosterone evaluation may be performed in the presence of decreased libido, erectile dysfunction, oligozoospermia or azoospermia, small testes, and examination findings suggesting hormonal disorders.
For male infertility evaluation in İzmir, you may consult Doç. Dr. Funda Göde. Semen analysis, existing test results, the couple’s reproductive history, and IVF treatment options, if necessary, are evaluated together. For appointments and information, you can contact us via our WhatsApp consultation line.
The causes of male infertility cannot be grouped under a single heading. Different conditions affecting sperm production, sperm transport, hormonal balance, or sexual function may lead to this condition. Potential causes of male infertility can be listed as follows:
The answer to the question “Is male infertility genetic?” is not the same for every patient. In some men, infertility may be associated with congenital structural or genetic conditions. Chromosomal anomalies, Y chromosome microdeletions, or congenital absence of the sperm transport duct called the vas deferens are evaluated within this group.
Certain diseases or treatments that develop later in life may affect sperm production. Testicular infections, previous surgeries, trauma, cancer treatments, certain systemic diseases, and obstructions in the sperm transport pathways are evaluated in this group.
For example, azoospermia means the absence of sperm cells in semen. This condition may result from impaired sperm production or may be related to an obstruction preventing the produced sperm from being transported outward.
Smoking, alcohol use, obesity and weight control, chemical/drug exposure, prolonged heat exposure, nutritional habits, sports, and exercise routines may be questioned during male reproductive health evaluation.
Erectile dysfunction, ejaculation problems, retrograde ejaculation (the backward flow of semen into the bladder), or conditions that make intercourse difficult may affect the ability to achieve pregnancy.
Sexual function disorders are not always the primary cause of male infertility; however, they are among the issues that should be reviewed during evaluation. If such a condition exists, the underlying cause is investigated through urological and, when necessary, andrological evaluation.
Male infertility diagnosis is not based on a single result. Spermiogram is often the first and most guiding test; however, this test alone does not fully explain male reproductive health. For accurate interpretation, the patient’s history, examination findings, hormonal balance, and genetic evaluations when necessary are assessed together. In this way, it can be better understood whether the issue is related to sperm production, sperm transport pathways, hormonal structure, or another cause.
“We do not proceed based on a single result in diagnosis. Although spermiogram provides us with important initial information, we evaluate the result together with the patient’s examination, hormone levels, and genetic evaluations when necessary. As I mentioned earlier, the causes of male factor infertility are highly diverse. Therefore, we plan the diagnostic process according to the patient’s findings rather than as a standard checklist.”
A spermiogram is the laboratory examination of a semen sample. In this test, sperm count, sperm motility, and sperm morphology — in general terms, sperm quality — are evaluated.
The result of semen analysis alone does not provide a definitive decision. One parameter may be low, multiple parameters may be impaired, or results may vary over time. For this reason, if an abnormal result is obtained, the test may be repeated.
Although genetic tests are not a routine step for every man, hormonal tests (FSH, LH, testosterone) may be requested in some men. These tests provide information about the hormonal system that regulates sperm production. Hormonal evaluation may especially be planned in cases of azoospermia, very low sperm count, decreased sexual desire, erectile dysfunction, or reduced testicular volume.
If physical examination reveals varicocele, reduced testicular volume, suspicion regarding duct structures, or signs of infection, additional examinations may be performed. Imaging methods such as ultrasound are not used as a first-line step in every patient; the decision is made according to examination and test results.
Male infertility treatment is planned according to the underlying cause. In selected cases, lifestyle modifications and medical follow-up may be sufficient, while in some patients hormonal treatments, surgical procedures, or assisted reproductive techniques may come into consideration. Treatment duration and expected response vary according to sperm count, sperm motility, sperm morphology, the man’s general health condition, female factors, and the couple’s reproductive plans.
“We do not describe treatment in male infertility through a single method. First, we try to understand the source of the problem. When sperm production, hormonal balance, the presence of varicocele, sperm transport pathways, and the couple’s overall condition are evaluated together, a more accurate roadmap can be created.”
Quitting smoking and alcohol, obesity and weight control, regular sleep, nutritional habits, sports, and exercise routines may be addressed during male reproductive health evaluation. Chemical/drug exposure, prolonged exposure to high temperatures, and certain occupational risks are also among the topics questioned.
These modifications should not be assumed to produce the same result in every man. The aim is to identify modifiable factors that may affect sperm production and support overall health status. Stress management may also be part of the treatment plan, but it should not be viewed as a method that alone resolves infertility.
In some men, treatments targeting hormonal balance may come into consideration. Hormonal tests (FSH, LH, testosterone) provide information about the system regulating sperm production. In certain hormonal conditions such as hypogonadotropic hypogonadism — which can be described as impaired sperm and testosterone production due to insufficient hormonal stimulation from the brain to the testes — medication treatment may be prioritized.
“Hormonal treatment is not always the first option in male infertility. First, hormonal balance, sperm production, and the couple’s overall reproductive profile are evaluated together. The use of external testosterone may not be appropriate for men planning to become fathers because it may reduce sperm production. Therefore, medication treatments, surgical sperm retrieval procedures, or assisted reproductive techniques such as IVF are planned according to the patient’s findings.”
Varicocele refers to the enlargement of the testicular veins. If varicocele identified during examination is accompanied by infertility and abnormal semen findings, varicocele surgery may be considered. Incidentally detected varicocele seen only on imaging and not palpable on examination is not approached with the same surgical decision.
Azoospermia means the absence of sperm cells in semen. If the cause is related to obstruction of the sperm transport pathways, surgical options may be considered. In non-obstructive azoospermia, Micro TESE surgery may be performed in selected patients.
Assisted reproductive techniques are planned according to the severity of the male factor and the couple’s overall evaluation. In some couples with mild male factor infertility, intrauterine insemination (IUI) may be considered. In cases with more significant sperm problems, IVF treatment or intracytoplasmic sperm injection (ICSI) may come into consideration.
Microinjection refers to the placement of a selected sperm cell directly into the egg in the laboratory environment. IMSI is a laboratory method in which sperm are selected under higher magnification. Sperm freezing, embryo freezing (cryopreservation), and in some couples egg freezing may be evaluated according to the treatment plan.
It would not be accurate to provide a single success rate figure. Results are evaluated together with age, ovarian reserve, semen analysis findings, embryo development, and previous treatment history.
In couples applying for male infertility treatment in İzmir, the process progresses through evaluating male findings together with female factors. Spermiogram results, hormonal balance, the presence of varicocele, findings such as azoospermia, and the couple’s reproductive history are considered within the same framework. In this way, factors affecting the chance of pregnancy can be evaluated more comprehensively.
Doç. Dr. Funda Göde adopts a couple-centered evaluation approach during the infertility process with her experience in gynecology, obstetrics, and IVF. When male factor infertility is suspected, semen analysis, hormonal tests when necessary, genetic evaluation, and urology/andrology consultation may be planned together.
In couples with identified male factors, options such as insemination/IUI, IVF treatment, intracytoplasmic sperm injection (ICSI), sperm freezing, or embryo freezing may come into consideration according to clinical evaluation. If severe sperm disorders, azoospermia, or a history of unsuccessful treatments are present, the process is planned in greater detail.
The initial evaluation includes a semen analysis, also known as a semen analysis. If deemed necessary, hormone tests (such as FSH, LH, and testosterone), genetic tests, and imaging studies may be added based on the findings of the physical examination.
Treatment is planned based on the cause of male infertility. Options such as lifestyle changes, hormonal therapy, varicocele surgery, micro-TESE, intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI) may be considered depending on the clinical presentation.
Varicocele surgery does not yield the same results for every man. If a varicocele detected during an examination is accompanied by infertility and abnormal semen findings, surgery may be considered as an option. When deciding on varicocele surgery, factors specific to both the man and the woman are taken into account simultaneously.
The duration varies depending on the diagnosis and the treatment used. Hormone therapy is not standard for every man.
Which factor is the primary cause varies from person to person. Male infertility may be linked to genetic causes in some cases. In other men, environmental exposures, smoking, alcohol, obesity, heat, medication use, or past illnesses are taken into account.
You must adhere to the period of sexual abstinence recommended by your doctor prior to the test. Since feverish illnesses, medications you are taking, or the conditions under which the sample is collected may affect the results, you should share this information during the evaluation.
Erectile or ejaculation problems can affect the ability to conceive. While treating these issues may help some couples, this should not be interpreted as a guarantee that fertility will return.
Completing the necessary tests, quitting smoking and alcohol, managing weight, attending regular follow-up appointments, and adhering to the recommended treatment plan can support the process. The success rate of results achieved through lifestyle changes may vary from person to person.
Note: This content is for general informational purposes only and does not replace diagnosis or treatment. A physician evaluation is required for personal diagnosis and treatment planning.
