Male infertility describes a man’s reduced ability to father a child. It is diagnosed when, despite no identifiable issues in the female partner, pregnancy does not occur, or when repeated semen analyses yield abnormal results. Men account for around 40 % of infertility cases among couples.
Primary and Secondary Infertility
Primary infertility refers to couples who have never conceived.
Secondary infertility refers to couples who have conceived previously but are now unable to conceive again.
Main Causes
The most common factors fall into the following categories:
1. Varicocele
Enlarged veins in the scrotum cause heat to build up, impairing sperm development.
- Diagnosis: Scrotal ultrasound or physical examination (EAU Guideline).
- Treatment: Microsurgical ligation or percutaneous embolisation.
2. Hormonal Imbalances
Low testosterone (hypogonadism) or disrupted LH/FSH levels can impede sperm production.
- Diagnosis: Blood tests for testosterone, LH, FSH and TSH (PubMed 2016).
- Treatment: Hormone replacement therapy or adjustment of medications.
3. Genetic Factors
Chromosomal abnormalities (e.g. Klinefelter syndrome) or microdeletions on the Y chromosome can significantly reduce sperm count and quality.
- Diagnosis: Karyotyping and PCR tests (PubMed 2013).
- Counselling: Genetic counselling to guide family planning.
4. Infections
Infections such as Chlamydia, gonorrhoea or mumps can inflame the reproductive tract and testes.
- Diagnosis: Swab or urine tests and antibody screening (CDC STI Guidelines).
- Treatment: Prompt antibiotic or antiviral therapy.
5. Ejaculatory and Erectile Disorders
Conditions like retrograde ejaculation or erectile dysfunction can prevent proper semen release.
- Diagnosis: Urological and sexual health assessment.
- Treatment: PDE5 inhibitors, injection therapy or psychosexual counselling.
6. Metabolic Disorders
Diabetes, obesity and chronic liver or kidney disease can disrupt hormone balance and sperm production.
- Diagnosis: Blood glucose and lipid profiles, BMI assessment.
- Treatment: Lifestyle modification, weight management and optimized care for underlying conditions.
7. Weight and Nutrition
Excess body fat can elevate oestrogen levels and reduce testosterone. A nutrient-rich diet supports healthy sperm.
- High in antioxidants: berries, nuts, leafy greens (vitamins C and E, zinc, selenium).
- Balanced macronutrients: quality proteins and whole grains.
8. Environmental and Occupational Exposures
Chemicals, solvents, heavy metals and prolonged heat exposure can damage testicular tissue.
- Wear protective clothing in labs or when handling pesticides.
- Avoid hot baths or saunas before providing a semen sample.
9. Sperm DNA Damage
Oxidative stress can cause DNA fragmentation in sperm, reducing fertilisation potential.
- Diagnosis: DNA fragmentation testing.
- Treatment: Antioxidant supplementation (vitamins C and E, zinc, selenium) and stress management.
10. Congenital Abnormalities
Conditions such as undescended testes or congenital ductal anomalies can impair fertility.
- Diagnosis: Medical history and physical exam.
- Treatment: Surgical correction or assisted reproductive technologies.
Lifestyle Recommendations
Alongside medical treatment, healthy lifestyle practices can significantly boost fertility.
- Exercise: Aim for 150 minutes of moderate aerobic exercise per week to improve circulation and hormone balance.
- Diet: Include plenty of fruits, vegetables, nuts and whole grains for essential nutrients.
- Weight Management: Maintain a BMI between 20 and 25 to reduce inflammation and optimise testosterone.
- Sleep & Stress: Get 7–8 hours of sleep and practise relaxation techniques to lower cortisol and support spermatogenesis.
Diagnostic Evaluation
- Semen analysis following WHO guidelines
- Hormone profile (testosterone, LH, FSH, TSH, prolactin)
- Andrological ultrasound
- Infection screening (Chlamydia, gonorrhoea, mumps)
- Genetic testing for abnormal results
- Varicocele assessment
Treatment and Reproductive Techniques
Surgical options, hormone therapies and procedures like ICSI or IVF offer additional paths. In ICSI, a single sperm is injected directly into the egg—particularly effective for low sperm counts (Study 2018).
Practice Checklist
- Prepare your semen sample and relevant test results
- Bring hormone and ultrasound reports to your appointment
- Arrange consultations with a urologist and an andrologist
- Check insurance coverage and reimbursement options
Conclusion
Male infertility is complex but often treatable. A thorough evaluation, personalised treatment plan and healthy lifestyle changes can greatly improve outcomes. Seek specialist care early and take advantage of modern techniques to fulfil your family aspirations.