Male infertility and semen analysis
A male factor plays a role in about half of infertility cases; that is why the evaluation always includes both partners together. The first and basic test on the male side is the semen analysis (sperm test): sperm count, movement (motility) and shape (morphology) are assessed. A single low result is not a final verdict; the result is usually confirmed by repeating the test. Conditions such as varicocele, hormonal causes, blockage or azoospermia may be involved. Diagnosis and treatment are often carried out together with urology/andrology; this page is for general information.
Infertility is often thought of as a "women's issue"; yet a male factor plays a role in about half of cases. That is why the evaluation always includes both partners together, and on the male side it starts with a simple test — the semen analysis. What does a sperm test tell us, and which causes are investigated? Diagnosis and treatment of the male factor fall mainly within urology/andrology; the aim here is general information.
How common is the male factor?
In infertility, causes are spread between women and men about equally often; roughly one third are due to the man, one third to the woman, and the rest to both partners or to unexplained causes. That is why the man's evaluation is not an "extra step" but a natural part of the first evaluation.
An infertility workup is not considered complete without evaluating the male side. The good news: even when a male factor is found, pregnancy is often possible with treatment or IVF (ICSI).
What is a semen analysis, and how is the sample given?
A semen analysis (sperm test) is the laboratory examination of a semen sample to assess sperm count, movement and shape. It is the first and basic test for the male factor.
- It is usually given after 2–5 days of sexual abstinence (abstinence that is too short or too long can affect the result),
- The sample is collected under suitable conditions and delivered to the laboratory on time,
- A feverish illness, intense stress or some medications can temporarily affect the result.
Your clinic or doctor will give you specific instructions on how and when to give the sample. Do not treat a single result as "final"; it is usually repeated for confirmation.
How is the result read?
A semen analysis assesses three main parameters:
The amount of sperm in a given volume. If it is low, this is called "oligozoospermia"; if there is no sperm at all, "azoospermia."
The proportion of sperm that can move forward. Low movement is referred to as "asthenozoospermia."
The proportion of sperm with a normal structure. If it is low, this is called "teratozoospermia."
These values are interpreted not on their own but together, and in the context of the couple as a whole. A borderline result does not mean "you can't have a child"; it may only call for a closer evaluation.
Main causes
Topics that commonly come up in male infertility:
- Varicocele — enlarged veins in the testicles (it does not affect everyone),
- Hormonal imbalances,
- Blockage (obstruction) — an obstruction in the sperm pathway,
- Previous infection, surgery or testicular problems,
- Gonadotoxic factors (some treatments, smoking, excessive heat, etc.),
- Some genetic causes.
What the cause is, and whether treatment is needed, is determined by a urology/andrology examination and the necessary tests.
Azoospermia, TESE and micro-TESE
Azoospermia is the absence of sperm in the semen sample. There are two main types: due to a blockage in the pathway (obstructive) or due to a production problem (non-obstructive). Azoospermia on its own does not mean "impossible":
- In some cases, sperm can be retrieved from the testicle with surgical methods (TESE / micro-TESE),
- The retrieved sperm can be used in IVF with ICSI (microinjection).
The suitability, likelihood of success and timing of these procedures are assessed individually by urology/andrology. When needed, sperm freezing may also be considered.
When to see urology/andrology?
- If the semen analysis result is low or borderline (for confirmation and to look for the cause),
- If no sperm was found in the semen (azoospermia),
- If there is a known testicular problem or previous surgery/infection,
- If, in the couple's evaluation, the male side needs to be examined in detail.
The male factor is a common and often resolvable part of infertility. The right step is to be evaluated together as a couple and, when needed, to move forward with the relevant specialist (urology/andrology).
Frequently asked questions
How is a semen analysis done, and how many days of abstinence are needed?
The sperm sample is usually given after 2–5 days of sexual abstinence; abstinence that is too short or too long can affect the result. The sample is collected under suitable conditions and delivered to the laboratory on time. Your clinic or doctor will give you specific instructions on how and when to give the sample.
My sperm test came back poor. Am I infertile?
A single low result is not a final verdict. Sperm values can change temporarily due to factors such as illness, fever, stress or the length of abstinence. That is why the result is usually confirmed by repeating the test a few weeks apart. Even if a lasting problem is found, pregnancy is possible in many cases with treatment or IVF.
Does a varicocele affect fertility?
A varicocele (enlarged veins in the testicles) can affect sperm values in some men; however, not every man with a varicocele has infertility. The evaluation and treatment decision belong to urology and are individual. The same approach is not applied to everyone.
Does azoospermia (no sperm in the semen) make having children impossible?
Not always. Azoospermia can be due to a blockage (obstructive) or to a production problem. In some cases, sperm can be retrieved from the testicle with surgical methods (TESE/micro-TESE) and used in IVF (ICSI). Urology/andrology assesses whether this is suitable.
Does an obstetrician-gynecologist treat male infertility?
Diagnosis and treatment of the male factor fall mainly within urology/andrology. The obstetrics-gynecology and IVF team manages the couple's process as a whole and works together with urology when needed. This page is for general information; the treatment decision belongs to the relevant specialist.
Sources
- World Health Organization (WHO) — Infertility
- ASRM — ReproductiveFacts (patient information)
- ESHRE — Reproductive medicine guidelines
Note: This content was written independently, based on current scientific information published by the institutions above; it is not a direct copy of any text.
This article is for general information only; it is not a diagnosis or treatment recommendation and does not replace a medical examination. Please consult your doctor about your own situation. The content reflects scientific knowledge as of the update date above.