How Common Is Male Infertility?
Infertility is defined as failure to conceive after 12 months of regular, unprotected intercourse. It affects about 15% of couples globally. In roughly half of these couples, a male factor is the sole or contributing cause — making andrology evaluation essential for any couple struggling to conceive. Evaluating both partners simultaneously saves valuable time.
Common Causes
- Varicocele — Enlarged veins in the scrotum that raise testicular temperature and impair sperm production. The most correctable cause, found in 40% of infertile men.
- Sperm production problems — Low sperm count (oligospermia), abnormal motility or shape; may be idiopathic or due to hormonal imbalance.
- Obstructive azoospermia — No sperm in ejaculate due to blockage in the vas deferens or epididymis (e.g., post-infection, post-vasectomy).
- Hormonal disorders — Low FSH, LH or testosterone; pituitary or thyroid dysfunction.
- Genetic causes — Klinefelter syndrome (XXY), Y-chromosome microdeletion.
- Lifestyle factors — Smoking, excessive alcohol, anabolic steroids, obesity, heat exposure (laptops on lap, saunas), tight underwear.
- Prior infection — Mumps orchitis, chlamydia, gonorrhoea causing epididymal obstruction.
When to Seek Help
A couple under 35 should see a specialist after 12 months of trying. See a doctor sooner — after 6 months — if either partner is over 35, has a known reproductive condition, has had previous surgery in the pelvic or genital area, or if the male partner has a known history of varicocele, undescended testis, or prior infection.
What Tests to Expect
- Semen analysis — the cornerstone test. Measures sperm count, motility, morphology and volume. Should be done after 2–5 days of abstinence and repeated once for confirmation.
- Hormones — FSH, LH, testosterone, prolactin, thyroid function.
- Scrotal ultrasound — identifies varicocele, testicular volume, obstruction.
- Genetic testing — karyotype and Y-chromosome deletion if severe oligospermia or azoospermia.
- Testicular biopsy — if azoospermia is suspected to be obstructive vs non-obstructive.
Treatment Options
- Varicocelectomy: Surgical or microscopic ligation of varicocele veins. Significantly improves sperm parameters and spontaneous pregnancy rates within 3–6 months.
- Hormone therapy: For hypogonadotropic hypogonadism — FSH/HCG injections stimulate sperm production.
- Surgical sperm retrieval (TESA/micro-TESE): For obstructive or non-obstructive azoospermia, sperm can be extracted directly from the testes for use in ICSI.
- Assisted reproduction (IUI / IVF-ICSI): Intrauterine insemination for mild male factor; ICSI for moderate-to-severe cases where a single sperm is injected directly into each egg.
A semen analysis and consultation with Dr. Azhar Anwar is the most important first step a couple can take.
Lifestyle Changes That Help
- Stop smoking — tobacco directly damages sperm DNA and motility.
- Limit alcohol to occasional, moderate intake.
- Avoid anabolic steroids and testosterone supplements — they suppress the body's own sperm production.
- Maintain a healthy weight — obesity raises scrotal temperature and lowers testosterone.
- Keep laptops off the lap; avoid prolonged hot baths or tight underwear.
- Eat a balanced diet rich in antioxidants: zinc, selenium, folate, vitamins C and E.