Fembryo Fertility & Gynaecology Clinic

Male infertility

Male infertility refers to any medical condition that makes it more difficult for a man’s female partner to become pregnant.

Fembryo Fertility Clinic – Gqeberha/Port Elizabeth

Statistically, about 13 out of every 100 couples can’t get pregnant through unprotected intercourse. There are numerous causes of infertility in both men and women.

In over a third of infertility cases, the problem is with the male partner.

This is usually due to issues with his sperm production or delivery.

What Happens Under Normal Conditions?

The body of a male produces microscopic cells known as sperm. Ejaculation generally transports sperm into the woman’s body during intercourse.

Sperm is produced, stored, and transported by the male reproductive system. Hormones are chemicals in your body that influence this. The testicles produce sperm and male sex hormone (testosterone). The testicles are located in the scrotum, a sac of skin below the penis. Sperm exits the testicles and enters a tube behind each testicle. This tube is called the epididymis.

The sperm are transferred from the epididymis into another set of tubes just before ejaculation. These tubes are called the vas deferens. Each vas deferens runs from the epididymis to the pelvis behind your bladder. Each vas deferens meets the ejaculatory duct from the seminal vesicle at this point. Sperm combine with fluid from the prostate and seminal vesicles as you ejaculate. The sperm then passes via the urethra and exits the penis.

The system works only when the genes, hormone levels, and environmental conditions are right.

Causes of male infertility

Making mature, healthy sperm that can travel is dependent on a variety of factors and is impaired if anatomical reasons like varicose veins of the scrotum are present. Childhood surgery for hernias or undescended testicles in small boys may also have a negative effect on male reproduction. Problems can prevent cells from developing into sperm. A variety of issues can prevent the sperm from reaching the egg. Even the temperature of the scrotum might have an impact on fertility.  The following are the primary reasons of male infertility:

Sperm Disorders

  • Varicoceles
  • Retrograde Ejaculation
  • Immunologic Infertility
  • Obstruction
  • Hormones
  • Medication
  • Sperm Disorders

The most common problems are with making and growing sperm. Sperm may:

  • not fully develop, be abnormally formed, or don’t move properly
  • be produced in very small quantities (oligospermia)
  • not be produced at all (azoospermia)

Sperm issues can be caused by inherited features. Lifestyle choices can reduce sperm count. Smoking, consuming alcohol, and using certain drugs can all reduce sperm count. Long-term illness (such as kidney failure), childhood infections (such as mumps), and chromosomal or hormone disorders are also possible causes of low sperm counts (such as low testosterone).

Damage to the reproductive system might result in low or no sperm production. Approximately four out of every ten males with total sperm failure (azoospermia) have an impediment (blockage) within the sperm canals. A blockage might be caused by a congenital abnormality or an issue such as an infection.


Varicoceles are swollen scrotal veins. They are found in 16 out of every 100 men. They are more prevalent in infertile men (40 out of 100). They inhibit sperm development by preventing appropriate blood drainage. Varicoceles may cause blood to flow back into your scrotum from your belly. The testicles are then too warm to produce sperm. This can lead to lower sperm counts.

Retrograde Ejaculation

Retrograde ejaculation occurs when sperm flows backwards into the body—usually the bladder—rather than out the penis. This occurs when your bladder’s nerves and muscles do not close during orgasm (climax). Semen may include normal sperm, but it is not discharged from the penis and hence cannot reach the vagina.

Surgery, drugs, or nervous system health problems can all cause retrograde ejaculation. Cloudy urine after ejaculation and less fluid or “dry” ejaculation are indications of this issue.

Immunologic Infertility

In rare cases, a man’s body can produce antibodies that destroy his own sperm. Antibodies are most commonly produced as a result of an injury, surgery, or infection. They prevent sperm from migrating and functioning appropriately. We don’t know how antibodies affect fertility. We do know that they can make it difficult for sperm to reach the fallopian tube and fertilize an egg. This is a rare cause of male infertility.


The tubes through which sperm travel can get clogged at times. Infections, surgery (such as vasectomy), edema, or developmental flaws can all result in obstruction. It is possible to obstruct any section of the male reproductive tract. Sperm from the testicles cannot leave the body after ejaculation if there is a blockage.


Hormones produced by the pituitary gland instruct the testicles to produce sperm. Sperm development is hampered by low hormone levels. Medication can sometimes help with this.


Half of the DNA necessary to create a baby is carried by sperm to the egg. Changes in chromosomal number and structure can have an impact on fertility. Parts of the male Y chromosome, for example, may be absent.



Certain medications have the potential to alter sperm production, function, and delivery. These medicines are typically prescribed to treat health issues such as arthritis, anxiety and depression, digestive issues, infections, cancer or a high blood pressure.

Male Infertility Diagnosis

Male fertility causes can be difficult to identify. The most common issues are with sperm production or delivery. The diagnosis process begins with a thorough medical history and physical examination. Blood work and a semen analysis may also be requested by your doctor.

Semen Analysis

Semen analysis is a common laboratory test. It can assist to determine the level of sperm production and whether the sperm are functioning normally (e.g., are moving, measured as sperm motility). Masturbation into a sterile cup is used to collect sperm. The sperm sample is then studied in a laboratory and will be assessed for factors that aid or hinder conception (fertilisation).

Your doctor will examine your sperm amount, count, concentration, movement (“motility”), and structure. The results of the sperm analysis tests reveal information about your ability to conceive (start a pregnancy).

Even if your sperm count is low or you have no sperm, this does not necessarily indicate you are infertile for life. It could simply indicate an issue with sperm development or delivery and that more testing may be required. Even if no sperm is found in a sperm analysis, there may still be treatment options available.

Testicular Biopsy

If a sperm test reveals very low number or no sperm, a testicular biopsy may be required. This test can be performed with either general or local anesthesia. In the scrotum, a tiny cut is made. It can also be performed in a clinic by inserting a needle into the numbed scrotal skin. In either case, a little piece of tissue is taken from each testicle and examined under a microscope. The biopsy has two functions. It assists in determining the reason of infertility and can harvest sperm for use in assisted reproduction (such as in vitro fertilisation; IVF).

Hormonal Profile

Your hormone levels may be tested by your doctor. This is to determine how successfully your testicles produce sperm. It can also rule out serious health issues. Follicle-stimulating hormone (FSH), for example, is a pituitary hormone that instructs the testicles to produce sperm. High levels may indicate that your pituitary gland is attempting to stimulate the testicles to produce sperm, but they will not.

Treatment Options for Male Fertility Issues

Treatment is determined by the cause of infertility. Many issues can be resolved with medications or surgery. This would allow for conception via normal sex. The treatments listed below are divided into three categories:

  • Non-surgical therapy for Male Infertility
  • Surgical Therapy for Male Infertility
  • Treatment for Unknown Causes of Male Infertility

Many male reproductive issues are treatable without surgery.

Frequently Asked Questions

Certain factors may put you at higher risk of infertility, including:

Q: What medical conditions can result in male infertility?

Male infertility can be caused by a variety of health issues, ranging from kidney disease to testicular cancer. “Whole-body” health issues and metabolic diseases, as well as common fevers and infections, can all affect sperm development. Diseases transmitted during intercourse can cause blockages and scarring in the reproductive tract.

Genetic health issues, such as cystic fibrosis, can result in the absence of the vas deferens or seminal vesicles, which results in no sperm in the semen. Many diseases can lead to infertility. It’s critical that you and your spouse share your family and personal health history with your doctor.

Q: Can cigarette smoke affect sperm?

Yes. According to research, smoking has a variety of effects on sperm. It may cause sperm cells be smaller and move more slowly, and smoking damages their DNA. Cigarette smoking can also have an effect on the seminal fluid ejaculated with sperm.

Q: Can using steroids for bodybuilding cause infertility?

Yes. Steroids taken orally or by injection can cause your body to stop producing the hormones required for sperm production.

Q: Do abnormal semen analyses or sperm lead to children with birth defects?

No, not always. The chance of conceiving a child with a birth defect is the same for most couples seeking fertility treatment as it is for the general population. Some conditions that cause infertility (most notably genetic abnormalities) may also increase the likelihood of conceiving a child with birth defects. Before embarking on different forms of ART, couples should undergo thorough testing and seek medical advice.

Q: What are assisted reproductive techniques (ARTs)?

ARTs are high-tech ways for joining sperm and egg when intercourse fails. If pregnancy does not occur despite the presence of sperm in your semen, your doctor may recommend one or more ARTs.

Q: When should my spouse and I consider sperm retrieval via assisted reproductive technology (ART) rather than surgery if I have obstructive azoospermia (no sperm in the ejaculate)?

Microsurgical correction frequently eliminates the need for ART. If that fails, sperm can be extracted from the testicle or epididymis and injected into your partner’s eggs by ICSI, even after surgery to remove the blockage. ICSI is employed because the number of motile sperm is frequently low and they move poorly. There are numerous methods for obtaining sperm cells. You and your urologist will make the decision. Sperm retrieval might take place before or after your partner’s egg retrieval and IVF. Many fertility clinics prefer to use “fresh” sperm obtained on the same day as the egg retrieval. Others prefer sperm that was extracted and frozen on a previous date. Needle aspiration or microsurgery can be used to extract sperm.

Q: When should my partner and I pursue assisted reproductive technology (ART) rather than surgery if I have a varicocele?

If you and your spouse both have reproductive issues and she is unable to conceive naturally, one of the ARTs may be more effective than surgery. However, the choice is not always straightforward. You and your doctor should think about the following:

  • the age and ovarian function of the female spouse, as well as whether ART may be required even if varicocele surgery is performed
  • the possibility that a varicocele surgery will not completely restore your fertility
  • the fact that ART is required for each pregnancy attempt if the varicocele is not corrected
  • research indicating that varicocele treatment may improve IUI and IVF outcomes
  • If you don’t have perfect sperm but your partner is fertile, varicocele repair should be considered. On the other hand, where there is a specific need for such treatments to address a woman’s infertility, IVF, with or without ICSI, should be the primary choice.