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Saturn Medic

Clinical Subject Page

Male Infertilty

Male Infertility is the inability of a male partner to contribute to conception after a period of regular unprotected sexual intercourse. It may result from abnormalities in sperm production, sperm transport, sexual or ejaculatory function, hormonal disorders, genetic conditions, or other medical and environmental factors

Also called

Male reproductive infertility

ICD-10

N46

Specialty

Urology

Onset

Chronic

Reviewed

August 2026

On This Page

Overview

-Male Infertility is a common contributor to infertility in couples and may occur alone or together with female-factor infertility.

 

-Major categories include:

  • Pre-testicular: hormonal or endocrine disorders affecting spermatogenesis
  • Testicular: impaired sperm production within the testes
  • Post-testicular: obstruction or dysfunction affecting sperm transport or ejaculation
  • Sexual or ejaculatory dysfunction: impaired delivery of sperm

 

-Common abnormalities include:

  • Low sperm concentration
  • Reduced sperm motility
  • Abnormal sperm morphology
  • Absence of sperm from the ejaculate

Etiology & Risk Factors

-Etiology

–Major causes include:

  • Varicocele
  • Primary testicular dysfunction
  • Hormonal disorders
  • Genetic abnormalities
  • Obstruction of the reproductive tract
  • Erectile or ejaculatory dysfunction
  • Medications and gonadotoxic exposures
  • Unexplained infertility

 

-Risk Factors

  • Varicocele
  • Previous testicular injury or surgery
  • Cryptorchidism
  • Sexually transmitted or reproductive tract infections
  • Testosterone or anabolic steroid use
  • Smoking and significant alcohol or recreational drug use
  • Exposure to heat or gonadotoxic substances

Pathophysiology

Pre-testicular, testicular, or post-testicular abnormality → impaired spermatogenesis or sperm transport → reduced sperm number, motility, or function → reduced ability to fertilize the ovum → Male Infertility

Clinical Presentation

–Symptoms

  • Male Infertility is often asymptomatic.

    Possible associated features include:

    • Difficulty achieving conception
    • Reduced libido
    • Erectile Dysfunction (ED)
    • Ejaculatory dysfunction
    • Reduced ejaculate volume
    • Scrotal discomfort
    • Symptoms of hormonal dysfunction

 

-Signs:

  • Possible findings include:

    • Varicocele
    • Small or abnormal testes
    • Absent vas deferens
    • Epididymal abnormalities
    • Signs of hypogonadism
    • Penile abnormalities

History Taking

-Ask about:

  • Duration of unsuccessful attempts at conception
  • Frequency and timing of intercourse
  • Previous pregnancies
  • Erectile and ejaculatory function
  • Libido
  • Childhood cryptorchidism
  • Testicular trauma
  • Testicular torsion
  • Previous pelvic, inguinal, or scrotal surgery
  • Sexually transmitted infections
  • Mumps orchitis
  • Current and previous medications
  • Testosterone or anabolic steroid use

Physical Examination

-General Examination

  • Body habitus
  • Secondary sexual characteristics
  • Features of hypogonadism or endocrine disease

 

-System-Specific Examination:

  • Testicular size and consistency
  • Presence of Varicocele
  • Epididymal abnormalities
  • Presence or absence of the vas deferens
  • Penile abnormalities

Investigations

Biochemistry / Specific Tests

Semen Analysis

This is the first-line investigation.

It assesses:

  • Semen volume

  • Sperm concentration

  • Total sperm number

  • Sperm motility

  • Sperm morphology

An abnormal result should generally be repeated to confirm persistent abnormalities.

 

-Hormonal Testing

Performed when indicated:

  • Follicle-stimulating hormone (FSH)

  • Luteinizing hormone (LH)

  • Morning total testosterone

  • Prolactin when clinically indicated

 

-Imaging

  • Scrotal ultrasound when examination findings are uncertain or a testicular abnormality is suspected

  • Transrectal ultrasound in selected patients with suspected ejaculatory duct obstruction

 

-Special / Confirmatory Tests

Depending on the clinical findings:

  • Genetic testing, including karyotype

  • Y-chromosome microdeletion testing

  • CFTR mutation testing in congenital bilateral absence of the vas deferens

  • Post-ejaculatory urinalysis when retrograde ejaculation is suspected

  • Testicular biopsy or sperm retrieval in selected patients with azoospermia

Diagnosis

Diagnosis is based on:

Failure to achieve conception + abnormal semen parameters and/or an identified male reproductive abnormality.

 

-The diagnostic approach includes:

  • Confirming infertility history
  • Semen analysis, usually repeated if abnormal
  • Focused hormonal testing when indicated
  • Examination for Varicocele, testicular abnormalities, and obstruction
  • Genetic or specialized testing in severe sperm abnormalities or azoospermia
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Management

1. Definitive Treatment

Treatment targets the underlying cause when identifiable:

  • Varicocele repair in selected patients

  • Treatment of endocrine disorders

  • Relief of reproductive tract obstruction when possible

  • Treatment of sexual or ejaculatory dysfunction

  • Assisted reproductive techniques when required

 

2. Medical Treatment

Depending on the cause:

  • Gonadotropin therapy for selected hypogonadotropic hypogonadism

  • Dopamine agonists for hyperprolactinemia

  • Treatment of underlying endocrine disorders

Testosterone therapy should not be used to treat Male Infertility when fertility is desired because it can suppress spermatogenesis.

 

3. Surgical / Procedural Treatment

Selected options include:

  • Varicocelectomy

  • Vasectomy reversal

  • Repair of selected reproductive tract obstruction

  • Surgical sperm retrieval

 

4. Supportive Management

  • Smoking cessation

  • Avoid testosterone and anabolic steroids when fertility is desired

  • Reduce excessive alcohol and recreational drug use

  • Maintain a healthy body weight

  • Avoid excessive testicular heat exposure

Complications

  • Persistent infertility
  • Psychological distress
  • Anxiety
  • Depression
  • Relationship difficulties
  • Reduced quality of life
  • Complications related to underlying genetic or hormonal disorders

Prognosis

The prognosis depends on the underlying cause and severity of sperm abnormalities. Many reversible causes can be treated, and modern assisted reproductive techniques allow biological parenthood for many men with severe infertility. Outcomes depend on both male and female factors, particularly female partner age and reproductive health.

Key Points / Clinical Pearls

  • Male Infertility may result from impaired sperm production, transport, hormonal dysfunction, or sexual dysfunction.
  • It is often asymptomatic.
  • Semen analysis is the first-line investigation.
  • An abnormal semen analysis should generally be confirmed with repeat testing.
  • Varicocele is an important potentially correctable cause.
  • Azoospermia means no sperm are present in the ejaculate.
  • Hormonal testing is indicated when endocrine dysfunction is suspected.
  • Physical examination should assess testicular size, Varicocele, and the vas deferens.
  • Genetic testing is important in selected men with azoospermia or severe sperm abnormalities.
  • Varicocele repair may improve fertility in appropriately selected patients.
  • Hormonal therapy is useful for specific endocrine causes.
  • Testosterone therapy can suppress spermatogenesis and should not be used when fertility is desired.