Male Factor Infertility
Male factor infertility occurs when a man’s reproductive health is affecting a couple’s ability to conceive. It can be caused by a low sperm count, how sperm move, hormone function or a problem with the reproductive anatomy. At University Hospitals, our fertility specialists provide coordinated, individualized care to help evaluate possible causes and guide next steps based on your specific situation.
Schedule a Male Infertility Evaluation
A reproductive urologist can evaluate male reproductive health concerns and recommend treatment options.
Schedule a Fertility Consultation
To schedule an appointment with a reproductive endocrinologist, call 216-765-3352 or find a fertility specialist.
Quick Facts About Male Factor Infertility
- Male factor infertility may be caused by sperm count, sperm movement, semen delivery, hormone function or reproductive anatomy.
- Semen analysis (or sperm test) is often one of the first tests used to evaluate male fertility.
- An abnormal semen analysis does not always mean pregnancy is not possible.
- Male factor infertility can occur alone or alongside female fertility factors and may be present even when there are no obvious symptoms.
- Treatment depends on the underlying cause and may include lifestyle changes, medication, surgery, intrauterine insemination (IUI), in vitro fertilization (IVF) or sperm retrieval in certain cases.
- A fertility specialist can help determine whether a reproductive urology evaluation or fertility treatment may be appropriate.
What Is Male Factor Infertility?
Male factor infertility occurs when a problem with the male reproductive system is making it harder for a couple to conceive. It contributes to about 40-50 percent of infertility cases, while female factors account for about 40-50 percent, and 10-30 percent have no clear cause (called unexplained infertility).
Male factor infertility can be caused by low sperm count, poor sperm movement, hormone imbalances or problems with the reproductive organs. Male factor infertility can be the only identified fertility factor in a couple, or it may be one part of a broader fertility picture where both partners have factors that affect conception.
Evaluation often starts with semen analysis, a test to examine sperm count, movement and shape, along with a medical history review. These provide important information to guide next steps.
Male factor infertility does not mean pregnancy is impossible. An abnormal semen analysis or male fertility concern does not measure masculinity or indicate a personal failure. It is simply a medical factor that can often be evaluated and addressed. A complete fertility evaluation may include assessment of both partners, since infertility can involve factors from one or both partners. Treatment decisions depend on the underlying cause, test results, age, fertility goals and any female partner factors.
What Causes Male Factor Infertility?
Male factor infertility can involve many different factors related to sperm production, sperm delivery, hormones, reproductive anatomy, genetics, medical history or lifestyle. Understanding possible causes helps guide evaluation and treatment planning.
- Low Sperm Count or Low Sperm Concentration
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Low sperm count means there may be fewer sperm available to fertilize an egg. Sperm count is measured as the total number of sperm in an ejaculation or the concentration of sperm per milliliter of semen. Low sperm count should be interpreted along with other semen analysis results, including motility, to get a complete picture of sperm health.
Some patients may have very low sperm count or no sperm seen in the semen at all, a condition called azoospermia. This may require additional evaluation by a reproductive urologist to determine the cause and explore whether treatment options are available.
- Sperm Motility, or Movement Issues
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Sperm motility refers to how well sperm move. For pregnancy to occur, sperm need to travel from the vagina through the cervix, into the uterus and up into the fallopian tubes to reach and fertilize an egg. Reduced sperm motility, meaning sperm don’t move as well as they should, may make this journey more difficult. Motility is one part of a semen analysis and is evaluated along with sperm count and morphology (the size and shape of sperm cells).
- Varicocele
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A varicocele is a cluster of enlarged veins by the testicles, similar to a varicose vein. In some patients, a varicocele may affect sperm production or quality by increasing heat or affecting blood flow in the testicles. Not all men with a varicocele have fertility problems, and not all low sperm counts are caused by a varicocele. If a varicocele is suspected based on a physical exam or imaging, an evaluation with a reproductive urologist may help determine whether treatment is appropriate.
- Hormone or Testicular Function Issues
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Hormones play an important role in regulating sperm production. If hormone levels are abnormal – such as low testosterone, elevated FSH or other hormone imbalances – sperm production may be affected. Hormone testing may be considered when semen analysis shows abnormal results or if symptoms suggest a possible hormone-related factor. Treatment with hormone therapy may be appropriate in some cases.
- Blockages or Ejaculation Problems
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Some patients produce sperm normally but have difficulty delivering sperm into semen due to a blockage in the reproductive tract, prior surgery, infection, ejaculation disorders or other congenital or acquired structural issues. Examples include vasectomy (which blocks sperm delivery), congenital absence of the vas deferens or retrograde ejaculation (where semen enters the bladder instead of exiting through the urethra). These issues are evaluated through medical history, a physical exam and imaging. Treatment options may include surgery or sperm retrieval during fertility treatment, depending on individual factors.
- Medical History, Medications or Prior Treatments
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Several medical factors and treatments can affect male fertility. Prior cancer treatment such as chemotherapy or radiation may affect sperm production. Pelvic or testicular surgery, infections, testicular injury, certain medications and chronic health conditions may also impact fertility. Additionally, use of testosterone or anabolic steroids can suppress natural sperm production. If you’re concerned about how medications or prior medical history may affect fertility, discuss this with your fertility specialist or reproductive urologist, who can review your specific situation and recommend next steps.
- Lifestyle and Environmental Factors
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Lifestyle factors may influence sperm health. Smoking and heavy alcohol use can affect sperm quality, and certain recreational drugs may also impact fertility. Heat exposure to the testicles (from occupational factors or tight clothing), body weight (both obesity and being significantly underweight), overall fitness and general health can influence sperm production. While lifestyle changes may support sperm health, they are not always a complete solution for male factor infertility. Other factors may require medical evaluation and treatment.
- Unexplained Male Factor Infertility
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Sometimes semen analysis shows abnormal results, but testing does not identify a single clear cause for the abnormality. This is called idiopathic, or unexplained, male factor infertility. Not knowing the exact cause can feel frustrating, but treatment options may still be available even when the underlying reason is not clear. Your fertility specialist can discuss approaches that may help.
- Genetic or Congenital Factors
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Some male fertility concerns may be related to genetic or congenital factors, meaning conditions that affect sperm production, reproductive anatomy or sperm delivery from birth or due to inherited genetic factors. Examples may include cystic fibrosis gene mutations or chromosomal abnormalities. When genetic or congenital factors are suspected based on semen analysis, medical history or other testing, additional testing or genetic counseling may be considered.
When Should You See a Fertility Specialist for Male Factor Infertility?
If you’re concerned about male infertility or have been trying to conceive without success, a fertility specialist can help evaluate your situation and discuss next steps. Semen analysis may be recommended as a first step, because male factors can contribute to infertility even when there are no obvious symptoms. If a reproductive urology evaluation is needed based on semen analysis results, medical history or fertility goals, your specialist can discuss a referral.
The timing for seeking evaluation depends on the age of your female partner and other individual circumstances. General guidelines for seeking evaluation include:
Earlier evaluation may be appropriate if:
- You have a known male fertility concern or prior abnormal semen analysis.
- You have a history of testicular surgery, injury or infection.
- You have had prior cancer treatment such as chemotherapy or radiation.
- You have erectile dysfunction, ejaculation concerns or other sexual function issues.
- You have had a prior vasectomy or vasectomy reversal.
- Your partner has experienced recurrent pregnancy loss.
- Your partner may have fertility factors that warrant evaluation.
Schedule a Male Infertility Evaluation
A reproductive urologist can evaluate and treat male reproductive health factors.
How Is Male Factor Infertility Evaluated?
Evaluation for male factor infertility involves a specific approach to understand sperm and reproductive health. Your fertility specialist will recommend appropriate testing based on your individual situation.
Step 1: Medical, Fertility and Sexual History Review
Your fertility specialist will review your complete medical and fertility history, including how long you and your partner have been trying to conceive, any prior pregnancies, prior semen analysis or fertility testing, and your medical, surgical and medication history. Your specialist will also ask about sexual function, ejaculation, testicular health, prior cancer treatment, infections, injury, reproductive tract surgery or vasectomy. This information provides important context to guide diagnosis and treatment.
Step 2: Semen Analysis
Semen analysis is one of the most important tests in male fertility evaluation. A semen sample is collected and examined in the laboratory to evaluate sperm and semen health. Results typically include semen volume, sperm count (total number of sperm), sperm concentration (sperm per milliliter), sperm motility (how well sperm move) and sperm morphology (sperm shape and structure).
Abnormal results may need repeat testing because sperm measures can vary over time and one abnormal result does not always provide a complete diagnosis. Repeat semen analysis helps confirm findings and guide treatment planning.
Step 3: Partner Evaluation
Fertility evaluation often considers both partners when applicable. Your female partner’s age, ovulation patterns, ovarian reserve, uterine health and fallopian tube health may all influence treatment planning and fertility outcomes. Understanding the complete fertility picture – for both partners – helps guide the most appropriate treatment approach.
Step 4: Hormone or Blood Testing
Hormone testing helps determine whether hormonal factors are contributing to male factor infertility. These tests evaluate hormone levels that affect sperm production and testicular function. They may be considered based on semen analysis results, symptoms or medical history.
Step 5: Physical Exam or Reproductive Urology Evaluation
A physical examination evaluates the size, consistency and anatomy of the testicles. If further evaluation is needed, a reproductive urologist may assess testicular anatomy, check for varicocele (enlarged veins in the scrotum), evaluate for obstruction or ejaculation problems, review prior vasectomy or vasectomy reversal, or assess other male reproductive health factors. Based on evaluation findings, your fertility specialist may recommend imaging or additional testing.
Step 6: Diagnosis and Treatment Planning
The results of the full evaluation help guide treatment decisions. Depending on findings, treatment may include lifestyle changes, medication, surgical treatment of varicoceles, IUI, IVF, sperm retrieval or other fertility options. Care planning may involve coordination between reproductive endocrinology and reproductive urology specialists to address both sperm health and broader fertility factors.
What Does a Semen Analysis Show?
Semen analysis evaluates both semen quality and sperm health. Understanding what semen analysis measures can help you when discussing the results with your fertility specialist.
Semen analysis typically measures several things:
- Semen volume: The amount of fluid in the ejaculation.
- Sperm count: The total number of sperm in the ejaculation.
- Sperm concentration: The number of sperm per milliliter of semen.
- Sperm motility: How many sperm are moving and how well they move.
- Sperm morphology: The percentage of sperm with normal shape and structure.
Results may help identify whether low sperm count, reduced motility, abnormal morphology, low semen volume or other factors may be contributing to infertility. Semen analysis results should be interpreted with your specialist in the context of your medical history, sexual function, physical exam and your partner’s fertility evaluation. One abnormal semen analysis does not automatically mean you cannot have biological children. Treatment options are typically available depending on your situation.
Additionally, sperm measures can vary over time based on health or environmental changes and other factors, so your fertility specialist may recommend repeat semen analysis or additional testing.
Treatment Options for Male Factor Infertility
Treatment for male factor infertility depends on your semen analysis results, the underlying cause, your partner’s fertility evaluation, age, medical history and fertility goals. Male factor infertility sometimes requires coordinated care between a fertility specialist and a reproductive urologist. Your fertility specialist and reproductive urologist (when appropriate) will recommend an approach that is most likely to help you and your partner achieve a healthy pregnancy.
- Treatment Based on Identified Cause
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Treatment recommendations depend on what evaluation reveals. Some patients, such as those who with azoospermia (zero sperm) or who have a varicocele, may benefit primarily from reproductive urology care. Others may need fertility treatment such as IUI or IVF, or other approaches. Your care team will discuss what approach is most appropriate based on your specific diagnosis.
- Lifestyle and Health Optimization
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Lifestyle modifications may be discussed when factors such as weight, smoking, heavy alcohol use, heat exposure, chronic health conditions or certain medications may be affecting sperm health. Examples of modifications include weight management, smoking cessation, reducing alcohol consumption and avoiding prolonged heat exposure to the testicles. While lifestyle changes may support sperm health and overall fertility, they are not a guaranteed treatment and may not resolve all male factor issues on their own.
- Medication or Hormone-Related Management
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Medication or hormone-related treatment may be considered in select cases based on testing and clinical evaluation. If hormone testing shows specific abnormalities affecting sperm production, targeted hormone treatment may be recommended. Your fertility specialist will discuss which medications or therapies, if any, may be appropriate for your situation.
- Varicocele Repair or Surgical Treatment
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Surgical treatment may be considered when varicocele, obstruction in the reproductive tract, prior vasectomy or other anatomical factors are contributing to male factor infertility. In some cases, surgical repair can improve sperm production and quality. A reproductive urologist can evaluate whether surgery is appropriate and discuss potential benefits and risks.
- Intrauterine Insemination (IUI)
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IUI may be considered for certain mild male factor concerns depending on sperm count, motility, your partner’s fertility evaluation and your fertility goals. IUI is a procedure where prepared sperm are placed directly into the uterus around the time of ovulation, which may improve chances of conception by reducing the distance sperm must travel. To optimize timing and chance for success, IUI is often combined with ovulation stimulation medications for a female partner.
- In Vitro Fertilization (IVF) and ICSI
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IVF may be considered for some male factor infertility cases, especially when sperm count or motility is significantly reduced, or when prior treatments have not resulted in pregnancy. During IVF, eggs are retrieved and fertilized with sperm in the laboratory. In cases where sperm count or motility is severely compromised, ICSI (intracytoplasmic sperm injection) may be used during IVF to inject a single sperm directly into an egg.
- Sperm Retrieval or Sperm Banking
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Sperm retrieval techniques may be considered in certain cases when sperm are not present in the ejaculation (azoospermia) or when ejaculation or obstruction issues prevent sperm delivery. Sperm can often be retrieved directly from testicular or epididymis tissue – where sperm are stored – for use in fertility treatment. Sperm banking (freezing and storing sperm) may be recommended before certain medical treatments such as cancer therapy, surgeries that may affect fertility or as part of fertility treatment planning.
- Donor Sperm or Other Family-Building Options
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In some cases where sperm production or quality is severely limited, donor sperm may be discussed as an option for family building. Donor sperm can be used with IUI or IVF. This option is a choice that may be discussed with your partner and fertility specialist.
Male Factor Infertility and Fertility Planning
When you meet with a fertility specialist for male factor infertility, your care team will review your medical history, semen analysis results, prior pregnancies, your partner’s fertility evaluation and your fertility goals. Based on this review, additional testing may be recommended before treatment decisions are finalized.
Once evaluation is complete, results guide treatment recommendations. Your care team will discuss whether options such as lifestyle modifications, medication, surgery, IUI, IVF, sperm retrieval or reproductive urology referral may be appropriate for your situation. Next steps depend on your semen analysis findings, diagnosis, medical history, your partner’s fertility evaluation and your shared fertility goals.
Your care may involve coordination between a fertility specialist and male reproductive urologist to address both sperm health and broader fertility factors such as your partner’s age, ovulation, ovarian reserve, uterine health and fallopian tube health.
What to Bring to a Fertility Consultation
To make the most of your first fertility consultation, bring the following information if available:
- Prior semen analysis results from any prior testing
- A current list of medications and supplements you take
- History of testosterone or anabolic steroid use, if applicable
- Details of prior surgeries, injuries, infection or cancer treatments that may affect fertility
- History of vasectomy or vasectomy reversal, if applicable
- Notes about sexual function, ejaculation concerns or other reproductive health issues
- Your partner’s fertility testing results, if available
- Questions about treatment options such as IUI, IVF, ICSI, sperm retrieval or a possible reproductive urology referral
Having this information available helps your fertility specialist understand your complete picture and can guide the evaluation and treatment process.
Emotional and Support Considerations
Male factor infertility can be emotionally challenging. Patients and partners may experience stress, frustration, concerns about what results mean for family planning or difficulty discussing fertility issues. These feelings are normal and valid.
It’s important to know that male factor infertility does not reflect personal failure or masculinity – it is a reproductive health condition like any other medical condition. A fertility specialist and reproductive urologist are experienced in discussing these issues with patients and partners, and conversations about male fertility are routine clinical discussions.
Additionally, support is available. Many fertility centers, including University Hospitals, offer counseling and mental health services for patients and couples navigating male factor infertility and fertility treatment. Speaking with a fertility counselor or therapist can help you and your partner process emotions, communicate openly about concerns, manage anxiety about testing or treatment, and develop coping strategies.
Specialized Care for the LGBTQ+ Community
University Hospitals offers compassionate, collaborative care for the LGBTQ+ community, including fertility and reproductive health services for LGBTQ+ individuals and same-sex couples.
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Frequently Asked Questions About Male Factor Infertility
- What is male factor infertility?
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Male factor infertility means a sperm, semen or male reproductive health factor may be affecting the ability to conceive. This could involve sperm count (the number of sperm), sperm movement (motility), sperm shape (morphology), semen volume, hormone function, reproductive anatomy or other male reproductive health factors. Male factor infertility can occur alone or alongside female fertility factors.
- What causes male factor infertility?
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Male factor infertility can be caused by several factors including low sperm count, reduced sperm movement, abnormal sperm shape, varicocele (enlarged veins in the scrotum), hormone or testicular function problems, blockages or ejaculation disorders, prior cancer treatment, pelvic or testicular surgery, infections, certain medications, lifestyle factors such as smoking or heavy alcohol use, or genetic factors. In some cases, no single cause is identified.
- What are signs of male infertility?
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Male factor infertility may have no obvious symptoms – many men with abnormal sperm have no physical signs or symptoms. Some men may notice erectile dysfunction, ejaculation problems, testicular pain or swelling, or visible enlargement of veins in the scrotum (varicocele). However, the only way to know whether male factors are contributing to infertility is through semen analysis and medical evaluation. If you’ve been trying to conceive without success, semen analysis can help evaluate male fertility.
- How is male factor infertility diagnosed?
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Diagnosis involves a comprehensive evaluation including medical and fertility history review, semen analysis, physical examination, and possibly hormone testing or reproductive urology evaluation. Semen analysis is often the first test used because it provides important information about sperm health. Results should be interpreted by a clinician in the context of your medical history and your partner’s fertility evaluation.
- What does a semen analysis show?
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Semen analysis evaluates semen and sperm health. Results typically measure semen volume, sperm count (total number of sperm), sperm concentration (sperm per milliliter), sperm motility (how well sperm move), and sperm morphology (sperm shape). An abnormal result may identify whether low sperm count, reduced movement, abnormal shape or other factors are affecting fertility. An abnormal semen analysis does not always mean pregnancy is not possible, and results should be interpreted along with your complete health picture and your partner’s evaluation.
- Can male factor infertility be treated?
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Yes. Male factor infertility can often be treated depending on the underlying cause. Treatment options may include lifestyle changes such as weight management or smoking cessation, medication or hormone therapy, surgical treatment for varicocele or obstruction, IUI (intrauterine insemination), IVF (in vitro fertilization), or sperm retrieval. The right treatment for you depends on your semen analysis results, the identified cause of infertility, your partner’s evaluation and your fertility goals. Your fertility specialist can discuss which options may be appropriate.
- Does IUI or IVF work for male factor infertility?
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Both IUI and IVF may be used to address male factor infertility depending on your specific situation. IUI places prepared sperm directly into the uterus around ovulation, which may help with mild sperm concerns. IVF may be recommended when sperm count or motility is significantly reduced. IVF with ICSI (injecting a single sperm into an egg) can be particularly helpful for severe male factor infertility. Your fertility specialist will discuss which option is most appropriate based on your semen analysis results, your partner’s evaluation and your fertility goals.
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Related Resources and Next Steps
Understanding male factor infertility and exploring treatment options is an important step in your fertility journey. University Hospitals provides comprehensive fertility care with experienced reproductive endocrinologists and reproductive urologists who can evaluate your individual situation and help you create a personalized treatment plan.
Learn More About Related Services
Your fertility care may involve additional treatments and services. Explore these resources to understand your full range of care options.
- Reproductive Urology – A reproductive urologist can evaluate testicular anatomy, varicocele, obstruction and other male reproductive health factors. Learn more.
- Intrauterine Insemination (IUI) – IUI may be recommended for minor male factor infertility. Learn about IUI.
- In Vitro Fertilization (IVF) – IVF with ICSI may be recommended when sperm count or motility is significantly reduced. Learn about IVF and how it works.
- Fertility Center Hub – Access all fertility services and resources at UH.
Schedule a Male Infertility Evaluation
Ready to discuss male factor infertility and your fertility options? A reproductive urologist can evaluate male reproductive health concerns and recommend treatment options.
Schedule a Fertility Consultation
To schedule an appointment with a reproductive endocrinologist, call 216-765-3352 or find a fertility specialist.