Male Infertility: You Are Not Alone
Infertility affects approximately 1 in 6 couples trying to conceive, and in nearly half of these cases a male factor is either the sole cause or a contributing one. A diagnosis of male infertility can be deeply personal — it touches a man's sense of identity and places real strain on a relationship. The important truth is that effective treatments exist for the vast majority of cases, and no couple should suffer in silence.
At Dr. Unnati Mamtora's clinic, fertility is approached as a shared journey. Every couple receives a thorough male factor workup alongside the female evaluation. Where complex andrological procedures are needed, Dr. Unnati coordinates closely with trusted specialist colleagues to ensure you have the best possible team working for you.
Common Causes of Male Infertility
- Low sperm count (oligospermia)
- No sperm in ejaculate (azoospermia)
- Poor sperm motility (asthenospermia)
- Abnormal sperm morphology (teratospermia)
- High sperm DNA fragmentation
- Varicocele (dilated testicular veins)
- Hormonal imbalances — pituitary or testicular
- Genetic conditions (Klinefelter syndrome, Y-chromosome microdeletion)
- Prior infections or epididymo-orchitis
- Lifestyle factors: smoking, alcohol, heat exposure
More than one factor is often present simultaneously. A full evaluation identifies all correctable and non-correctable contributors so that the most efficient treatment path can be chosen.
Diagnostic Evaluation
Semen Analysis
The cornerstone of male fertility assessment — evaluating sperm count, motility, morphology, and volume. At least two samples 4–6 weeks apart are recommended for reliable results.
Hormonal Profile
Blood tests for FSH, LH, testosterone, prolactin, and TSH identify hormonal imbalances affecting sperm production. Elevated prolactin or pituitary dysfunction may respond well to medical treatment.
Scrotal Ultrasound
Identifies varicocele, testicular abnormalities, or obstructions of the reproductive tract. Findings guide the decision between surgical correction and sperm retrieval.
Sperm DNA Fragmentation & Genetic Testing
When routine parameters appear normal but cycles have failed, DNA fragmentation testing and karyotype/Y-deletion analysis provide critical additional information.
Treatment Options
1. Lifestyle Optimisation
Weight loss, stopping smoking, reducing alcohol, and correcting nutritional deficiencies (such as vitamin D) can meaningfully improve sperm parameters for some men and should always be the first step where applicable. This window of optimisation typically requires 3 months — the length of one full sperm production cycle.
2. Medical Treatment — An Honest Overview
The majority of men do not benefit significantly from oral fertility medications such as clomiphene, tamoxifen, or anastrozole, and these do not consistently improve live birth rates in their partners. Testosterone and anabolic steroids actively suppress sperm production and must be avoided. Supplements also carry no proven clinical benefit in most men.
However, medical treatment is effective in specific situations:
- Men with hypogonadotropic hypogonadism (e.g. Kallmann syndrome) respond well to gonadotropin injections (hCG/FSH), which can stimulate sperm production where none existed
- Elevated prolactin causing reduced libido and intercourse frequency — treated with dopamine agonists
Dr. Unnati will be straightforward with you about whether medical therapy is likely to help in your specific case, rather than prescribing interventions that provide false hope.
3. Surgery
- Obstruction reversal: In men with prior vasectomy or acquired obstruction, surgical reconnection may restore natural sperm flow. Alternatively, sperm can be directly retrieved for IVF-ICSI.
- Varicocele repair: Current evidence does not demonstrate a consistent improvement in pregnancy or live birth rates in female partners following varicocele surgery. This will be discussed honestly if varicocele is identified.
4. IUI with Processed Sperm
For mild male factor (typically more than 5–10 million motile sperm after processing), sperm washing concentrates the best-quality cells for intrauterine insemination (IUI), bypassing the cervix and improving fertilisation chances. IUI is a less invasive, lower-cost first step before proceeding to IVF.
5. IVF with ICSI / IMSI
IVF with Intracytoplasmic Sperm Injection (ICSI) is the standard of care for moderate-to-severe male infertility — a single sperm is selected and injected directly into each egg, bypassing most barriers to fertilisation. IVF-ICSI is generally recommended when:
- Fewer than 10 million motile sperm are produced
- Multiple sperm parameters are abnormal simultaneously
- Prior IUI cycles have not succeeded
- There has been fertilisation failure in a previous IVF cycle
IMSI (Intracytoplasmic Morphologically-Selected Sperm Injection) uses ultra-high magnification to select the most structurally normal sperm before injection. It may offer additional benefit in cases of severe morphological abnormalities or repeated ICSI failure.
Sperm Retrieval for Azoospermia
When no sperm is present in the ejaculate, sperm can often still be obtained through specialised retrieval techniques performed in coordination with an andrologist:
PESA / MESA
Percutaneous or microsurgical epididymal sperm aspiration — used in obstructive azoospermia (blocked ducts). Sperm are retrieved from the epididymis via needle aspiration or microsurgical dissection.
TESA / Micro-TESE
Testicular sperm aspiration (needle) or microsurgical testicular sperm extraction — used when the block is at the testicular level or in non-obstructive azoospermia. Even when sperm production is severely impaired, isolated pockets of production are often found under a surgical microscope.
Electroejaculation (EEJ)
Used in men with spinal cord injury who cannot ejaculate normally. Vibratory stimulation or EEJ is performed to collect sperm for IVF-ICSI.
Retrograde Ejaculation
When sperm is expelled backwards into the bladder (retrograde ejaculation), a post-ejaculation urine wash can recover live sperm for processing and use in IUI or IVF-ICSI.
Sperm retrieved via any of these methods can also be frozen (cryopreserved) for use in future cycles, reducing the need for repeated procedures.
Donor Sperm
When repeated sperm retrieval procedures are unsuccessful, or when a genetic condition makes use of the partner's sperm inadvisable, donor sperm from an ICMR-accredited, anonymous sperm bank is a safe and effective option. Dr. Unnati walks couples through this decision with sensitivity and without judgement, ensuring every option is fully understood before a choice is made.