Overview

Male factors contribute to ~50% of all infertility cases when combined with female or unexplained causes. Despite this, male infertility is still under-investigated in many settings. Most causes, once identified, can be effectively addressed.

Symptoms

• Usually no obvious symptoms — detected through semen analysis
• Pain, swelling, or a lump in the testicular area
• Reduced facial or body hair (hormonal issues)
• Gynaecomastia (breast enlargement)
• Problems with sexual function

Causes & Risk Factors

• Sperm production problems — low count, absent sperm, poor motility, abnormal shape
• Varicocele — most common correctable cause
• Obstruction — blockages in the vas deferens or epididymis
• Hormonal imbalances — low testosterone, elevated FSH/LH or prolactin
• Genetic causes — Y-chromosome deletions, Klinefelter syndrome
• Infections — mumps orchitis, chlamydia, gonorrhoea
• Lifestyle — smoking, alcohol, anabolic steroids, heat, obesity

Diagnosis

• Semen analysis — WHO 2021 criteria
• Hormone panel — FSH, LH, testosterone, prolactin
• Scrotal ultrasound
• Genetic testing — karyotype, Y-chromosome microdeletion
• Sperm DNA fragmentation (SDF) test

Treatment

• Lifestyle changes — stop smoking, reduce alcohol, lose weight, avoid heat
• Varicocele repair — improves sperm parameters in the majority of men
• IUI — for mild male factor
• IVF with ICSI — for moderate-to-severe male factor
• Surgical sperm retrieval — for azoospermia

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