Male Fertility

When the cause of infertility is on the male side, it usually accounts for 30-50% of all infertility.

Rather than being the result of a single factor, male infertility is more often the result of a combination of complex and diverse factors, including lifestyle.


In general, the causes of male infertility can be categorised into 'azoospermia', where the testicles do not produce sperm well, 'epididymal azoospermia', where the testicles produce sperm normally but the sperm cannot be released due to epididymis or vas deferens obstruction, 'adrenal dysfunction', where the testicles produce sperm normally, and 'sexual dysfunction', such as erectile dysfunction or ejaculatory disorders due to seminal vesicles or prostate problems.

Diagnosis and testing

In the male partner, an important part of the diagnosis of male infertility is a questionnaire about the internal and reproductive history, medications, and past surgeries related to conception, and a physical examination of the scrotum, testicles, epididymis, and vas deferens.

  • 1. Semen analysis: This is the most important part of assessing fertility in male infertility patients. It involves an abstinence period of at least      3-4 days, followed by a comprehensive evaluation that takes into account physical examination, lifestyle, etc
  • 2. Hormone testing: testing for endocrine abnormalities in male infertility
  • 3. Genetic, chromosomal testing: testing for genetic causes of male infertility
  • 4. Imaging studies: including transrectal ultrasound, scrotal ultrasound, etc
  • Internal medical treatment

    Pharmacological treatments for male infertility include specific pharmacological therapies for endocrine disorders, oligospermia due to seminal vesicle infection, immune infertility due to antisperm antibodies, and ejaculatory disorders, as well as non-specific empiric pharmacological therapies.

  • Surgical treatment
    • ∙ Vasovasostomy
      In the case of sperm passage obstruction due to vasectomy, reconstructive surgery can be performed mainly under a microscope, and the duration of vas obstruction can affect the patency rate.
    • ∙ Epididymovasostomy
      This is done if the testicular biopsy is normal and there is no vas deferens or ejaculatory duct obstruction.
    • ∙ Varicocelectomy
      Varicocele is known to cause male infertility due to elevated testicular temperature and reflux of testicular toxic substances, and improvement in semen test results can be expected in 60-80% of patients.
    • ∙ Sperm retrieval technique
      In cases of obstructive or non-obstructive azoospermia that cannot be surgically corrected, sperm is extracted from the testes or epididymis to try to conceive via in vitro fertilisation, which can reduce complications such as blood vessel damage during microsurgery under a microscope.

    In addition to the development of assisted reproductive technologies such as in vitro fertilisation (IVF), the treatment of male infertility requires the collaboration of related medical specialists such as obstetrics and gynaecology and urology. Furthermore, in-depth research into the causes and treatment of male infertility due to genetic abnormalities, testicular and sperm dysfunction, etc. is necessary to increase the chances of curing male infertility.