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Male Factor Infertility


Male infertility is the inability of a man to successfully fertilize a woman's egg. Male infertility can be caused by any number of factors, including low sperm motility, abnormal sperm shape, varicocele, and oligospermia (low sperm count). Find out about male factor infertility and treatment options, as well as how to locate a fertility specialist in your area. Male factor infertility refers to the failure of a couple to achieve conception due to problems specifically related to the man's sperm, seminal fluid, or reproductive organs. There are several conditions that contribute to male factor infertility.

Abnormal Semen

Abnormal semen is a form of male infertility that presents itself in a variety of ways. When there are problems with the semen, the sperm might be prevented from achieving fertilization.

Abnormal Semen Symptoms

A basic examination and semen evaluation are necessary to determine conclusively whether there is a semen abnormality; however, some of the most common symptoms of this disorder include:

  • Yellow or greenish semen
  • Red or brown tinted semen (may indicate blood in the ejaculate)
  • Ejaculate with an especially strong, foul odor
  • Abnormally thick ejaculate
  • Watery ejaculate
  • Low volume of semen

Treatment for Men with Abnormal Semen

Some of the causes of abnormal semen, such as STDs, infection, retrograde ejaculation, and the ability of the ejaculate to clot properly, can significantly affect male fertility. If you have experienced any of these symptoms, you might have a serious infection leading to male infertility. It is important to talk with your physician or fertility specialist about the causes of and treatment options for abnormal semen.

Abnormal Sperm

Male factor infertility can be caused by abnormalities in the shape and size of the sperm. As with low sperm count, at least two-thirds of the sperm in the ejaculate must be of an adequate shape and size in order to be considered normal. Male infertility can result when the sperm's shape prevents it from having normal mobility or strength to penetrate the ovum. In fact, some specialists believe that abnormal sperm shape has an even greater effect on male fertility than low motility or oligospermia (low sperm count).

A semen test can reveal whether the sperm are of normal shape and size. Some of the common sperm abnormalities are:

  • A very large round head
  • An extremely small pinpoint head
  • A tapered head
  • A crooked head
  • Two heads
  • A tail with kinks and curls

Azoospermia (No Sperm)

Azoospermia refers to a condition in which there is no measurable amount of sperm in the semen, which is usually discovered through semen analysis. A diagnosis of azoospermia doesn't mean that conception is impossible. Many causes of azoospermia can be successfully treated to restore fertility.

  • Azoospermia Causes: Azoospermia can be caused from a transport problem when there is a blockage that prevents sperm from mixing with semen (obstructive azoospermia), or from a problem with the production of sperm (non-obstructive azoospermia).
  • Sperm Transport Problems: Sperm is transported from the testes to the urethra through a series of ducts, and blockages within these ducts can prevent sperm from mixing with the ejaculate before it leaves the body. Causes of these transport problems can include infections such as STDs, vasectomy, or a congenital absence of the vas deferens (tubes that transport sperm to the urethra).
  • Sperm Production Problems: Sperm production problems may be caused by a dysfunction within the testes resulting from hormonal imbalances, trauma, or a condition called cryptorchidism (undescended testicles).

Treatments for Azoospermia

In many cases, the sperm transport and production problems that cause azoospermia can be treated, restoring sperm to the semen. Treatment may involve:

  • Removal of blockages
  • Medications to restore hormonal balances or clear up infections
  • Surgery to correct physical problems

If the cause of azoospermia cannot be successfully treated, other infertility treatments and methods of sperm retrieval make it possible for an azoospermic man to father a biological child.

Germ-Cell Aplasia

Germ-cell aplasia, also known as Sertoli-cell Only Syndrome (SCO), is an extremely rare but serious male infertility condition. In the United States, approximately 10 percent of couples struggle with fertility problems; only one-third of these cases result from pure male factor infertility, and only 5 to10 percent of these are caused by SCO.

Germ-Cell Aplasia Diagnosis

Because this male fertility condition is so rare, tests for SCO are performed multiple times and carefully screened by specialists. Diagnosing germ-cell aplasia is done only after several testicular biopsies have been completed.

A diagnosis of germ-cell aplasia means that the semen lacks the germ cells which lead to the creation of sperm and is azoospermic (devoid of sperm cells). While there are no studies that have conclusively shown the causes of germ-cell aplasia, researchers believe that gonadotropin deficiency, hormonal therapy, irradiation, chemicals, and environmental toxins may be potential causes.

Germ-Cell Aplasia Fertility Treatment

In the majority of SCO cases, male fertility is impossible. However, there has been some advancement in male infertility solutions for men suffering from germ-cell aplasia. If a testicular biopsy reveals that there is a small amount of sperm present in patches of the testes, a specialist can extract them for in vitro fertilization (IVF) or artificial insemination.

Low Semen Production (Hypospermia)

Low semen volume is a condition in which a less than normal amount of semen is produced in each ejaculation. Because there is an inadequate amount of fluid to bring the sperm in contact with the cervix, this condition can cause fertility problems. Occasional low semen production may be normal. However, if volume is consistently low, and if you and your partner are experiencing fertility problems, there are treatments that may be helpful in correcting the problem.

Normal semen volume is described as 1 to 5.6 milliliters (mL) per ejaculation. Abnormally low (less than 1 ml) or high (more than 5.6 ml) semen volumes can cause fertility problems. High semen volume (hyperspermia) can also cause fertility problems because the sperm is diluted with excess seminal fluid.

Low Semen Volume Causes

Low semen volume has several causes, including:

  • Blockages in a seminal vesicle or ejaculatory duct, sometimes due to a varicocele (varicose vein), or cyst
  • Retrograde ejaculation, a condition in which part or all of the semen flows backwards into the bladder
  • Certain infections
  • Hormonal abnormalities

If you are experiencing abnormal semen production, your doctor may perform a semen analysis to determine the cause. In addition to evaluating the volume, semen analysis also checks for a number of other factors that may point to a cause for the low production, such as the absence of fructose which may suggest a blockage in the ejaculatory duct.

Low Semen Volume Infertility Treatments

Oftentimes, low semen volume, as well as high semen volume, can be treated through surgical procedures to eliminate blockages, or with antibiotics to clear up infections. However, when the low semen volume is due to a problem that cannot be successfully treated, there is a range of infertility treatments, including sperm retrieval and artificial insemination, which can help a couple conceive.

Low Sperm Count (Oligospermia)

A common cause of male factor infertility is low sperm count (also known as oligospermia). This condition can result from a variety of factors. Twenty million or more sperm per milliliter of semen is considered a normal sperm count, with at least 60 percent of those sperm having normal shape and motility.

Although men with sperm counts lower than 20 million have fathered children, and some men with relatively high sperm counts have not, these cases are considered exceptions to the rule. A semen analysis can determine sperm count and also check for abnormalities with their movement and shape.

Low Sperm Count Causes

Low sperm count can be caused by innumerable, and sometimes unexplainable, factors; there are generally no predictable signs of low sperm count other than infertility. The causes of low sperm count include, but are not limited to, the following:

  • Overheating of the testicles
  • Stress (emotional, psychological, and physical)
  • Drug use
  • Smoking
  • Nutritional deficiencies and obesity
  • Environmental toxins

Contrary to popular belief, wearing tight pants or briefs is no longer considered a viable cause of oligospermia. However, it is still advisable to avoid restrictive, tight clothing if you and your partner are trying to conceive.

Low Sperm Count Fertility Treatment

In many cases, low sperm count and subsequent male infertility is only temporary- solutions like losing weight, quitting smoking, or avoiding hot baths and saunas can often lead to improvements in sperm count.

However, if these solutions do not increase sperm count, there is a range of infertility treatments available for this condition.

Low Sperm Motility

Low sperm motility is a condition in which the sperm's capacity for swimming forward and penetrating the egg is diminished. If movement is slow, not in a straight line, or both, the sperm have difficulty invading the cervical mucus, leading to male infertility.

Normal sperm motility exists when approximately two-thirds of the sperm in the semen can move forward through the cervical mucus and pierce the ovum. If a semen test shows that fewer than 8 million sperm per milliliter of semen show normal forward movement, then low sperm motility may be causing male factor infertility.


A common cause of male infertility, varicocele is a condition in which the varicose veins of the spermatic cord are enlarged and improperly dilated. The spermatic cord is the structure running between the testicles and the scrotum, supporting and holding them in place. Within the spermatic cord are myriad valves and veins; when there are abnormalities in these valves, the blood does not flow properly and starts to back up. As a result, the veins are over-dilated, causing varicocele.

Some of the signs of varicocele are:

  • Extremely dilated and visible veins across the scrotum
  • A noticeable but painless bulge, lump, or swelling within the testes and scrotum
  • Increased pain when lifting heavy objects
  • Shrinking of the testes

It is important to note that varicocele does not always produce these signs, though male fertility tests can discover the source of obstruction.

Varicocele and Fertility Problems

Varicocele has been known to cause male fertility problems such as a low sperm count, decreased sperm motility, and abnormally shaped sperm.

There are many ways of remedying varicocele and the male fertility problems they cause, including a scrotal support to ease blockage and improve blood flow. However, a varicocelectomy to tie off the enlarged veins is the most effective method of treatment.

Locate a Fertility Specialist

If you think that male factor infertility may be affecting your chances of conception, contact a fertility clinic in DocShop's national network today. A male fertility specialist can help by running tests to diagnose potential infertility causes and provide assistance with male infertility solutions and treatment. Locate an infertility specialist in your region today.

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