Male infertility

Male infertility


Male fertility is affected in half of all cases of couple infertility, usually without symptoms or warning signs.

If a man still has children, this does not guarantee that he has maintained good fertility.

In all cases where pregnancy does not occur, a spermogram is also indicated, a simple investigation that can provide useful information about fertility.

More details about this investigation Sperm collection instructions

What are the most common situations that can affect male fertility?
  • Sexually transmitted diseases or a history of pelvic infections
  • History of abdominal or urological surgery
  • Varicocele and other types of vascular damage
  • Chronic diseases: diabetes, hypertension, etc.
  • Chemistry or radiotherapy in the background
  • Ectopic testicles (not descended into the scrotum)
  • Mumps started after puberty
  • Genetic diseases in the family
  • Lifestyle: smoking, obesity, drugs, steroids, anabolics, stress
What are the most useful investigations?
  • It is enough, if it is in normal parameters – here the WHO reference values
  • Repeat after 2 months for confirmation, in case of changes

The additional evaluation is useful in case of detection of a modified spermogram:

Urological / andrological consultation with a male infertility specialist

Assess risk factors and medical history

Clinically examine the genital area

Perform testicular ultrasound

Recommends other useful investigations

  • Sperm culture or culture of urethral secretions
  • Evaluation of antisperm antibodies in semen (MAR-test)
  • Assessment of sperm DNA fragmentation – reversible genetic changes caused by the environment, lifestyle (smoking, obesity) or certain conditions (varicocele)
  • Evaluation of urine – in retrograde ejaculation, caused by some surgery
  • Hormonal dosages in the blood: FSH, LH, Testosterone, Inhibin B, Prolactin
  • Genetic testing: karyotype, Y chromosome microdeletions, CFTR cystic fibrosis mutations, sperm FISH
  • Epididymal puncture / Testicular biopsy
What can be found during the evaluation?
  • Sperm changes:
    • Oligozoospermia (OS) – decrease in the concentration of sperm in the sperm
    • Asthenozoospermia (AS) – decrease in the percentage of mobile sperm in the sperm
    • Teratozoospermia (TS) – decrease in the percentage of normal sperm in the sperm
    • Combinations of these changes: OAS, OATS etc
    • Azoospermia – the absence of sperm in the sperm
    • Antisperm antibodies – often after trauma, reduce the ability to fertilize
  • Modifications of other investigations:
    • Hormonal imbalances – sometimes after the administration of anabolic steroids
    • Transmissible or reversible genetic changes
  • Erectile or ejaculatory dysfunction:
    • Retrograde ejaculation – elimination of sperm in the bladder
    • Erection problems caused by drugs, alcohol, medication, stress
    • Anatomical changes or other conditions
    • Varicocele – dilation of the veins in the testicular area
    • Testicular tumors – benign or malignant, operable
    • Absence or obstruction of semen
    • Changing the position of the testicles, usually at birth
What therapeutic solutions are possible?


Hormone medication – effective only in infertility due to hormonal causes
Antibiotics – in case of infections
Nutritional supplements (vitamins) and antioxidants – used to maintain and maintain a healthy environment in which sperm grow


Microsurgical interventions to correct varicocele – sometimes improves sperm quality
Tumor removal
Reconstruction of sperm removal ducts – after vasectomy
Epididymal puncture or testicular biopsy – for diagnostic purposes or for the use of sperm in assisted reproduction techniques

Assisted reproduction techniques

Most cases of male infertility do not have an identified or treatable cause (idiopathic infertility) and are treated by assisted reproduction.

Assisted reproduction techniques include:

Artificial insemination

In vitro fertilization with its variants – standard IVF, ICSI, P-ICSI or other techniques

Sperm sampling and storage techniques for reproductive procedures:

Often, no sperm are found in the spermogram or men cannot be available or cannot collect sperm on the day of the reproductive procedure. There are solutions, and in these cases:

Freezing sperm – for short periods or for several years
Surgical collection of sperm – by puncture or biopsy sperm can be found and later used in assisted reproduction or frozen
Recovery of sperm from urine – for assisted reproduction

How can you prevent or improve male fertility problems?

Give up harmful habits: smoking, steroids, anabolics, drugs

Protect yourself effectively during sexual intercourse – use a condom

Optimize body weight if you gain extra pounds

Improve your reproductive function through sports and a healthy diet

Efficient sexual activity – sexual intercourse at intervals of 1-2 days during the fertile period

Avoid unprofessional advice and myths:

Sexual position, rest, orgasm do not affect fertility.

Prolonged sexual rest does not increase, but fertility decreases!

Contact your specialist in time for any genital problems

Consider freezing sperm
  • If you are going to have genital interventions, chemotherapy, radiotherapy
  • If you have a genetic disease or fertility problems in your family