• A detailed history

• Comprehensive physical examination which includes a scrotal examination

• 2 semen analysis

• Blood work to evaluate hormone levels

• Additional tests may be required based on the findings of the semen analysis and initial blood work

It is not uncommon for couples to undergo assisted reproductive technologies like intrauterine insemination (IUI) or IVF (in-vitro fertilization) without the male partner having seen a male infertility specialist.

However, there are reversible male infertility causes that can help a couple conceive naturally, like fixing varicoceles (see treatments below).

Further, studies have shown that optimizing the male partner and improving their sperm quality can improve success rates of IUI and IVF. There are also situations where testicular sperm may be used for the IVF cycle as opposed to ejaculate sperm.

For starters, your infertility may be caused by a diminished output of sperm by your testicles. Abnormal sperm production can also be triggered by genetic factors and a number of lifestyle choices (e.g., smoking, alcohol, and certain medications), all of which can impair the normal production of sperm cells resulting in a decreased sperm count. Long-term illnesses (e.g., kidney failure), childhood infections (e.g., mumps), and hormonal or chromosomal deficiencies (e.g., insufficient testosterone) can also account for abnormal sperm numbers.  

Perhaps the most common sperm production problem, however, is linked to structural abnormalities, most notably varicoceles. A worm-like bundle of enlarged or dilated varicose veins around the testicles; varicoceles are the most common identifiable cause of male infertility. They are found in about 15 percent of normal males and in approximately 40 percent of infertile men, most often on the left side or simultaneously on both sides.

Evidence suggests that by creating an abnormal backflow of blood from the abdomen into the scrotum, triggering a rise in testicular temperature, varicoceles hinder sperm production and cause low sperm count. 

Another issue that would lead to infertility would be a lack of sperm in the semen.

Azoospermia, which accounts for 10 to 15 percent of all male infertility, refers to a complete absence of sperm in your ejaculate. In its “non-obstructive” form, azoospermia can be triggered by various hormonal or genetic defects often linked to testicular failure. But just as likely, it is the result of damage to some portion — the epididymis, vas deferens, or, ejaculatory duct — of the reproductive delivery system. In fact, 40 percent of azoospermia sufferers are diagnosed with an “obstructive” form caused by either congenital or acquired problems like infections. Vasectomy, the chief contraceptive method available to men today, is a primary example of an acquired obstructive azoospermia.

Microsurgical Varicocelectomy 

Among the most exciting treatment developments are microsurgical approaches to repair dilated varicose scrotal veins to improve semen quality. You should consider treatment if you meet the following criteria: 

• you and your partner are trying to conceive a child, but thus far have been unsuccessful 

• you have been diagnosed with a varicocele that can be felt 

• your semen analysis or sperm function tests are abnormal your partner has normal fertility or treatable infertility 

• you are an adolescent male with a varicocele and reduced testicle size 

 Cited by many specialists as their preferred approach, this operation uses a high-powered microscope to provide direct visual access to veins and arteries. Through a mini-incision in the groin, the doctor can reliably separate and preserve testicular arteries, while identifying and tying off both large and small veins that could dilate in the future. Also, while technically demanding, microsurgical varicocelectomy virtually eliminates the risk of developing a hydrocele, the most common varicocele repair complications. In fact, microsurgical techniques have significantly reduced recurrence rates to less than 2 percent and complications rates to less than 5 percent while significantly increasing fertility. The effectiveness of this procedure has been reported in the scientific literature to be as high as a 43 percent pregnancy rate for couples after one year and 69 percent after two years. 

After varicocele repair, semen samples will be tested about every three months for at least one year or until pregnancy. If your varicocele returns, or you remain infertile after the repair, ask your doctor about assisted reproductive techniques (ART). These high-tech procedures are often successful in circumventing the same problem to produce a pregnancy. 

Medical Therapy For Male Infertility

Medical treatment generally involves hormonal manipulation. After ruling out reversible causes of male infertility, if there is evidence of hormonal problems, such as low testosterone, treatment may involve taking medication to increase the body’s production of testosterone to stimulate sperm production.