Fertility & IVF
Male Factor Infertility: Semen Analysis, Causes and Treatment Basics
Male factor infertility means a problem with sperm production, function or delivery is making it harder to conceive. It plays a role in a large share of couples with infertility, commonly cited as about a third to half, alone or alongside a female factor. The first test is a semen analysis, which is simple, non-invasive, and should happen early, at the same time the partner trying to carry is tested.
This page is written for both partners. If you're the one producing the sample: yes, it's a little awkward, everyone feels that way, and it's one of the most useful tests in all of fertility care.
Why both partners should be tested at the same time
A common pattern: one partner spends months on blood tests, ultrasounds and ovulation pills before anyone checks the sperm. ASRM and the American Urological Association (AUA) recommend evaluating both partners at the same time. A semen analysis can change the plan overnight, for example pointing toward IVF with ICSI instead of months of ovulation medicine that was never going to fix the problem.
The semen analysis: what actually happens
Before: abstain from ejaculation for 2 to 7 days. Not less, not more; both can skew results.
Collection: by masturbation into a sterile cup, usually in a private room at the clinic or lab. Some labs allow collection at home if the sample can be delivered quickly and kept at body temperature (an inside jacket pocket works). Ask about this when you book, because rules vary and travel time on the subway or LIRR counts.
Things people ask but don't want to:
- Regular lubricants can harm sperm. Use none, or ask the lab for an approved one.
- A regular condom can't be used for collection; special collection condoms exist if needed.
- If you can't produce a sample on the day, it happens a lot. Reschedule; nobody at the lab will think twice.
Results: often within a few days. The lab checks:
| Measure | What it means | WHO 2021 lower reference limit |
|---|---|---|
| Volume | Amount of semen | 1.4 mL |
| Concentration | Sperm per milliliter | 16 million/mL |
| Total motility | Percent of sperm moving | 42% |
| Progressive motility | Percent moving forward | 30% |
| Morphology | Percent with normal shape | 4% |
These are reference limits, based on men whose partners conceived within a year. They aren't strict cutoffs. Someone below a limit may still conceive naturally, and someone above every limit can still have fertility problems.
Counts naturally vary from sample to sample. If results are abnormal, doctors usually repeat the test before deciding anything. One bad result isn't a diagnosis.
What causes male infertility?
- Varicocele: enlarged veins in the scrotum, which can affect sperm production
- Hormone problems: such as low hormones from the pituitary gland
- Testosterone or anabolic steroid use: a very common, reversible cause of low counts
- Blockages: from infection, past surgery, or being born without the vas deferens
- Genetic conditions: such as Klinefelter syndrome or Y-chromosome microdeletions
- Past cancer treatment: chemotherapy or radiation
- Undescended testicles in childhood
- Ejaculation problems: including retrograde ejaculation into the bladder
- Lifestyle and exposures: smoking, heavy alcohol use, marijuana, obesity and frequent high heat
Sometimes no cause is found.
A warning about testosterone
Testosterone therapy, including gels, patches, injections and products sold online or at "men's health" clinics, tells the body to stop making sperm. It can drive counts very low or to zero. If you're trying to conceive, don't start testosterone, and talk to a doctor before stopping any prescribed treatment. Recovery after stopping can take months.
If the semen analysis is abnormal
The next step is a urologist trained in male reproduction. The workup may include:
- A full history and physical exam
- Hormone tests, such as testosterone and FSH
- Scrotal ultrasound in some cases
- Genetic testing if the count is very low or zero
- Post-ejaculation urine test if volume is low
Treatment options
| Situation | Possible treatment |
|---|---|
| Lifestyle factors | Stop smoking, cut back on alcohol and marijuana, reach a healthy weight, avoid testosterone |
| Clinically significant varicocele | Surgical repair in selected cases |
| Hormone imbalance | Medicines prescribed by a specialist |
| Mild decrease in count or motility | IUI with washed sperm |
| Moderate to severe decrease | IVF with ICSI |
| No sperm in the ejaculate (azoospermia) | Sperm retrieval surgery, then IVF with ICSI, or donor sperm |
| Blockage | Surgical repair or sperm retrieval |
ICSI (intracytoplasmic sperm injection) lets an embryologist inject a single sperm into each egg. It has made biological parenthood possible for many men with very low counts. See IVF step by step and IUI vs IVF.
Your 90-day sperm plan
Sperm take roughly two to three months to develop, so what you do today shows up in a semen analysis about three months from now.
- Don't smoke or vape.
- Limit alcohol and skip recreational drugs.
- Aim for a healthy weight and stay active.
- Skip frequent hot tubs and saunas.
- Review every medication and supplement with your doctor.
- Have sex every one to two days during the fertile window.
Can a home sperm test replace a lab analysis?
Home tests can estimate sperm count or concentration, and some smartphone kits estimate movement. They're a reasonable first look. But they don't measure everything a lab does, like volume, detailed motility and shape. If a home test is abnormal, or you've been trying without success, get a full lab analysis.
What about supplements?
Plenty of supplements promise better sperm, often with antioxidants. Evidence that they improve pregnancy or live birth rates is limited and mixed, and they're no substitute for an evaluation. Ask your doctor before starting one, and avoid anything containing testosterone or hormone "boosters."
Fertility preservation
Sperm banking before cancer treatment is simple and effective. In New York, comprehensive insured plans must cover medically necessary fertility preservation, including sperm freezing, when a treatment may cause infertility. See fertility preservation before cancer treatment.
The bigger picture
A normal semen analysis doesn't end the workup, and an abnormal one doesn't mean the other partner should skip testing. Fertility depends on both people. Many couples also say it helps to treat results as "our" problem, not one person's.
When to see a doctor
Get a semen analysis and see a doctor if:
- You and your partner have tried for 12 months (or 6 months if your partner is 35 or older)
- You have a history of undescended testicles, testicular surgery or cancer treatment
- You notice a lump, pain or swelling in the testicles
- You have erectile or ejaculation problems
- You've used testosterone or anabolic steroids
Fertility clinics can order a semen analysis and coordinate with a urologist. Find a reproductive endocrinologist in New York, such as fertility specialists in Westchester, to start testing as a couple.
Frequently asked questions
How common is male factor infertility?
Male factors contribute to a large share of infertility cases, commonly cited as about a third to half of couples, either alone or together with a female factor. That's why both partners should be tested.
What is a normal sperm count?
The World Health Organization's 2021 manual lists 16 million sperm per milliliter as the lower reference limit for concentration. Results below that don't mean pregnancy is impossible, and results above it don't guarantee fertility.
Does taking testosterone affect fertility?
Yes. Testosterone, including gels and injections, can shut down sperm production and cause very low or zero sperm counts. Anyone trying to conceive should talk to their doctor before using testosterone.
How long does it take to improve sperm health?
Sperm take roughly two to three months to develop, so lifestyle changes or treatment usually need about three months before they show up in a new semen analysis.
What kind of doctor treats male infertility?
A urologist with training in male reproductive medicine (often called an andrologist) evaluates and treats male infertility. Reproductive endocrinologists coordinate treatment such as IUI or IVF with ICSI.
Sources
- ASRM/AUA — Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline
- ASRM — Diagnostic evaluation of the infertile male: a committee opinion
- WHO — Laboratory Manual for the Examination and Processing of Human Semen, 6th edition (2021)
- CDC — Infertility FAQs
This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.