Male infertility is common and can have many different causes. Difficulties conceiving may be related to sperm production, sperm quality, blockage of the reproductive tract, hormonal problems, varicocele or previous surgery or infection.
At our clinic, we provide a comprehensive assessment of male fertility to identify the underlying cause and determine the most appropriate treatment. Every patient is assessed individually, with treatment tailored to his fertility goals and, where appropriate, the couple’s plans for conception.
Our approach combines detailed investigation, modern imaging, specialist laboratory testing and advanced microsurgical treatments where required.
Infertility affects both males and females. Male infertility refers to the man’s inability to contribute to conception and pregnancy in a fertile female partner despite having unprotected sexual intercourse for a year or more.
For a successful pregnancy, approximately 20 million sperm in each millilitre of semen is a requisite. These sperm should have high motility and quality to swim up the fallopian tubes to fertilise the egg. When a sperm fertilises an egg, a new life begins.
A young, healthy couple has a 25% chance of getting pregnant each month. However, if the couple is unable to conceive after a year, it is most likely another case of male infertility requiring medical attention.
It can occur due to various issues associated with the male reproductive system, such as low sperm production, poor sperm motility and quality, etc.
Male infertility can be a result of many causes ranging from genetic disorders to environmental factors to lifestyle choices.
Below, we categorise male infertility causes according to factors:
Male infertility symptoms include:
Your Fertility Assessment
The first step is a detailed consultation. We will discuss your medical and surgical history, previous fertility treatments, medications, lifestyle, sexual health and any previous pregnancies. A physical examination is then performed, including assessment of the testes, epididymis and spermatic cords, looking for conditions such as varicocele or abnormalities affecting sperm production.
Depending on your history and initial findings, further investigations may include:
Semen Analysis
A semen analysis is one of the most important investigations in the assessment of male fertility. It evaluates the quantity and quality of sperm, including:
● Sperm concentration and total sperm count
● Sperm motility – how effectively sperm move
● Sperm morphology – the size and shape of sperm
● Semen volume and other characteristics
● The presence of inflammatory cells or other abnormalities
If an initial result is abnormal, repeat testing is often recommended because sperm production can vary over time.
Hormone and Blood tests
Blood tests can help identify hormonal or medical conditions affecting sperm production and sexual function. Depending on your circumstances, these may include testosterone, follicle-stimulating hormone (FSH), luteinising hormone (LH), prolactin and oestradiol.
Additional blood tests may be recommended where there is a specific clinical concern.
Ultrasound and Scanning
A scrotal ultrasound can provide detailed information about the testicles, epididymis and surrounding structures. It can help identify a varicocele, assess testicular size and structure, and investigate other abnormalities.
In selected patients, additional ultrasound imaging, including transrectal ultrasound, may be useful to assess the prostate, seminal vesicles or possible obstruction of the reproductive tract.
Ultrasound can also be used to assist with certain sperm retrieval procedures when appropriate.
Genetic Testing
Genetic testing may be recommended when sperm counts are extremely low or when no sperm are found in the ejaculate (azoospermia). Depending on the clinical findings, this may include testing for chromosomal abnormalities, such as Klinefelter syndrome, or Y-chromosome microdeletions.
Genetic testing can provide important information about the cause of infertility and help guide treatment and assisted reproduction.
Sometimes no single cause can be identified. Even in these circumstances, there are treatment options that may improve the chances of achieving a pregnancy.
Treatment depends on the cause identified during your assessment. In some men, correcting an underlying medical or surgical problem can improve sperm production or allow sperm to be obtained for assisted reproduction.
Microsurgical varicocele ligation
A varicocele is an enlargement of the veins surrounding the testicle and is one of the potentially reversible causes of male infertility.
Where treatment is appropriate, microsurgical varicocelectomy (varicocele ligation) can be performed to identify and ligate the abnormal veins while preserving the testicular artery, lymphatic vessels and other important structures.
The aim is to improve the environment in which sperm are produced and, in selected patients, improve sperm count and motility and the chances of natural conception.
Not every varicocele requires surgery. The decision is based on factors such as the clinical grade of the varicocele, semen analysis, testicular function, symptoms and the couple’s fertility plans.
Sperm retrieval procedures
For some men, particularly those with azoospermia, sperm may be produced within the testicle but unable to reach the ejaculate. In these cases, sperm can sometimes be retrieved directly from the epididymis or testicle for use with assisted reproductive treatment such as IVF and ICSI.
Depending on the underlying cause, techniques may include:
A personalised approach to fertility treatment
Male infertility can be complex, but a diagnosis does not necessarily mean that biological fatherhood is impossible.
The purpose of a specialist assessment is to understand why fertility is impaired and identify the treatment that offers the best opportunity for you and your partner.
From the initial consultation, semen analysis and hormonal assessment through to ultrasound, genetic testing, microsurgical varicocele treatment and advanced sperm retrieval, we provide a comprehensive approach to male reproductive health.
Where assisted reproduction is required, surgical sperm retrieval can be coordinated with fertility specialists and IVF/ICSI treatment.
If you are experiencing difficulties conceiving, have been diagnosed with a low sperm count or azoospermia, or have been told that you have a varicocele, a specialist male fertility assessment can help establish the next steps.
Making mindful lifestyle changes like eating a balanced diet and taking supplements increases sperm count naturally.
Yes, as obesity causes hormonal imbalance that affects sperm quality.
Yes, chronic stress significantly impacts male fertility.
Sperm quality and production are impaired due to an imbalance of testosterone, FSH, or LH hormones.
At least try to conceive for one year with regular unprotected sexual intercourse.
Dealing with male infertility can be overwhelming, but knowing the causes and the proper treatment options empowers you to take charge of your reproductive health. If you have concerns about your fertility or are experiencing challenges, then seeking expert advice is the step towards a brighter future. Book your consultation today with Dr Giulio Garaffa, a leading private urologist in London who specialises in diagnosing and treating male infertility.
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