The 10 Most Common Questions About Male Infertility

When a couple has difficulty conceiving, attention often turns to the woman first. Yet infertility is a couple’s problem, and the male factor plays an important part. Below we have brought together the 10 questions we hear most often in the consulting room, with short answers.

When should infertility be investigated?

If a pregnancy has not occurred after a year of regular, unprotected sex, it is recommended that the couple is assessed. If the female partner is over 35, this period is shortened to 6 months. If the man has a history of an undescended testicle, inflammation of the testicle after mumps, cancer treatment or a known varicocele, he can be seen without waiting.

Is the problem with the woman or the man?

In about half of all cases of infertility, a male factor plays a role, either alone or together with a female factor. For this reason, starting the assessment of both partners at the same time avoids losing time. For the man, the assessment begins with a detailed history, a physical examination and a semen analysis.

During the examination, the size and consistency of the testicles, the presence of a varicocele and the condition of the sperm ducts are checked. Depending on the result of the semen analysis, hormone tests, a scrotal ultrasound scan and, in some patients, genetic tests may be requested. The female partner’s assessment is carried out in parallel by a gynaecologist.

How is a semen sample given?

For an accurate result, the following points should be observed:

• Abstain from ejaculation for 2–7 days before the test.
• The sample should be collected by masturbation into the sterile container provided by the laboratory. Condoms or lubricants should not be used.
• The whole sample should go into the container; if any part is lost, the laboratory should be told.
• A sample collected at home should be kept at body temperature and brought to the laboratory within one hour at the latest.

Is a single semen analysis enough?

Sperm values can vary from day to day depending on a feverish illness, stress or the length of abstinence. If the first test is not normal, a second test a few weeks later is recommended. Decisions are not made on the basis of a single result.

The standard test assesses the number, movement (motility) and shape (morphology) of the sperm. In selected situations, such as recurrent pregnancy loss or unexplained infertility, additional tests showing sperm DNA damage may also be considered. Op. Dr. Mücahit Kabar has a scientific publication examining the effect of varicocele surgery on sperm DNA damage.

Why are sperm count and motility low?

The main causes are:

• Varicocele (widening of the veins of the testicle)
• A history of an undescended testicle
• Hormonal disorders
• Genital infections
• Genetic causes
• Smoking, excessive alcohol and obesity
• Use of testosterone or anabolic steroids from outside the body
• Certain medicines, chemotherapy and radiotherapy

In some patients, no specific cause can be found despite detailed investigation.

Does a varicocele cause infertility?

Varicoceles are found in many men in the general population and do not always lead to infertility. However, they are more common in men who are unable to father children and can impair sperm quality. According to current guidelines, treatment is recommended for men with a varicocele that can be felt on examination and abnormal sperm values. Surgery is generally not needed for a varicocele that is only seen on ultrasound when sperm values are normal. For details, see the varicocele page.

Can I have children if there are no sperm in my semen?

The complete absence of sperm in the semen is called azoospermia. There are two main types: obstructive azoospermia, where sperm production is normal but the ducts are blocked, and non-obstructive azoospermia, where the testicle cannot produce enough sperm. In both cases, sperm can be retrieved surgically from the testicle (for example by micro-TESE) and used in IVF treatment. The chance of finding sperm varies from person to person and is assessed beforehand with hormone and genetic tests.

Does lifestyle affect sperm quality?

Yes. To support sperm quality:

1. Stop smoking.
2. Limit alcohol.
3. Lose excess weight and exercise regularly.
4. Avoid exposing the testicles to heat for long periods (saunas, hot tubs, a laptop on your lap for a long time).
5. Eat a balanced diet rich in vegetables and fruit.
6. Do not use anabolic steroids or hormone products not recommended by a doctor.

Do vitamin and testosterone supplements work?

Evidence on the effect of antioxidant and vitamin supplements on pregnancy rates is limited; they should be used after talking to a doctor. Testosterone, however, is not a treatment for infertility. Testosterone taken from outside the body can make the situation worse by suppressing sperm production. In men found to have a hormone deficiency, different treatments that support sperm production are chosen.

How long does it take to see results after treatment?

It takes about three months for a sperm cell to form. For this reason, the effect of surgery, medication or lifestyle changes is usually assessed with a follow-up test at the earliest three months later. During this time, the treatment plan should be made together, also taking into account the female partner’s age. For comprehensive information, see the male infertility page.

When should you see a urologist?

See a urologist if a pregnancy has not occurred after trying for a year (6 months if the female partner is over 35), if your semen analysis is abnormal, if you have swelling, pain or a lump in the testicles, or if you have had testicular problems or cancer treatment in the past.

Op. Dr. Mücahit Kabar sees patients in Bursa (Nilüfer), Turkey, at Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00, +90 444 8 112) and Özel Jimer Hastanesi (weekdays 13:00–17:00, +90 444 45 67). Appointments are booked through the hospitals’ online booking pages or appointment lines. Consultations are held in English or Turkish and are confidential; the hospitals’ international patient departments can arrange interpreters for other languages. If you are travelling from abroad, you can send questions or previous semen analysis reports by WhatsApp to +90 541 622 54 82 before your visit. Further details are on the contact page.