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Male Infertility


This term applies when the male partner is either the sole or a contributing cause of infertile couples. A detailed history and physical, hormonal panel, and two separate semen analyses are used to examine the male.


The cause of abnormal sperm can be:

  • Varicocele (dilated or varicose veins in the scrotum)
  • Duct obstruction
  • Hormonal
  • Infectious

Additional testing including blood, semen cultures and a comprehensive examination by a urologist can help identify the cause.

Treatment for male factor infertility may include:

  • Surgical correction of a varicocele or duct obstruction
  • Hormonal medications to improve sperm production
  • Antibiotic therapy for infection

In many cases, no direct treatment for decreased sperm counts is effective. In those instances, IVF with ICSI may be recommended.

Surgical Options

Male factor infertility can result in a variety of issues such as complete absence of sperm in the ejaculate (azoospermia) due to either an obstruction/blockage (obstructive azoospermia) often caused by a previous vasectomy or congenital-birth defects. For these conditions, a surgical option can retrieve sperm from either the vas deferens, epididymis or testis for use in an IVF cycle(s) to conceive. Because the surgically retrieved sperm are immature, fertilization is achieved by injecting selected sperm directly into the egg by a process called intracytoplasmic sperm injection (ICSI).

Males considering this option are required to see a urologist prior to surgery to help determine the best approach for retrieving sperm including:

Microsurgical Varicocelectomy (Varicocele)

Outpatient procedure for the correction of a varicocele by ligature and excision and by ligation of the dilated veins.

Microsurgical Epididymal Sperm Aspiration (MESA)

MESA is an outpatient microsurgical procedure used to collect sperm in men with blockage of the male reproductive ducts such as a prior vasectomy or absence of the vas deferens. It is used in IVF-ICSI procedures.

Testicular Sperm Extraction (TESE)

TESE is the operative removal of testicular tissue in an attempt to collect living sperm for use in an IVF-ICSI procedure.

If possible, MESA and TESE procedures are timed to coincide with the egg retrieval step during the IVF cycle. For some, scheduling may be an issue. Surgical sperm retrieval can be completed before the IVF cycle begins and frozen (cryopreserved) for future use. The extraction of sperm completed by MESA and TESE typically results in enough sperm to allow several IVF cycles. These procedures can be performed on an outpatient basis using sedation to eliminate any pain or discomfort.