Here’s a number that still surprises most people: male factor infertility is involved in approximately 40–50% of all cases where couples have difficulty conceiving. Not 5%. Not 10%. Nearly half.
And yet, when a couple starts worrying about fertility, the conversation almost always starts with the woman. The tests. The appointments. The weight of the investigation. Men are often added to the picture later — sometimes much later — as a secondary concern.
This guide is for the men, and the partners who are trying to understand what’s happening. It covers causes, testing, diagnosis, treatment options — including IUI, IVF, and ICSI — and what male factor infertility really means for a couple’s chances.
| Male infertility is not the same as impotence. The ability to have an erection and ejaculate has nothing to do with sperm quality. These are completely separate systems. |
How Common Is It?
The WHO estimates that male factor is a primary or contributing cause in approximately 50% of all infertility cases globally. Despite this, it remains significantly under-investigated. A semen analysis is faster, cheaper, and less invasive than almost any female fertility investigation — it should be among the first tests done in any fertility workup.
What Does a Semen Analysis Measure?
| Parameter | What It Reflects | Normal (WHO 2021) | ||
| Volume | Total fluid per ejaculate | ≥1.4 mL | ||
| Concentration | Sperm per millilitre | ≥16 million/mL | ||
| Total sperm count | Total sperm in sample | ≥39 million | ||
| Total motility | % of sperm moving | ≥42% | ||
| Progressive motility | % moving forward | ≥30% | ||
| Morphology (Kruger) | % normally shaped | ≥4% | ||
| One semen analysis is not conclusive. Sperm production takes approximately 74 days, and parameters fluctuate significantly based on recent illness, stress, and abstinence period. Most guidelines recommend two analyses, 4–6 weeks apart, before drawing conclusions. | ||||
Understanding Your Results: Common Diagnoses
Oligospermia (Low Sperm Count)
Below 16 million sperm per mL. Mild, moderate, or severe depending on degree. Many men with oligospermia can father children naturally, especially with mild reduction.
Asthenospermia (Poor Motility)
Less than 42% of sperm moving, or less than 30% with progressive forward movement. Can result from varicocele, infection, antibodies against sperm, or lifestyle factors.
Teratospermia (Abnormal Morphology)
Less than 4% normal forms. Usually addressed with ICSI in an IVF cycle. Read more about when ICSI is appropriate in our IUI vs IVF vs ICSI comparison guide.
OAT Syndrome
All three parameters affected simultaneously — count, motility, and morphology. The most common pattern in significant male factor infertility. Treatment typically involves ICSI within an IVF cycle. See what this diagnosis means for your chances.
Azoospermia (No Sperm)
No sperm detected in the ejaculate. This is the most challenging finding but is not the end of the road:
- Obstructive: Sperm are produced but blocked (blocked vas deferens, previous vasectomy, infection). Surgical retrieval (PESA, MESA) is often possible.
- Non-obstructive: Sperm production itself is impaired. Surgical retrieval (TESA, micro-TESE) may still find usable sperm in some men.
What Causes Male Infertility?
Varicocele
The most common treatable cause — present in approximately 35–40% of men with fertility concerns. A varicocele is an enlargement of the veins draining the testicle. It raises scrotal temperature, which impairs sperm production. Surgical repair (varicocelectomy) can significantly improve parameters and is covered by most medical aids.
Hormonal Imbalances
Low testosterone, elevated prolactin, or problems with FSH and LH can impair sperm production. Diagnosed with a blood test and may be treatable with medication.
Genetic Factors
Y chromosome microdeletions and Klinefelter syndrome (XXY) are genetic causes of severely reduced or absent sperm production. Genetic testing — including the PGT-A testing offered by Next Biosciences — is recommended for men with azoospermia or severe oligospermia before proceeding with ICSI.
Modifiable Lifestyle Factors
- Smoking: Reduces count, motility, and morphology; increases DNA fragmentation
- Excessive alcohol: Reduces testosterone and sperm quality
- Anabolic steroids: Severely suppress sperm production — recovery can take 12–24 months
- Heat exposure: Laptops on laps, hot baths, heated seats — sustained elevated scrotal temperature impairs sperm production
- Obesity: Associated with hormonal changes that reduce sperm quality
- Cannabis: Associated with reduced count and motility
Treatment Options
Lifestyle Modification
For mild parameter abnormalities, 3–6 months of lifestyle optimisation can produce meaningful improvement. Stopping smoking, reducing alcohol, losing weight, and eliminating heat exposure are the most evidence-supported changes. The sperm production cycle takes approximately 74 days — so improvements take 2–3 months to show in a repeat analysis.
Supplements with Evidence
- CoQ10 (200–600 mg daily): Antioxidant, shown to improve motility and morphology in some studies
- Zinc and Folate: Combined supplementation associated with improved count and morphology
- Omega-3 fatty acids: Associated with improved motility
- Vitamin C and E: Antioxidants with some evidence for reducing DNA fragmentation
IUI with Processed Sperm
For mild male factor infertility with at least one open fallopian tube in the female partner. IUI vs IVF: when is IUI appropriate for male factor?
IVF with ICSI
For moderate-to-severe male factor infertility. A single sperm is selected and injected directly into each egg. This works even with very low counts or abnormal morphology. At SASREG-accredited South African clinics, ICSI fertilisation rates are typically 70–80% of injected eggs. For detailed IVF costs, see our IVF cost guide for South Africa.
Surgical Sperm Retrieval
For azoospermia, sperm can be retrieved from the epididymis (PESA) or testis (TESA/micro-TESE). For non-obstructive azoospermia, micro-TESE finds usable sperm in approximately 50–60% of men. Retrieved sperm is used with ICSI.
Myths vs Facts
Myth: If I can have sex normally, my fertility must be fine.
Fact: Sexual function and sperm quality are completely independent. Erectile function, libido, and ejaculation have no correlation with sperm count, motility, or morphology.
Myth: Low sperm count means I can’t have children.
Fact: Even very low counts can result in natural conception or successful IVF with ICSI. Only complete azoospermia eliminates the possibility of using a man’s own genetic material — and even then, surgical retrieval may be possible.
Myth: Tight underwear is a myth.
Fact: There is genuine evidence that sustained elevated scrotal temperature impairs sperm production. Reducing heat exposure is a legitimate recommendation from most andrologists.
People Also Ask
Q: What are the signs of male infertility?
A: Male infertility typically has no symptoms — it is diagnosed through semen analysis. The majority of men with abnormal parameters have no physical symptoms at all. This is why testing is the only reliable way to assess male fertility.
Q: How do I get a semen analysis in South Africa?
A: Your GP can refer you to a pathology laboratory, or it can be arranged through most fertility clinics. The test requires 2–5 days of abstinence. Results are typically available within 24–48 hours.
Q: Can lifestyle changes improve sperm quality?
A: Yes — particularly for borderline results. Stopping smoking, reducing alcohol, losing weight, and reducing heat exposure can produce measurable improvements within 2–3 months.
Q: What is a normal sperm count?
A: According to WHO 2021 reference values: concentration ≥16 million/mL, total count ≥39 million, progressive motility ≥30%, morphology (Kruger) ≥4% normal forms.
Practical Takeaways
- Male factor infertility is involved in nearly half of all fertility challenges. If you haven’t been tested, get tested now
- A semen analysis is simple, quick, and relatively inexpensive — the highest-information-per-cost test in fertility medicine
- Abnormal results are the beginning of an investigation, not a verdict — see what a fertility diagnosis means for your chances
- Many causes are treatable — from lifestyle changes through varicocelectomy to ICSI. Find a fertility clinic in South Africa that has an experienced andrology team
Disclaimer: This content is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider before making decisions about fertility treatment.
About the Author
Leigh-Ann Geydien is the founder of Fertility Solutions, South Africa’s only dedicated fertility directory. With a deep commitment to patient advocacy, she built the platform to bridge the gap between those navigating fertility challenges and the clinics and reproductive health specialists best placed to help them.
