Infertility is often spoken about as if it is exclusively a woman’s experience. It is not. In approximately 40 to 50 percent of couples experiencing difficulty conceiving, the primary cause is a male factor — and in a further 20 percent, both partners contribute.
Despite this, men rarely seek help proactively. The subject is wrapped in shame and silence that delays diagnosis and treatment. This guide is written to change that.
Related reading: The Sperm Test Explained — what semen analysis measures and how to read your results. What Is ICSI? — the primary treatment for male factor infertility. Infertility as a Couple’s Issue — facing this together.
How Common Is Male Infertility?
Male infertility contributes to 40–50% of all infertility cases. The World Health Organisation defines infertility as a disease of the male or female reproductive system — explicitly recognising that it affects both sexes equally.
Important: Male infertility is a medical condition, not a reflection of masculinity, sexual performance, or general health. A man can be completely healthy in every other way and still have a sperm issue. The two are entirely unrelated.
What Causes Male Infertility?
Problems with sperm production
- Varicocele: Enlarged scrotal veins raising testicular temperature — the most common correctable cause, found in up to 40% of infertile men
- Hormonal imbalances: Low testosterone, elevated prolactin, pituitary dysfunction
- Genetic causes: Klinefelter syndrome, Y chromosome microdeletions — see Next Biosciences for genetic testing
- Cryptorchidism: Undescended testicle(s) in childhood
- Previous infections: Mumps orchitis, STIs
- Cancer treatment: Chemotherapy and radiation can severely affect sperm production
Sperm transport problems
- Vasectomy (intentional obstruction)
- CBAVD (congenital bilateral absence of the vas deferens) — often linked to CFTR gene mutations
- Retrograde ejaculation — sperm enter the bladder instead of being ejaculated
Lifestyle and environmental factors
- Smoking — one of the most consistent negative factors for sperm quality
- Excessive alcohol and recreational drugs including cannabis
- Anabolic steroid use — can shut down sperm production almost completely
- Obesity, sedentary lifestyle, and chronic stress
- Excessive heat exposure (hot baths, saunas, occupational heat)
How Is Male Infertility Diagnosed?
Semen analysis (sperm test)
The semen analysis is the foundation of male fertility investigation. For a complete explanation of what it measures and how to interpret your results, read our dedicated guide: The Sperm Test (Semen Analysis) Explained.
Hormone blood tests
FSH, LH, testosterone, and prolactin levels identify hormonal causes of reduced sperm production.
Genetic testing
If count is very low or absent, karyotype and Y chromosome microdeletion analysis identifies chromosomal causes. This testing is available through Next Biosciences (nextbio.co.za).
Scrotal ultrasound and testicular biopsy
Ultrasound identifies varicoceles and structural abnormalities. Testicular biopsy in azoospermia cases distinguishes obstructive from non-obstructive causes — a critical distinction for treatment planning.
Male Infertility Treatment Options
Lifestyle changes
Stopping smoking, reducing alcohol, stopping anabolic steroids, achieving a healthy weight, and reducing heat exposure can all meaningfully improve sperm parameters. Allow three months for changes to appear in a repeat semen analysis.
Medical treatment
- Hormonal therapy where hormonal causes are identified
- Antibiotic treatment for reproductive tract infections
- Varicocele repair — can improve parameters in selected men
Surgical sperm retrieval
- PESA, TESA, TESE, micro-TESE: surgically retrieved sperm is used with ICSI
- Even men with azoospermia (no sperm in the ejaculate) can often have sperm retrieved
IUI (Intrauterine Insemination)
Appropriate for mild to moderate male factor infertility. Prepared sperm is placed directly into the uterus at the time of ovulation. Available at all major clinics in the Fertility Solutions directory.
IVF with ICSI
For moderate to severe male factor infertility — see our full guide: What Is ICSI?. All clinics below offer this treatment:
Clinics Specialising in Male Factor Infertility
| Clinic / Agency | FS Directory | External Website |
| Cape Fertility (Cape Town) | View on FS → | capefertility.co.za |
| Aevitas Fertility Clinic (Cape Town) | View on FS → | aevitas.co.za |
| Fembryo Fertility Clinic (Port Elizabeth) | View on FS → | fembryo.co.za (andrology services) |
| Durban Fertility Clinic | View on FS → | durbanfertilityclinic.co.za |
| C.A.R.E Clinic (first ICSI clinic in KZN) | View on FS → | careclinic.co.za |
| Wilgers Infertility Clinic (Pretoria) | View on FS → | wilgersinfertility.co.za |
Donor sperm
Where no sperm can be found, or where a genetic condition makes use of the partner’s sperm inadvisable, donor sperm is an option. Donor insemination services are available at most major SASREG clinics.
The Emotional Side of Male Infertility
Receiving a male infertility diagnosis can be deeply painful. Many men feel shame and guilt that, while entirely understandable, are entirely misplaced.
Couples who face fertility challenges together, with open communication, consistently report better outcomes — medically and emotionally. Read our companion article: Infertility as a Couple’s Issue: Facing the Journey Together.
Frequently Asked Questions
What if only donor sperm is an option?
Donor insemination has helped many thousands of South African families. It is a well-established and legally clear option. Counselling support is available at clinics listed above.
Can sperm quality improve?
Yes — in many cases. Lifestyle changes, treatment of underlying conditions, and removing environmental factors can lead to meaningful improvement. Allow three months and repeat your semen analysis.
How long should we wait before investigating?
12 months for women under 35; 6 months for women over 35. If a male factor is known or suspected, a semen analysis can be done immediately — it is quick, inexpensive, and non-invasive.
External references: SASREG | WHO on infertility
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.
