Half of infertility involves the male side — yet men are often the last to be tested. The evaluation, the numbers that matter, and the treatments that actually work.
✍️ By Dr. Patsama Vichinsartvichai, MD, MClinEmbryol, EFOG-EBCOG, EFRM-ESHRE/EBCOG, FACOG — Reproductive Medicine Specialist · Updated August 2026
Male factors contribute in roughly 40–50% of infertile couples and are the sole cause in about 20–30%. Despite that, couples often undergo months of female-side testing before anyone orders the one test that screens the male side: a semen analysis. It's non-invasive, inexpensive, and belongs at the very start of every fertility workup.
Volume ≥ 1.4 mL · Concentration ≥ 16 million/mL · Total motility ≥ 42% · Progressive motility ≥ 30% · Normal morphology ≥ 4%. These are the 5th-percentile values of fertile men — falling below one doesn't mean pregnancy is impossible, and a single abnormal result should always be repeated after 2–3 months before conclusions are drawn (a full sperm-production cycle takes about 72–90 days).
Performed to WHO 6th-edition standards after 2–7 days of abstinence; abnormal results confirmed with a second sample at least a few weeks later.
Prior conceptions, surgeries (hernia, undescended testis, vasectomy), infections, medications, anabolic steroid or testosterone use — a surprisingly common and reversible cause — heat exposure, smoking, and alcohol.
FSH, LH, and testosterone distinguish production problems from obstruction and detect endocrine causes.
Karyotype and Y-chromosome microdeletion testing when concentration is very low or zero — findings that change both prognosis and counseling.
Sperm DNA fragmentation testing has a role in selected situations (recurrent loss, unexplained IVF failure), but isn't a routine screen; we'll say so plainly. See our evidence review of add-ons.
Even azoospermia — no sperm in the ejaculate — is not the end of the road: obstructive cases have excellent retrieval rates, and a meaningful share of non-obstructive cases yield usable sperm surgically.
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By WHO 2021 (6th edition) reference limits: volume ≥ 1.4 mL, concentration ≥ 16 million/mL, total motility ≥ 42%, progressive motility ≥ 30%, and normal morphology ≥ 4%. One abnormal result should be repeated after 2–3 months before drawing conclusions.
Often, yes. Stopping testosterone or anabolic steroids, quitting smoking, limiting alcohol, avoiding prolonged heat, and weight loss all measurably help — but improvements take 3–6 months because a full sperm-production cycle lasts roughly 72–90 days.
No — the opposite. External testosterone shuts down the brain's signal to the testes and can suppress sperm production to zero. It's one of the most common reversible causes of male infertility we see. Recovery after stopping usually takes several months.
First, the type must be determined. Obstructive azoospermia (blockage, e.g., after vasectomy) has excellent surgical retrieval rates; in non-obstructive cases, sperm can still be found surgically in a meaningful proportion of men. Retrieved sperm is used with ICSI.
Both, in parallel. Infertility involves male factors in about half of couples and combined factors are common — evaluating one partner at a time wastes months. A semen analysis and the female workup can be completed within a single cycle.
Dr. Patsama Vichinsartvichai, MD, MClinEmbryol, EFOG-EBCOG, EFRM-ESHRE/EBCOG, FACOG is a board-certified reproductive endocrinology & infertility specialist, former head of the Vajira IVF unit at Navamindradhiraj University, and founder of LIFE by Dr. Pat in Bangkok. His published research focuses on the dysmorphic (T-shaped) uterus and uterine-factor infertility.
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