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MALE FACTOR INFERTILITY

When it comes to fertility, sperm play just as big a part as eggs, yet male fertility is often the last thing people think to check. If you've been trying for a while, or you just want answers, a simple semen analysis is usually the place to start. 

Book a male fertility test
Call us on 0800 564 2270

What is male factor infertility?

Male factor infertility means there's something about the sperm, or the way sperm is produced or released, that makes it harder to conceive. That might be a lower sperm count, sperm that don't move as well as they could, or sperm with an unusual shape. Sometimes it's a mix of all three.

It's more common than many people realise. According to the Human Fertilisation and Embryology Authority (HFEA), sperm-related issues are the cause for around half of heterosexual couples who are having problems conceiving. And because it rarely comes with obvious symptoms, plenty of people only find out once they start asking questions.

Male factor infertility isn't only relevant to couples, either. If you're a single man or part of a same-sex male couple planning a family through surrogacy, or a trans or non-binary person thinking about using your own sperm, understanding your sperm health is a useful first step. Whatever your situation, a diagnosis isn't the end of the road; it's what helps us find the right route forward with you.


AROUND HALF

of heterosexual couples who are having problems conceiving have a sperm-related cause. 

Source: HFEA

Patient story

Charlie and Tom's story

When the diagnosis is yours

Tom was diagnosed with low sperm morphology, and one of the hardest parts of treatment was watching his wife, Charlie, go through IVF knowing his results were part of the picture. In this short clip, he talks openly about the guilt that came with that, and how it affected him.

"There's this guilt that creeps in."

Tom

If any of that sounds familiar, you're not on your own. A lot of men feel this way, and it's something our counselling and support team can help you talk through.

Read Charlie and Tom's full story

What causes male factor infertility?

There isn't always a single, clear-cut reason, and the NHS notes that many cases of abnormal semen are unexplained. Where a cause can be found, it usually falls into one of these areas. 

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Sperm quality
The most common issues are a low sperm count (or no sperm at all, known as azoospermia), sperm that don't swim well (low motility), and sperm with an unusual shape (abnormal morphology). Each one can make it harder for sperm to reach and fertilise an egg. 
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Blockages

The vas deferens is the tube that carries sperm from the testicles. If it's blocked, missing from birth, or has been cut during a vasectomy, sperm can't make it into the semen, even when the testicles are producing it perfectly well.

male-factor-testicles-icon_1
The testicles

Because the testicles produce and store sperm, anything that affects them can affect fertility. That includes past infections, injury, surgery, undescended testicles, and treatment for testicular cancer.

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Hormones and genetics

Sperm production relies on hormones, including testosterone. Abnormally low testosterone (hypogonadism) can reduce sperm production, and some genetic conditions, such as Klinefelter syndrome, can affect fertility too.

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Medicines, treatments, and lifestyle

Chemotherapy can severely reduce sperm production, which is why we offer sperm freezing before cancer treatment. Long-term anabolic steroid use, some prescription medicines, and recreational drugs can all affect sperm. Smoking, drinking above recommended limits, and a body mass index (BMI) of 30 or over are also linked to lower fertility, and a higher temperature around the scrotum is associated with lower semen quality.

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Erection and ejaculation problems

Some men find it difficult to get or keep an erection (erectile dysfunction), or to release semen during sex. Either can make conceiving through sex harder, even when sperm quality is good. Erectile dysfunction is common and often treatable, so it's worth raising with your GP or our team rather than keeping it to yourself. If you're having fertility treatment, we'll talk you through how your sample can be collected in a way that works for you. 

Signs and symptoms

For most men, the only sign is that pregnancy hasn't happened yet. Sperm count, movement, and shape can't be seen or felt, so you can feel completely well and still have results that affect your chances of conceiving.

The NHS suggests seeing your GP if you haven't conceived after a year of trying, or sooner if you already know there may be a fertility issue. You don't need a referral to come to us, though, and testing early simply means you'll have answers to work with.


It's worth getting checked sooner if you've had: 

a vasectomy, or a vasectomy reversal

surgery, injury, or infection affecting the testicles or groin

undescended testicles as a child

chemotherapy or radiotherapy

long-term use of anabolic steroids

difficulty getting or keeping an erection, or problems ejaculating

How we test for male factor infertility

At Care Fertility, your tests always come before your consultation. That way, your doctor has your results in front of them when you meet, and you can talk everything through there and then instead of going home to wait for news.

Semen analysis

This is the starting point for almost everyone. You'll produce a sample in a private room at the clinic (or at home, if you'd prefer, and we'll explain how to store and bring it in), and our on-site lab will look at:

Sperm count

How many sperm are in the sample

Motility

How well the sperm are moving

Morphology

The size and shape of the sperm

We'll ask you to avoid ejaculating for two to three days beforehand, and to skip lubricants, as these can affect the sample.

Further tests, if you need them

Depending on your results and history, your doctor may suggest a male hormone profile to look at sperm production, or genetic testing to check for underlying genetic causes. We'll always explain why a test is being recommended and what it could tell us.

What happens next

1
Enquiry call
Most people fill in our enquiry form first, then our patient enquiry team calls you to talk things through and book your tests. 
2
Your tests
You'll come into clinic for your semen analysis, plus any tests your partner is having if you're going through this together. 
3
Your consultation
You'll meet a fertility doctor, who'll go through your results with you and talk about your options. 
4
Your summary in Salve
Afterwards, you'll receive a summary of your treatment options and cost estimates in Salve, our treatment companion app. 
5
Screening and consent
If you decide to go ahead with treatment, you'll complete viral screening blood tests and your consent forms through EngagedMD.
6
Treatment planning
You'll meet one of our nurses to go through your treatment plan and any medication. 
7
Your medication
Any medication you need is supplied by Stork, our medication partner.

Start with our pre-treatment bundle

If you're planning treatment as a couple, our pre-treatment bundle brings all the essential tests and your consultation together, so your doctor has the full picture from day one. It includes a semen analysis for the partner providing sperm, so if there's a male factor involved, we'll know about it before you sit down with your doctor.

What's included

Semen analysis for the partner providing sperm

A pelvic ultrasound scan for the partner providing eggs

Blood tests: AMH, full blood count, thyroid (TSH), HbA1c, and vitamin D

A joint consultation with a Care Fertility doctor to go through your results

We'll book all your appointments at the same time, and everything after that is managed through Salve, our treatment companion app. Just want to check your sperm health on its own? You can book a semen analysis separately from £265.

Save £730

Pre-treatment bundle

£595

Tests, scan, and consultation

Spread the cost with Klarna. Available to new patients at all our UK clinics.

Book now See full breakdown and individual prices →

Treatment options for male factor infertility

The right treatment depends on what your results show, your partner's results if you have one, and what you want from treatment. Your doctor will talk you through the options that fit your situation.

Lifestyle changes

For some men, small changes can make a real difference to sperm health. Stopping smoking, keeping alcohol within 14 units a week, working towards a healthy weight, and keeping things cool down below are all worth a go. Sperm take around three months to develop, so changes made now show up in later samples.

Medication or surgery

If a hormone imbalance is affecting sperm production, medication may help. Where there's a blockage in the epididymis, the coiled tube behind each testicle that stores sperm, surgery can sometimes correct it.

Intrauterine insemination (IUI)

Where sperm results are only slightly below normal, IUI can be an option. Sperm is washed and prepared in the lab so the best-moving sperm are selected, then placed directly into the womb at the most fertile point of the cycle.

Learn more about IUI →

ICSI

Intracytoplasmic sperm injection (ICSI) is the most widely used treatment for male factor infertility. It's carried out as part of IVF: instead of leaving sperm and eggs together in a dish, our embryologists select a single sperm and inject it directly into each mature egg. The HFEA recommends ICSI where there's a very low sperm count, sperm with poor movement or shape, or where few or no eggs fertilised in a previous IVF cycle. It doesn't improve outcomes where sperm results are normal, so we'll only recommend it when it's likely to help.

Learn more about ICSI →

Surgical sperm retrieval

If there's no sperm in the semen, sperm can often still be found in the testicles or epididymis. Surgical sperm retrieval collects it directly, usually under local anaesthetic or sedation, using a fine needle (PESA or TESA) or by taking a small tissue sample (TESE). The sperm is then used in ICSI. It's an option after a vasectomy, where the vas deferens is blocked or missing, or where sperm numbers are very low. For some men, your consultant may suggest trying a lab technique called multiple ejaculation resuspension and centrifugation (MERC) first.

Learn more about surgical sperm retrieval →

Donor sperm

If it isn't possible to use your own sperm, or you'd rather not go through retrieval, treatment with donor sperm is another route to parenthood. Our donors are carefully assessed and screened, and you can choose from the Care Fertility Sperm Bank or import from an external sperm bank. We'll also offer you counselling to help you think it through.

Learn more about donor sperm →

Looking after yourself

Hearing that your sperm results aren't where you'd hoped can knock you sideways. A lot of men tell us they felt they had to keep it to themselves, or that the conversation always seemed to centre on their partner. Whatever you're feeling, it's a normal reaction, and it's worth talking about.

Everyone having treatment with us can access our fertility counselling and support, whether you want to talk through a diagnosis, think about using donor sperm, or just have somewhere to offload. Our teams see male factor infertility every day, so there's nothing you'll say that we haven't heard before.

Explore our support

Get in touch with us

If you're worried about your sperm health, or you've had results you'd like to talk through, our patient enquiry team is here to help.

Fill in the form and we'll call you back to talk through your next steps and book your tests. Or, if you'd rather talk now, call us on 0800 564 2270.

FREQUENTLY ASKED QUESTIONS

How common is male factor infertility? Very common. The HFEA says sperm-related issues are the cause for around half of heterosexual couples who are having problems conceiving, which is why we recommend a semen analysis for anyone producing sperm as part of their fertility tests. 
Can I have male factor infertility if I already have children? Yes. Sperm quality can change over time with age, health, medication, or lifestyle, so having conceived before doesn't rule out a problem now. Our page on secondary infertility explains more. 
Can male factor infertility be treated?  In most cases, yes. Depending on the cause, options range from lifestyle changes and medication to ICSI, surgical sperm retrieval, or treatment with donor sperm. 
Can you still have a baby if there's no sperm in the semen? Often, yes. Many men with no sperm in their semen still produce sperm in the testicles, and surgical sperm retrieval can collect it for use in ICSI. Your doctor will explain whether it's likely to work for you. 
How long does it take to get semen analysis results? Your results will be ready for your consultation, where your doctor will go through them with you in person. 
Can I improve my sperm quality? Sometimes. Stopping smoking, cutting back on alcohol, reaching a healthy weight, and avoiding anabolic steroids and recreational drugs can all help. Because sperm take around three months to develop, it's worth giving changes time before a repeat test. 
Do I need ICSI if I have male factor infertility? Not always. ICSI is recommended where sperm count, movement, or shape are significantly affected. If your results are only slightly below normal, IUI or standard IVF may be suitable instead.