🔹 Introduction: When Sperm Struggles Have a Medical Cause

While lifestyle and environment play a big role in sperm health, many men experience fertility issues due to underlying medical conditions. Some are inherited, others acquired — but all of them can impact sperm production, function, or delivery.

The good news? In many cases, there are treatments or procedures that can improve fertility or assist with conception.

🔬 Common Medical Causes of Male Infertility

1. Varicocele (Dilated Testicular Veins)

• What it is: Enlarged veins in the scrotum (like varicose veins)

• Why it matters: Increases scrotal temperature, leading to DNA fragmentation and reduced sperm count/motility

• Symptoms: May feel like a “bag of worms”; often painless

• Diagnosis: Physical exam, scrotal ultrasound

• Treatment:

  • Varicocelectomy (surgical repair)

  • Can improve sperm quality in 30–50% of men within 6–12 months

2. Obstructive Azoospermia

• What it is: A complete absence of sperm in semen due to a physical blockage

• Causes:

  • Prior vasectomy

  • Congenital bilateral absence of the vas deferens (common in men with CF gene)

  • Scarring from infection or trauma

• Diagnosis: Semen analysis + scrotal or transrectal ultrasound

• Treatment Options:

  • Sperm retrieval: TESA, PESA, MESA, or Micro-TESE

  • IVF with ICSI using retrieved sperm

3. Hormonal Imbalances

• What it is: Disruption in hormone signals between brain and testicles

• Causes: Pituitary tumors, low FSH/LH, anabolic steroid use, obesity

• Diagnosis: Bloodwork: FSH, LH, testosterone, prolactin

• Treatment:

  • Stopping steroids

  • Medications like clomiphene citrate, aromatase inhibitors, hCG injections

4. Genetic Conditions

• Examples:

  • Klinefelter Syndrome (XXY): Low testosterone, high FSH/LH, small testes

  • Y chromosome microdeletions: Missing sperm production genes

• Diagnosis: Karyotype + Y-chromosome microdeletion testing

• Treatment:

  • Some men can undergo micro-TESE to retrieve sperm directly from testicles

  • Genetic counseling recommended

5. Infections or STIs

• Examples:

  • Epididymitis, prostatitis, mumps orchitis

• Impact: Inflammation can damage sperm-producing structures or block ducts

• Diagnosis: Semen culture, urinalysis

• Treatment:

  • Antibiotics, anti-inflammatory meds

  • Treating underlying STI (e.g., chlamydia)

6. Retrograde Ejaculation

• What it is: Semen goes into the bladder instead of out through the urethra

• Causes: Diabetes, spinal injury, prostate surgery, medications

• Diagnosis: Post-ejaculation urine test (sperm in urine)

• Treatment:

  • Medications like pseudoephedrine

  • Sperm collection from urine + IUI or IVF

🧪 Procedures That Can Help Retrieve or Improve Sperm

These options are often used before or during IVF cycles:

🔹 Sperm Retrieval Techniques

Used in cases of azoospermia or failed ejaculation:

• TESA (Testicular Sperm Aspiration)

• PESA (Percutaneous Epididymal Sperm Aspiration)

• MESA (Microsurgical Epididymal Sperm Aspiration)

• Micro-TESE (Microsurgical Testicular Sperm Extraction) – most effective for non-obstructive azoospermia

🔹 Medical Therapies

Used for men with hormonal issues or borderline counts:

• Clomiphene citrate (Clomid): Increases FSH/LH

• hCG injections: Boost testosterone and sperm

• Aromatase inhibitors: Lower estrogen in overweight men

🔹 Lifestyle Changes

Can improve mild-to-moderate male factor infertility:

• Quit tobacco, alcohol, or marijuana

• Take antioxidant supplements (zinc, CoQ10, L-carnitine)

• Treat obesity and manage chronic stress

• Avoid heat (hot tubs, laptops, tight clothing)

🧠 Final Thoughts

Male infertility is more common than most couples realize — and often treatable. In fact, up to 50% of IVF cases involve a male factor. A detailed semen analysis and medical evaluation can uncover the root cause and help fertility specialists tailor the most effective plan — whether that’s hormone therapy, retrieval, or assisted reproduction.