A Clinical Review of Male Infertility

The Hormonal Axis (HPG Axis)

Sperm production is governed by a precise hormonal feedback loop between the brain and the testes. Disruption at any point can lead to infertility.

Primary Causes of Infertility

The Diagnostic Funnel

The diagnosis of male infertility follows a systematic progression, starting with broad assessments and moving to more specific tests as needed.

Core Diagnostic Tests

• Semen Analysis: The cornerstone test. Assesses sperm volume, concentration, motility, and morphology. At least two tests are recommended due to natural variability.
• Endocrine Evaluation: Hormone testing (FSH, LH, Testosterone) for men with low sperm counts or signs of hypogonadism.
• Genetic Screening: Recommended for men with severe oligozoospermia or azoospermia to detect conditions like Klinefelter Syndrome or Y-Chromosome Microdeletions.
• Ultrasound Imaging: Scrotal ultrasound to detect varicoceles or testicular abnormalities, and transrectal ultrasound (TRUS) to check for ejaculatory duct obstructions.

Pyramid of Interventions

Treatment for male infertility is typically approached in a stepwise manner, starting with the least invasive options.

Treatment Options

• Lifestyle Optimization: The first-line approach, including weight loss, adopting a healthy diet, quitting smoking, reducing alcohol, and managing stress.
• Pharmacotherapy: Medications like Clomiphene Citrate (Clomid) or hCG can correct hormonal imbalances in select men. Exogenous testosterone therapy should be avoided as it acts as a contraceptive.
• Surgical Interventions: Includes varicocele repair (varicocelectomy), vasectomy reversal, and surgical sperm retrieval (e.g., micro-TESE) for use with ICSI.
• Assisted Reproductive Technologies (ART): IVF with ICSI is the treatment of choice for severe male factor issues. The female partner's age is the most important predictor of success.

The Emotional Toll on Men

A male infertility diagnosis can be a profound psychological blow, challenging notions of masculinity and self-worth. It often triggers feelings of:

• Shame & Guilt
• Inadequacy & Personal Failure
• Anxiety & Depression

This distress can create a vicious cycle, where stress negatively impacts sexual function and hormone levels, further worsening the condition.

Coping Strategies and Support

• Become an Active Participant: Educate yourself about your diagnosis and treatment options to regain a sense of control.
• Open Communication: Break the silence. Talk about your feelings with your partner, friends, or a professional.
• Prioritize Self-Care: Engage in stress-reducing activities like exercise, meditation, or hobbies.
• Seek Support: Connect with others through support groups (e.g., RESOLVE) or professional counseling. Knowing you are not alone is a powerful tool.

This checklist is an educational tool to help you identify potential risk factors for male infertility. The presence of any of these factors warrants a discussion with a healthcare provider. Check all that apply to you.

Enter your semen analysis values below to see how they compare to the World Health Organization (WHO) 6th Edition reference standards. This tool is for educational purposes only.