Male Factor Infertility: Prevalence, Causes & Evaluation

Infertility affects 15% of couples. Male factor contributes solely in 20–30%, combined in 20–30% → ~50% of cases involve male factor.

Primary Etiologies

• Spermatogenic Failure: Varicocele (40%), genetic (Klinefelter, Y microdeletion), idiopathic, toxins (heat, chemo, smoking).
• Obstructive: Vasectomy, CBAVD (CFTR), infection, ejaculatory duct obstruction.
• Sexual Dysfunction: ED, retrograde ejaculation, anejaculation.
• Endocrine: Hypogonadotropic hypogonadism, thyroid, prolactinoma.

Evaluation

1. History + exam (varicocele, testicular volume).
2. Semen analysis ×2 (WHO 2021: volume ≥1.5 mL, conc ≥16M/mL, motility ≥42%, morphology ≥4%).
3. Hormones: T, LH, FSH, prolactin, estradiol.
4. Genetics: Karyotype, Y-microdeletion if conc <5M.
5. Scrotal ultrasound (varicocele, lesions).

Treatment

• Varicocelectomy (improves parameters 60–70%).
• Medical: hCG/clomiphene (hypogonadotropic), antioxidants (mixed evidence).
• ART: IUI (mild), IVF/ICSI (severe), TESE/MicroTESE (azoospermia).