Male infertility is the impaired ability to achieve a pregnancy due to male reproductive causes. The process of conception involves several steps that need to occur normally for fertility to be intact: there needs to be the production of healthy sperm, the ability for the sperm to move well, the presence of normal genetic material in the sperm, and the ability of the sperm to reach the egg via an open reproductive tract. Notably, male infertility may not always present with noticeable symptoms.
Male infertility is a major contributor to difficulties in conception globally. According to the World Health Organisation (WHO), male-related factors are responsible for half of the infertility cases among couples. This indicates that infertility is not just a woman’s health issue but a common problem.
Male fertility depends on hormonal stimulation from the brain to make sperm in the testes. The sperm mature and pass through a series of ducts to join fluids from the seminal glands. During ejaculation, the sperm needs to be normally propelled into the female reproductive system. For fertility to be normal, there needs to be normal hormonal stimulation, normal testicular function, open channels, and normal ejaculation. Anything that goes wrong with these may cause infertility.
Male infertility can be classified into three broad medical categories depending on the origin of the problem:
Pre-testicular infertility is caused by the improper functioning of the hormonal system that regulates sperm production. The brain and pituitary gland transmit signals that regulate testosterone production and sperm production. If the signals are weak or irregular, sperm production can be greatly reduced.
This type of infertility can be associated with hormonal imbalance, chronic systemic disease, extreme nutritional deficiency, or genetic disorders related to hormonal regulation. Since the testes are normal, the hormonal environment is the primary concern.
Testicular infertility occurs when the testes are not able to produce healthy sperm effectively. This can occur due to low sperm count, poor sperm production, or the absence of sperm production. The reasons for this type of infertility can be genetic, previous testicular infections, injury, exposure to heat, or the enlargement of veins in the testes (varicocele).
In some cases, the testicular tissue may contain sperm-producing cells that are not functioning properly, even when hormone levels are normal. Testicular causes are one of the most common causes of male infertility.
Post-testicular infertility is when there is a problem with the delivery of sperm, but the production of sperm is normal. The reproductive system has very small tubes that transport sperm from the testes to the outside of the body. If these tubes are obstructed, absent, scarred, or damaged, sperm cannot enter the semen. This could be due to structural obstructions, previous surgeries, absence of ducts at birth, or problems with ejaculation. In this situation, the semen may be low in volume or may not have sperm, even though the testes are producing sperm normally.
| Type | Description | What It Means |
|---|---|---|
| Azoospermia | No sperm in semen | Production or blockage issue |
| Oligozoospermia | Low sperm count | Fewer sperm available |
| Asthenozoospermia | Poor sperm movement | Reduced swimming ability |
| Teratozoospermia | Abnormal sperm shape | Structural defects |
| Combined Defect | Multiple abnormalities | Count + movement + shape affected |
Functional infertility is more about the function of the sperm rather than the number of sperm:
These problems may not be apparent without special testing.
Some of the factors that can affect sperm quality include:
According to the WHO reproductive health research, there is an increasing recognition of environmental and lifestyle factors in fertility patterns.
The initial infertility testing for men often consists of a semen analysis conducted on multiple occasions for accuracy. Other tests that a doctor might recommend, depending on the results, include hormone testing, imaging procedures, and genetic tests. The doctor will also seek to understand the lifestyle and occupational habits of the man in order to point out what factors might be contributing to the male infertility.
Males considering the evaluation include those who have not achieved pregnancy after a year, those with known injuries to the reproductive system, those with past genital infections, and those with difficulties with sexual functions. Early evaluation helps reduce confusion and improve planning.
Male infertility is getting pretty common today, and it comprises several types of medical problems depending on the regulation by hormones, sperm formation, and the delivery system. Knowledge of the types of male infertility can help dispel misconceptions. In addition, it can encourage affected individuals to reach out to fertility specialists for early diagnosis and receive the right treatment in time.
Chief Infertility Specialist, MBBS(DU), FCPS(Obstetrics and Gynaecology), Fellowship in Assisted reproduction
Dr. Umme Ruman is a BMDC-registered infertility specialist based in Dhaka. She holds advanced qualifications in assisted reproductive techniques, sexual and reproductive medicine. Dr. Ruman serves as a Chief Consultant at Indira IVF Dhaka, helping patients with personalised fertility care based on her vast experience and expertise. Her knowledge and compassion will support couples navigating reproductive health challenges and guide them effectively towards their parenthood dreams.
IVF specialist, MBBS (SSMC), MS (Obstetrics and Gynaecology), Fellowship in Assisted reproduction
Dr. Rezwana Kabir is a BMDC-registered specialist in obstetrics and gynaecology, and now a part of Indira IVF’s team of fertility specialists in Bangladesh. She combines medical proficiency with a patient-centric approach, offering tailored solutions to couples seeking fertility assistance. She is committed to helping individuals confidently navigate the journey to parenthood through ethical, empathetic, and evidence-based care.
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