Male Infertility

It is an important reproductive health issue that may affect couples’ pregnancy process. At İRENBE, male infertility is addressed through detailed evaluation, up-to-date medical approaches, and personalized treatment planning.

Accurate Evaluation and Personalized Treatment Planning in Male Infertility
Male infertility is not a condition that develops due to a single cause. Therefore, the correct approach is to create a personalized roadmap by evaluating sperm parameters, hormonal structure, genetic factors, and the couple’s overall reproductive plan together. Conducting the evaluation of male infertility simultaneously with the evaluation of the female partner holds an important place in treatment planning.

1) What Is Male Infertility?

Male infertility refers to male-related reproductive problems that affect the formation of pregnancy. This condition may be associated with low sperm count, motility or morphology disorders, inadequate sperm production, blockages in the sperm transport pathways, or hormonal and genetic causes. Since every patient’s clinical condition is different, the process should not be evaluated based on a single test result alone, but through a detailed specialist assessment.

At İRENBE, male infertility is addressed not only through laboratory data, but also with a cause-oriented and planned approach in which the couple is evaluated together.

2) Causes of Male Infertility

Male infertility may occur due to many different reasons. Low sperm count, motility and morphology disorders, azoospermia, varicocele, hormonal imbalances, genetic factors, previous infections, a history of undescended testicles, certain medications, environmental exposures, and lifestyle factors may all be among these causes. Current guidelines recommend evaluating lifestyle, medical history, and accompanying health conditions together in the assessment of male infertility.

For the correct treatment plan, the important point is not only identifying the existence of the problem, but also accurately determining the underlying cause. This approach prevents unnecessary loss of time and helps determine the most appropriate treatment option.

3) Evaluation and Diagnostic Process

The evaluation of male infertility is planned through detailed medical history, physical examination, semen analysis, and when necessary, hormonal, genetic, or imaging examinations. International guidelines recommend that male and female evaluations in infertile couples should be performed simultaneously, and that men with abnormal

semen parameters should be evaluated by a specialist experienced in male reproductive health.

The aim of this process is not only to identify the factors affecting the chance of pregnancy, but also to review accompanying general health problems. Because male infertility may sometimes be a sign of underlying medical conditions.

4) Spermiogram (Semen Analysis)

Spermiogram is one of the basic steps in the evaluation of male infertility. Sperm count, motility, morphology, volume, and some other parameters are evaluated through this examination; however, a single result may not always be sufficient for a definitive interpretation. Guidelines recommend performing at least two semen analyses if abnormalities are detected in the first test.

Semen parameters may vary biologically. Therefore, the test result should be evaluated together with the patient’s history, physical examination, and other investigations. At İRENBE, spermiogram results are interpreted not only numerically but together with the clinical picture.

5) Azoospermia

Azoospermia is the absence of sperm cells in the semen sample. Clinically, it is evaluated as obstructive azoospermia due to blockage and non-obstructive azoospermia due to impaired sperm production. This distinction is of great importance for both the diagnostic process and treatment planning.

In patients diagnosed with azoospermia, hormonal evaluation, physical examination, genetic assessment when necessary, and imaging methods in selected cases may be planned. While surgical repair or sperm retrieval methods may be considered in obstructive cases, advanced surgical options such as Micro TESE may be evaluated in non-obstructive cases.

6) Varicocele

Varicocele is a condition characterized by enlargement of the veins surrounding the testicles and is one of the common clinical findings in infertile men. The current EAU guideline recommends evaluating varicocele through physical examination, while Doppler ultrasonography is recommended in cases where the examination is unclear or in selected patients.

Not every varicocele requires treatment. However, in appropriate patients with clinical varicocele and impaired semen parameters, treatment may provide benefits in terms of sperm parameters and pregnancy probability; on the other hand, routine treatment is not recommended in men with normal semen analysis or subclinical varicocele.

7) Hormonal and Genetic Evaluation

In some male infertility cases, hormonal and genetic examinations are an inseparable part of the diagnosis. Especially in patients with severe low sperm count, azoospermia, suspected hormonal imbalance, or impaired sperm production, hormone tests such as FSH, testosterone, and when necessary LH and prolactin may be planned.

Genetic evaluation provides important information in selected patients. Y chromosome microdeletions may be significant especially in severe oligospermia and azoospermia cases; additionally, CFTR-related evaluations may come to the agenda in suspected absence of the vas deferens or obstructive azoospermia. These examinations are important both for the treatment plan and possible genetic counseling.

8) Sperm DNA Damage

Sperm DNA damage is a special evaluation area related to the integrity of the genetic material within the sperm cell. According to current guidelines, this test is not routinely recommended as a first step in every patient; however, it may be evaluated in selected couples with recurrent pregnancy loss, unexplained infertility, or a history of failure in assisted reproductive treatments.

Sperm DNA damage may be associated with age, varicocele, infections, hormonal imbalances, and certain lifestyle factors. Therefore, the test result should always be interpreted within the clinical picture and the couple’s overall treatment plan.

9) Micro TESE / TESE

Micro TESE is a microscopic surgical method applied especially in patients with non-obstructive azoospermia to search for sperm within testicular tissue. The AUA/ASRM guideline recommends the microdissection TESE approach in men with non-obstructive azoospermia who are planned for surgical sperm retrieval.

In obstructive azoospermia, sperm may be obtained from the testicle or epididymis; in some cases, reconstructive surgery may also be an appropriate option. Which method will be preferred should be determined according to the cause of azoospermia, the condition of the female partner, and the couple’s overall treatment plan.

10) Sperm Freezing

Sperm freezing is an important option in preserving male fertility. According to the ASRM 2026 opinion, the established fertility preservation method in men is sperm cryopreservation, and when possible, it should be planned before chemotherapy, radiotherapy, or surgical procedures that may damage the gonads begin.

Sperm freezing may come to the agenda before cancer treatment, after surgical sperm retrieval, or for fertility preservation purposes for future use. Proper counseling and rapid guidance at the appropriate time are of great importance in this process.

11) Male Factor in IVF

The male factor plays an important role in planning IVF treatment. Sperm parameters, the presence of azoospermia, the need for surgical sperm retrieval, and the methods to be used may directly affect the IVF/ICSI process. Current guidelines recommend that the evaluation and decision-making process in infertile couples should be carried out by considering both male and female factors together.

At İRENBE, the male factor is evaluated together with the female partner’s age, ovarian reserve, and the couple’s overall goals. The aim is not only to create a technical treatment plan, but also to determine the most appropriate timing and the most accurate approach for the couple.