Male Fertility
Male fertility is the sperm half of the question. It covers the tests that describe what sperm are there and how they are behaving. It covers the assessment that looks for a reason when the numbers are poor. And it covers freezing sperm for later, plus the operations that retrieve sperm from the testicle when the ejaculate has none.
Almost all of it starts in the same place. A semen analysis is a sample in a pot, a technician with a microscope and a counting chamber, and a result the same week. Everything else on this page is a response to what that one test says.
Here is the part worth carrying into your first appointment. A male factor is involved in something like half of couples who struggle to conceive, on its own or alongside a female factor. Testing for it is the cheapest and quickest thing in the whole of fertility medicine, and the least invasive. It is still routinely done late, or not at all, while the female partner goes through blood tests, scans and sometimes a laparoscopy first. I have lost count of the consultations where the test that should have come first had not been done.
Who male fertility is for
Anyone with testicles who has been trying to conceive for about a year without success. Make it six months if the female partner is over thirty-five. You do not need a reason to test earlier. If there is an obvious one, an undescended testicle as a child, chemotherapy, a testicular injury, surgery in the groin, you should.
Two other groups belong here. People about to start treatment that damages sperm production, cancer treatment most of all, who need to freeze first. And anyone planning to be a known or clinic donor, where the testing is more thorough and includes infection screening and genetics.
A clinic asks about medical and surgical history, how long you have been trying, and previous pregnancies with any partner. Then medication, recreational drugs, anabolic steroids and testosterone, heat exposure at work, and whether ejaculation and erections are normal. None of it is a moral test, and a doctor who has heard it before will not react. See fertility testing for the female side, which should be running in parallel rather than first.
Before the first appointment
Write down every drug you take, prescription and otherwise, and be specific about any testosterone or steroid use, including how long ago. Testosterone switches sperm production off, and a doctor who does not know about it will spend months investigating the wrong thing.
Choosing between them
There is an order to this, and it is nearly always the same. A semen analysis comes first. If it is normal, the male side is largely answered and attention moves elsewhere. If it is abnormal, the test gets repeated after a gap of a few weeks. A single sample varies enormously, and plenty of men are labelled on the strength of one bad morning.
Only after two abnormal samples does a full assessment earn its place. That means an examination, hormone blood tests and, where the count is very low or absent, genetic testing.
The assessment looks for the small number of causes that can be acted on. A hormone problem that responds to treatment, an obstruction, a varicocele, or a genetic explanation that changes what retrieval is likely to find.
Varicocele is the one that generates the most argument. It is common, it is easy to find, and repairing it improves semen parameters in a fair number of men. Whether that turns into more babies is less clear than the marketing around it suggests. I would want a surgeon to say plainly what the evidence does and does not show before agreeing to an operation.
Where there is no sperm in the ejaculate at all, the question stops being treatment and becomes retrieval. Can sperm be found in the testicle, and if so, by which method.
At the results appointment
Ask what the plan is if the repeat test comes back the same, and what it is if it comes back normal. Getting both answers in one sitting saves you a month of waiting for an appointment to be told the obvious next step.
The male fertility procedures
These pages fall into two halves that follow each other. Testing describes what is there. Treatment and retrieval is what you do about it, and almost nobody needs the second half until the first half has been done twice.
Start with semen analysis. It explains what every number on the report means, and why a single result is a snapshot rather than a verdict. Read the retrieval pages only if a result sends you there.
Semen Analysis
A semen analysis is a laboratory test of one ejaculated sample, measuring volume, sperm concentration, total count, motility and shape. It is the first and cheapest test on the male side, and a single result is a snapshot of one sample rather than a verdict on a man.
Best for: anyone with testicles at the start of a fertility workup, and anyone about to start treatment that could damage sperm production
- Back to work
- None
- Typical cost
- $50–$300
Male fertility recovery
Most of this group has no recovery at all. Producing a sample, giving blood and freezing sperm are appointments you walk out of and forget. The only inconvenience is the abstinence period beforehand and, for freezing, the paperwork.
The two that involve an operation are gentler than people expect. A varicocele repair and a surgical sperm retrieval are both day cases, under general or local anaesthetic depending on the technique. Expect a few days of bruising and aching, supportive underwear, and a week or two off anything strenuous.
Micro-TESE is the most involved. The surgeon opens the testicle and searches through it under a microscope, and the soreness lasts longer. Semen parameters after a varicocele repair take three to six months to shift, if they shift at all, because sperm take roughly that long to be made.
Male fertility cost
The gap between the cheapest and the dearest thing on this page is enormous, and it runs in your favour. A semen analysis is one of the least expensive tests in medicine. Tens of dollars or pounds in the public system, and often free through a family doctor. A full assessment with hormones and genetics is still modest. Surgical retrieval is the outlier, because it involves an operating theatre, an embryologist standing by and, almost always, an IVF cycle with ICSI running alongside it.
Two things routinely fall outside a quoted price. Storage, which is billed annually and can run for years, and the IVF cycle itself where retrieval is being done to feed one. Ask for the retrieval price and the cycle price separately. Ask too what happens to the fee if no sperm are found, because that outcome is real and clinics differ on it.
Where it fits
The male tests should run at the same time as the female ones, not after them. There is no clinical reason to wait and every practical reason not to, since a result that comes back badly abnormal changes the whole plan.
Freezing has its own timing and it is unforgiving. Sperm should be banked before cancer treatment starts, not between cycles, and before starting testosterone rather than after. Surgical retrieval is usually timed to an egg collection so the sperm and the eggs meet fresh. Many clinics freeze retrieved sperm instead and thaw it for the cycle, which decouples the two operations. If a varicocele repair is on the table, it sits earliest of all, because it needs months to show any effect.
Eligibility
Nothing here has an age limit or a waiting criterion in the way that funded IVF does. A semen analysis is available through a family doctor in most public systems and through any fertility clinic privately, without a referral in many countries.
Where rules do bite is storage and donation. How long sperm may legally be stored varies by country, and has changed recently in several of them. Consent has to be renewed, and it is specific about what happens if you die or lose capacity.
Donor anonymity differs completely between jurisdictions, and clinics apply infection screening before anything is frozen. See donor conception for the legal side, which is the part people underestimate.
Frequently asked questions
How do I get a semen analysis?
Through a family doctor in most public systems, or directly from a fertility clinic privately. No referral is needed in many countries. See semen analysis.
Is one bad result enough to diagnose a problem?
No. Samples vary a lot between weeks, so an abnormal result should be repeated after a gap of a few weeks before anyone draws conclusions. See choosing.
Does a low count mean IVF is the only option?
Not by itself. A low count can still conceive naturally. Treatment ranges from nothing at all through IUI to IVF with ICSI, depending on how low it is and what else is going on.
Can anything be done if there is no sperm in the ejaculate at all?
Often, yes. Sperm can be retrieved directly from the testicle or the epididymis in a meaningful share of men, and used with ICSI. What is likely depends on why the ejaculate is empty.
Will taking testosterone help my fertility?
The opposite. Testosterone suppresses the signal that drives sperm production and commonly drops the count to zero, sometimes for many months after stopping.
New to fertility treatment?
The Start Here guide walks through the tests, the treatments, the order they usually come in, and what the numbers actually mean.
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