{"id":5832,"date":"2026-07-11T09:00:00","date_gmt":"2026-07-11T09:00:00","guid":{"rendered":"https:\/\/drcemipek.com\/male-infertility-causes-tests\/"},"modified":"2026-07-29T21:50:12","modified_gmt":"2026-07-29T21:50:12","slug":"male-infertility-causes-tests","status":"publish","type":"post","link":"https:\/\/drcemipek.com\/tr\/male-infertility-causes-tests\/","title":{"rendered":"Male Infertility: Causes, Tests, and What Your Results Mean"},"content":{"rendered":"<p><!--\n================================================================\nARTICLE 14\/20 \u2014 drcemipek.com English blog (medical tourism)\nTitle: Male Infertility: Causes, Tests, and What Your Results Mean\nAuthor: Op. Dr. Cem \u0130pek, MD  |  Reviewed: 2026-07-29\nSlug:   \/male-infertility-causes-tests\/\nWord count: ~2,400  |  Reading time: 11 min\n\nELEMENTOR PASTE INSTRUCTIONS\n1. Add \"HTML\" widget on the blank post canvas\n2. Paste EVERYTHING below (including the \n\n<style> block and JSON-LD)\n3. 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Set post language to English\n================================================================\nYOAST META (copy into Yoast panel)\nTitle:        Male Infertility: Causes & Tests Explained | Dr. Cem \u0130pek\nMeta desc:    A board-certified urologist explains what causes male infertility, the full workup (semen analysis, hormones, imaging, genetics), and what your results mean.\nFocus KW:     male infertility causes tests\nOG image:     \/uploads\/2026\/07\/male-infertility-causes-tests-og.jpg (1200\u00d7630)\n================================================================\n--><\/p>\n<style>\n\/* All rules are scoped to .dci-article to avoid Elementor \/ theme conflicts *\/\n.dci-article{font-family:-apple-system,BlinkMacSystemFont,\"Segoe UI\",Roboto,Helvetica,Arial,sans-serif;color:#1f2933;line-height:1.7;font-size:17px;max-width:820px;margin:0 auto}\n.dci-article *{box-sizing:border-box}\n.dci-article h1{font-size:2.15rem;line-height:1.25;font-weight:700;color:#0b2545;margin:0 0 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.dci-toc-title::before{content:\"\";display:inline-block;width:18px;height:2px;background:#1e7c8a}\n.dci-article .dci-toc ol{margin:0;padding:0;list-style:none;counter-reset:toc}\n.dci-article .dci-toc li{counter-increment:toc;margin:.35em 0;padding-left:2em;position:relative;font-size:.98rem}\n.dci-article .dci-toc li::before{content:counter(toc,decimal-leading-zero);position:absolute;left:0;top:0;color:#1e7c8a;font-weight:700;font-size:.85rem;font-variant-numeric:tabular-nums}\n.dci-article .dci-toc a{color:#0b2545;text-decoration:none;border-bottom:1px dashed transparent;transition:border-color .15s}\n.dci-article .dci-toc a:hover{border-bottom-color:#1e7c8a;color:#1e7c8a}\n@media (max-width:640px){.dci-article{font-size:16px}.dci-article h1{font-size:1.7rem}.dci-article h2{font-size:1.3rem}.dci-article table{font-size:.9rem}.dci-article .dci-author{flex-direction:column;align-items:center;text-align:center}}\n<\/style>\n<article class=\"dci-article\" itemscope itemtype=\"https:\/\/schema.org\/MedicalWebPage\">\n<h1 itemprop=\"headline\">Male Infertility: Causes, Tests, and What Your Results Mean<\/h1>\n<div class=\"dci-meta\">\n  <span><strong itemprop=\"author\" itemscope itemtype=\"https:\/\/schema.org\/Physician\"><span itemprop=\"name\">Op. Dr. Cem \u0130pek, MD<\/span><\/strong> \u2014 Board-Certified Urologist &amp; Andrologist<\/span><br \/>\n  <span>Medically reviewed <time itemprop=\"lastReviewed\" datetime=\"2026-07-29\">29 July 2026<\/time><\/span><br \/>\n  <span>11 min read<\/span>\n<\/div>\n<div class=\"dci-answer\">\n<strong>Short answer<\/strong><br \/>\nA male factor is involved in roughly 40\u201350% of infertility cases, either alone or alongside a female factor. The core workup includes two semen analyses (WHO 2021 criteria), a hormone panel (FSH, LH, total testosterone, prolactin), scrotal ultrasound, and \u2014 in selected cases \u2014 karyotype and Y-chromosome microdeletion testing. Varicocele is the single most common correctable cause. Most men benefit from a proper evaluation before jumping to IVF or ICSI.\n<\/div>\n<p>When a couple has been trying to conceive for a year without success, the workup should <em>always<\/em> include the man from the start. Yet studies from multiple countries show that in more than half of couples reaching a fertility clinic, the male partner has never had even a single semen analysis. This is a mistake that costs time, money, and sometimes the chance of natural conception.<\/p>\n<p>This guide, written by a practising Istanbul urologist and andrologist, explains what causes male infertility, what tests are done, and \u2014 critically \u2014 what the numbers on the report actually mean. It is written for men and couples navigating an infertility workup for the first time.<\/p>\n<div class=\"dci-tldr\">\n<h2>Key takeaways<\/h2>\n<ul>\n<li>A male factor contributes to 40\u201350% of infertility \u2014 the workup must include him.<\/li>\n<li>The foundational test is <strong>two semen analyses<\/strong> at least 2 weeks apart, interpreted using WHO 2021 (6th edition) reference values.<\/li>\n<li>Varicocele is the most common surgically correctable cause; hormonal, genetic, obstructive, and DNA fragmentation issues follow.<\/li>\n<li>Azoospermia (no sperm in the ejaculate) affects about 1% of men and 10\u201315% of infertile men \u2014 many can still father a biological child using microTESE + ICSI.<\/li>\n<li>A urologist\/andrologist should be involved from the beginning, not after a failed IVF cycle.<\/li>\n<\/ul>\n<\/div>\n<nav class=\"dci-toc\" aria-label=\"Article contents\">\n<p class=\"dci-toc-title\">Table of contents<\/p>\n<ol>\n<li><a href=\"#what-is\">What counts as male infertility?<\/a><\/li>\n<li><a href=\"#how-common\">How common is a male factor?<\/a><\/li>\n<li><a href=\"#causes\">The main causes of male infertility<\/a><\/li>\n<li><a href=\"#history\">History and physical exam<\/a><\/li>\n<li><a href=\"#semen\">Semen analysis \u2014 WHO 2021 values<\/a><\/li>\n<li><a href=\"#hormones\">Hormone panel \u2014 FSH, LH, testosterone, prolactin<\/a><\/li>\n<li><a href=\"#ultrasound\">Scrotal and transrectal ultrasound<\/a><\/li>\n<li><a href=\"#genetic\">Genetic testing \u2014 karyotype, Y-microdeletion, CFTR<\/a><\/li>\n<li><a href=\"#dna\">Sperm DNA fragmentation<\/a><\/li>\n<li><a href=\"#azoospermia\">Azoospermia \u2014 obstructive vs non-obstructive<\/a><\/li>\n<li><a href=\"#interpret\">How to interpret your report<\/a><\/li>\n<li><a href=\"#next-steps\">Next steps after a diagnosis<\/a><\/li>\n<li><a href=\"#doctors-perspective\">Doctor&#8217;s perspective \u2014 Op. Dr. Cem \u0130pek<\/a><\/li>\n<li><a href=\"#when-to-see\">When to see a urologist<\/a><\/li>\n<li><a href=\"#faq\">Frequently asked questions<\/a><\/li>\n<\/ol>\n<\/nav>\n<h2 id=\"what-is\">What counts as male infertility?<\/h2>\n<p><strong>K\u0131s\u0131rl\u0131k<\/strong> is the inability of a couple to conceive after 12 months of regular, unprotected intercourse (6 months if the female partner is over 35). <strong>Male infertility<\/strong> is diagnosed when the male partner has an identifiable factor \u2014 an abnormal semen analysis, hormonal derangement, genetic abnormality, or structural problem \u2014 contributing to that failure.<\/p>\n<p>The full staircase of options \u2014 from tablets to injections to prosthesis \u2014 is mapped on our <a href=\"\/tr\/treatments_urology\/erectile-dysfunction\/\">erectile dysfunction treatment<\/a> overview.<\/p>\n<p>Importantly, &#8220;male factor&#8221; is not always the sole factor. Roughly 20% of infertility is purely male, another 20\u201330% is combined (male + female), and about 10\u201315% remains unexplained even after full evaluation of both partners.<\/p>\n<h2 id=\"how-common\">How common is a male factor?<\/h2>\n<p>Meta-analyses and WHO data converge on similar numbers:<\/p>\n<p>A non-drug option that some men trial first is <a href=\"\/tr\/shockwave-therapy-for-erectile-dysfunction\/\">low-intensity shockwave therapy for ED<\/a>.<\/p>\n<ul>\n<li>A male factor is involved in approximately <strong>40\u201350%<\/strong> of infertile couples.<\/li>\n<li>Sperm concentration in the general population has declined ~50% over the past four decades in Western studies (Levine et al.), a trend seen across most regions.<\/li>\n<li>About <strong>1% of all men<\/strong> and <strong>10\u201315% of infertile men<\/strong> have azoospermia \u2014 no sperm in the ejaculate.<\/li>\n<\/ul>\n<p>The clinical implication: any couple starting a fertility investigation must have the man evaluated in parallel with the woman, not months later after IUI or IVF has already been attempted.<\/p>\n<h2 id=\"causes\">The main causes of male infertility<\/h2>\n<p>Grouped by mechanism:<\/p>\n<p>Regenerative medicine adds a further tier: <a href=\"\/tr\/stem-cell-therapy-for-erectile-dysfunction-op-dr-cem-ipek\/\">stem cell therapy for erectile dysfunction<\/a>.<\/p>\n<table>\n<thead>\n<tr>\n<th>Category<\/th>\n<th>Examples<\/th>\n<th>Approx share<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td>Varikosel<\/td>\n<td>Left-sided most common; often clinically palpable<\/td>\n<td>~35\u201340% of infertile men<\/td>\n<\/tr>\n<tr>\n<td>Idiopathic<\/td>\n<td>Abnormal semen with no identifiable cause after full workup<\/td>\n<td>~25%<\/td>\n<\/tr>\n<tr>\n<td>Cryptorchidism \/ testicular history<\/td>\n<td>Undescended testis, torsion, orchitis (mumps)<\/td>\n<td>~10%<\/td>\n<\/tr>\n<tr>\n<td>Obstruction<\/td>\n<td>Vasectomy, CBAVD (CFTR-related), ejaculatory duct obstruction, prior hernia surgery<\/td>\n<td>~5\u201310%<\/td>\n<\/tr>\n<tr>\n<td>Endocrine \/ hormonal<\/td>\n<td>Hypogonadotropic hypogonadism, hyperprolactinaemia, exogenous testosterone use, steroid abuse<\/td>\n<td>~5\u201310%<\/td>\n<\/tr>\n<tr>\n<td>Genetic<\/td>\n<td>Klinefelter (47,XXY), Y-chromosome microdeletions (AZFa\/b\/c), CFTR mutations<\/td>\n<td>~5\u201310%<\/td>\n<\/tr>\n<tr>\n<td>Infection \/ inflammation<\/td>\n<td>Epididymo-orchitis, prostatitis, STIs<\/td>\n<td>~2\u20135%<\/td>\n<\/tr>\n<tr>\n<td>Sexual \/ ejaculatory<\/td>\n<td>ED preventing intercourse, retrograde ejaculation, anejaculation<\/td>\n<td>~2\u20135%<\/td>\n<\/tr>\n<tr>\n<td>Iatrogenic \/ lifestyle<\/td>\n<td>Chemotherapy, radiotherapy, anabolic steroids, opioids, heavy smoking<\/td>\n<td>Variable<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Anabolic steroid and exogenous testosterone use deserves special mention: it is a rapidly growing cause of azoospermia in men under 40. Long-acting testosterone or SARMs shut down the pituitary\u2013testis axis and can suppress sperm production for 6\u201318 months after cessation.<\/p>\n<h2 id=\"history\">History and physical exam<\/h2>\n<p>A proper first consultation covers:<\/p>\n<ul>\n<li>Duration of trying to conceive; frequency and timing of intercourse<\/li>\n<li>Prior pregnancies (with current or previous partners)<\/li>\n<li>Childhood surgery (hernia, hydrocele, undescended testis)<\/li>\n<li>Puberty timing, testicular trauma, mumps orchitis, torsion history<\/li>\n<li>Sexually transmitted infections, urinary infections<\/li>\n<li>Medications (testosterone, finasteride, chemotherapy, opioids, SSRIs)<\/li>\n<li>Recreational drug and anabolic steroid use<\/li>\n<li>Occupational exposure (heat, pesticides, solvents)<\/li>\n<li>Family history of infertility, cystic fibrosis, or genetic disease<\/li>\n<\/ul>\n<p>Physical examination assesses testicular volume (normal 15\u201325 mL by orchidometer), consistency, presence of both vasa deferentia, epididymal swelling, varicocele on Valsalva, and secondary sex characteristics.<\/p>\n<h2 id=\"semen\">Semen analysis \u2014 WHO 2021 values<\/h2>\n<p>Semen analysis is the cornerstone. It should be done <strong>at least twice, 2\u20133 weeks apart<\/strong>, after 2\u20137 days of ejaculatory abstinence. Reference values from WHO 2021 (6th edition) \u2014 the current international standard:<\/p>\n<p>The newer, cell-free regenerative sibling of stem cell work is <a href=\"\/tr\/exosome-therapy-for-erectile-dysfunction-op-dr-cem-ipek\/\">exosome therapy for erectile dysfunction<\/a>.<\/p>\n<table>\n<thead>\n<tr>\n<th>Parameter<\/th>\n<th>Lower reference limit (5th centile)<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td>Semen volume<\/td>\n<td>\u22651.4 mL<\/td>\n<\/tr>\n<tr>\n<td>Sperm concentration<\/td>\n<td>\u226516 million\/mL<\/td>\n<\/tr>\n<tr>\n<td>Total sperm number<\/td>\n<td>\u226539 million per ejaculate<\/td>\n<\/tr>\n<tr>\n<td>Total motility (progressive + non-progressive)<\/td>\n<td>\u226542%<\/td>\n<\/tr>\n<tr>\n<td>Progressive motility<\/td>\n<td>\u226530%<\/td>\n<\/tr>\n<tr>\n<td>Normal morphology (strict Kruger)<\/td>\n<td>\u22654%<\/td>\n<\/tr>\n<tr>\n<td>Vitality (live sperm)<\/td>\n<td>\u226554%<\/td>\n<\/tr>\n<tr>\n<td>pH<\/td>\n<td>\u22657.2<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Important nuance: these are <em>reference limits<\/em>, not thresholds for fertility. A man below cutoff can still father a child; a man above cutoff can still be subfertile. That is why the analysis is interpreted alongside the couple&#8217;s whole picture.<\/p>\n<p>Common patterns:<\/p>\n<ul>\n<li><strong><a href=\"\/tr\/low-sperm-count-treatment\/\">Oligozoospermia<\/a><\/strong> \u2014 sperm concentration &lt;16 million\/mL<\/li>\n<li><strong>Asthenozoospermia<\/strong> \u2014 progressive motility &lt;30%<\/li>\n<li><strong>Teratozoospermia<\/strong> \u2014 normal morphology &lt;4%<\/li>\n<li><strong>Oligoasthenoteratozoospermia (OAT)<\/strong> \u2014 all three abnormal (classic &#8220;varicocele stress pattern&#8221;)<\/li>\n<li><strong>Azoospermia<\/strong> \u2014 no sperm found after centrifugation<\/li>\n<li><strong>Cryptozoospermia<\/strong> \u2014 sperm found only after centrifugation<\/li>\n<\/ul>\n<h2 id=\"hormones\">Hormone panel \u2014 FSH, LH, testosterone, prolactin<\/h2>\n<p>A basic andrology hormone panel includes:<\/p>\n<p>Anatomical length or girth is a separate procedure \u2014 details on our <a href=\"\/tr\/penis-enlargement-surgery\/\">penis enlargement surgery<\/a> page.<\/p>\n<ul>\n<li><strong>FSH<\/strong> \u2014 reflects Sertoli cell function and spermatogenesis. High FSH (&gt;10 IU\/L) with small testes and azoospermia suggests non-obstructive azoospermia.<\/li>\n<li><strong>LH<\/strong> \u2014 pituitary drive to Leydig cells<\/li>\n<li><strong>Total testosterone<\/strong> \u2014 early morning, fasting; repeated on a second day if low<\/li>\n<li><strong>Prolactin<\/strong> \u2014 elevation (&gt;20 ng\/mL) can suppress the HPG axis and warrants pituitary MRI<\/li>\n<li><strong>TSH<\/strong> \u2014 screening for thyroid disease<\/li>\n<li><strong>Oestradiol<\/strong> \u2014 helpful when testosterone is low or when obesity is present<\/li>\n<\/ul>\n<p>Interpretation patterns:<\/p>\n<table>\n<thead>\n<tr>\n<th>Pattern<\/th>\n<th>Suggests<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td>High FSH, high LH, low T, small testes<\/td>\n<td>Primary testicular failure (e.g. Klinefelter, prior chemo)<\/td>\n<\/tr>\n<tr>\n<td>Low FSH, low LH, low T<\/td>\n<td>Secondary hypogonadism (pituitary or hypothalamic) \u2014 potentially treatable with gonadotropins<\/td>\n<\/tr>\n<tr>\n<td>Normal FSH, normal LH, low T<\/td>\n<td>Compensated \/ early primary; consider exogenous T use<\/td>\n<\/tr>\n<tr>\n<td>Normal FSH, azoospermia, normal testes<\/td>\n<td>Obstructive azoospermia \u2014 sperm production usually intact<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2 id=\"ultrasound\">Scrotal and transrectal ultrasound<\/h2>\n<p><strong>Scrotal Doppler ultrasound<\/strong> is the imaging workhorse. It confirms varicocele (reflux &gt;2 s on Valsalva), measures testicular volume, and detects hydroceles, cysts, and \u2014 critically \u2014 testicular tumours, which are 20-times more common in infertile men.<\/p>\n<p><strong>Transrectal ultrasound (TRUS)<\/strong> is reserved for suspected ejaculatory duct obstruction: low semen volume (&lt;1.5 mL), low pH, absent fructose, and azoospermia with normal testes and normal FSH. TRUS looks for midline prostatic cysts and dilated seminal vesicles.<\/p>\n<div class=\"dci-cta\">\n<p>Need a complete fertility workup with all tests under one roof?<\/p>\n<p><a href=\"\/tr\/treatments_urology\/male-infertility\/\">Explore our male infertility programme \u2192<\/a><\/p>\n<\/div>\n<h2 id=\"genetic\">Genetic testing \u2014 karyotype, Y-microdeletion, CFTR<\/h2>\n<p>Genetic testing is recommended when:<\/p>\n<p>A common, surgically-treatable cause is discussed in <a href=\"\/tr\/varicocele-symptoms-treatment\/\">varicocele symptoms and treatment<\/a>.<\/p>\n<ul>\n<li>Sperm concentration is &lt;5 million\/mL (severe oligozoospermia)<\/li>\n<li>Azoospermia (any type)<\/li>\n<li>Congenital bilateral absence of the vas deferens (CBAVD)<\/li>\n<li>Recurrent pregnancy loss with the same partner<\/li>\n<\/ul>\n<p>The three main tests:<\/p>\n<ul>\n<li><strong>Karyotype<\/strong> \u2014 detects chromosomal abnormalities. <em>Klinefelter syndrome (47,XXY)<\/em> is found in ~10% of azoospermic men.<\/li>\n<li><strong>Y-chromosome microdeletion<\/strong> \u2014 assays for deletions in the AZFa, AZFb, and AZFc regions. AZFa or AZFb deletions predict no sperm retrieval; AZFc offers reasonable retrieval rates.<\/li>\n<li><strong>CFTR mutation panel<\/strong> \u2014 mandatory in CBAVD, since ~80% carry at least one CFTR mutation. Genetic counselling for the couple is essential before ICSI.<\/li>\n<\/ul>\n<h2 id=\"dna\">Sperm DNA fragmentation<\/h2>\n<p><strong>Sperm DNA fragmentation index (DFI)<\/strong> quantifies the proportion of sperm carrying damaged DNA. Elevated DFI (&gt;25\u201330% depending on assay) is associated with:<\/p>\n<p>For a topline summary, read <a href=\"\/tr\/common-causes-of-male-infertility\/\">common causes of male infertility<\/a>.<\/p>\n<ul>\n<li>Recurrent early pregnancy loss<\/li>\n<li>Poor embryo development in IVF<\/li>\n<li>Failed ICSI cycles despite morphologically normal embryos<\/li>\n<li>Longer time to natural conception<\/li>\n<\/ul>\n<p>Drivers of high DFI include varicocele, infection, smoking, obesity, advanced paternal age, environmental heat, and oxidative stress. DFI often improves after varicocele repair, antioxidant therapy, and lifestyle changes over 3\u20136 months.<\/p>\n<h2 id=\"azoospermia\">Azoospermia \u2014 obstructive vs non-obstructive<\/h2>\n<p>The critical fork in the road for men with no sperm in the ejaculate:<\/p>\n<table>\n<thead>\n<tr>\n<th><\/th>\n<th>Obstructive azoospermia<\/th>\n<th>Non-obstructive azoospermia<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td>Cause<\/td>\n<td>Blockage (vasectomy, CBAVD, ejaculatory duct obstruction)<\/td>\n<td>Failed sperm production (Klinefelter, AZF microdeletion, prior chemo, idiopathic)<\/td>\n<\/tr>\n<tr>\n<td>Testicular volume<\/td>\n<td>Normal<\/td>\n<td>Often small<\/td>\n<\/tr>\n<tr>\n<td>FSH<\/td>\n<td>Normal<\/td>\n<td>Usually elevated<\/td>\n<\/tr>\n<tr>\n<td>Semen volume<\/td>\n<td>Normal or low<\/td>\n<td>Normal<\/td>\n<\/tr>\n<tr>\n<td>Sperm retrieval rate<\/td>\n<td>~100% (PESA\/MESA\/TESA)<\/td>\n<td>~40\u201360% (microTESE); ~20\u201335% in select cases after varicocele repair<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>MicroTESE<\/strong> (microsurgical testicular sperm extraction) is the gold-standard sperm retrieval technique for non-obstructive azoospermia. Under high-magnification microscopy, individual seminiferous tubules are examined and the largest, most opaque tubules are sampled \u2014 dramatically improving yield versus conventional TESE and minimising loss of functional testicular tissue.<\/p>\n<h2 id=\"interpret\">How to interpret your report<\/h2>\n<p>A few practical rules:<\/p>\n<p>The mental-health side is under-discussed \u2014 see <a href=\"\/tr\/the-emotional-impact-of-male-infertility\/\">the emotional impact of male infertility<\/a>.<\/p>\n<ul>\n<li><strong>Never treat one bad semen sample as a diagnosis.<\/strong> Repeat after 2\u20133 weeks. Volatility is real \u2014 a fever, an antibiotic, or a stressful week can move numbers.<\/li>\n<li><strong>Look at the whole pattern, not one number.<\/strong> Isolated low morphology with everything else normal rarely explains infertility on its own.<\/li>\n<li><strong>Correlate with the hormones and the physical exam.<\/strong> A single semen number in isolation misleads.<\/li>\n<li><strong>Check DNA fragmentation<\/strong> when repeated IVF or ICSI has failed with a woman who has an otherwise normal workup.<\/li>\n<li><strong>Ask about total motile sperm count<\/strong> (concentration \u00d7 volume \u00d7 motility) \u2014 a stronger fertility predictor than any single value.<\/li>\n<\/ul>\n<h2 id=\"next-steps\">Next steps after a diagnosis<\/h2>\n<p>Options depend on the finding:<\/p>\n<p>If a diagnosis is missing, start with the <a href=\"\/tr\/why-cant-i-get-hard-12-medical-causes-of-erectile-dysfunction\/\">12 medical causes of erectile dysfunction<\/a>.<\/p>\n<ul>\n<li><strong>Varicocele + abnormal semen:<\/strong> consider <a href=\"\/tr\/treatments_urology\/microscopic-varicocele-surgery\/\">microsurgical varicocelectomy<\/a><\/li>\n<li><strong>Endocrine cause (hypogonadotropic hypogonadism):<\/strong> gonadotropin therapy (hCG \u00b1 FSH) or clomiphene<\/li>\n<li><strong>Obstructive azoospermia:<\/strong> vasovasostomy or vasoepididymostomy where feasible; otherwise sperm retrieval + ICSI<\/li>\n<li><strong>Non-obstructive azoospermia:<\/strong> optimise hormones, treat varicocele where present, then microTESE + ICSI<\/li>\n<li><strong>Idiopathic oligozoospermia:<\/strong> lifestyle optimisation, antioxidant therapy, IUI or ICSI depending on total motile count<\/li>\n<li><strong>Elevated DFI:<\/strong> treat cause, antioxidants, consider testicular sperm for ICSI<\/li>\n<\/ul>\n<div class=\"dci-cta\">\n<p><strong>Ready for a proper fertility workup?<\/strong><\/p>\n<p>Get semen analysis, hormone panel, scrotal Doppler and \u2014 if indicated \u2014 genetic testing at our Istanbul andrology clinic.<\/p>\n<p><a href=\"\/tr\/contact\/\">Request an international patient consultation \u2192<\/a><\/p>\n<\/div>\n<h2 id=\"doctors-perspective\">Doctor&#8217;s perspective \u2014 Op. Dr. Cem \u0130pek<\/h2>\n<blockquote><p>The most avoidable pattern I see is a couple two years into IVF cycles where the husband has never seen a urologist. In perhaps a third of these men there is a treatable finding \u2014 a varicocele, an untreated infection, exogenous testosterone use, high DFI, or a hormonal issue \u2014 that could have shifted the entire treatment plan.<\/p><\/blockquote>\n<blockquote><p>Numbers on a semen analysis are important, but they are probabilistic, not deterministic. I have seen men with counts under 5 million\/mL conceive naturally, and I have seen men with textbook-normal reports remain infertile for years. This is why we treat the couple, not the number.<\/p><\/blockquote>\n<blockquote><p>For azoospermic men, the conversation used to end with a shrug. Today, with microTESE and ICSI, roughly half of men with non-obstructive azoospermia can father a genetically related child. Even Klinefelter syndrome \u2014 long considered hopeless \u2014 has sperm retrieval rates of about 40\u201350% in experienced hands.<\/p><\/blockquote>\n<h2 id=\"when-to-see\">When to see a urologist<\/h2>\n<p>Book an appointment if any of the following applies:<\/p>\n<ul>\n<li>Trying to conceive for &gt;12 months (or &gt;6 months if the female partner is &gt;35)<\/li>\n<li>Any abnormal semen analysis, even a single one<\/li>\n<li>History of undescended testis, testicular torsion, mumps orchitis, or hernia repair<\/li>\n<li>History of chemotherapy, radiotherapy, or pelvic surgery<\/li>\n<li>Current or recent use of testosterone, SARMs, or anabolic steroids<\/li>\n<li>Low libido, small testes, or gynaecomastia<\/li>\n<li>Recurrent pregnancy loss<\/li>\n<li>Failed IUI or IVF cycles<\/li>\n<\/ul>\n<h2 id=\"faq\">Frequently asked questions<\/h2>\n<div class=\"dci-faq\">\n<details>\n<summary>How is male infertility diagnosed?<\/summary>\n<p>Diagnosis begins with a detailed history, physical exam, and at least two semen analyses interpreted using WHO 2021 reference values. This is combined with a hormone panel (FSH, LH, testosterone, prolactin) and scrotal Doppler ultrasound. Genetic testing and sperm DNA fragmentation are added when indicated.<\/p>\n<\/details>\n<details>\n<summary>What is the most common cause of male infertility?<\/summary>\n<p>Varicocele is the single most common identifiable and correctable cause, present in about 35\u201340% of infertile men. Idiopathic infertility (unexplained after full workup) accounts for another ~25%.<\/p>\n<\/details>\n<details>\n<summary>Can a man with zero sperm count have children?<\/summary>\n<p>Often yes. Obstructive azoospermia allows sperm retrieval in nearly 100% of cases. In non-obstructive azoospermia, microTESE retrieves sperm in about 40\u201360% of men overall, and ~40\u201350% even in Klinefelter syndrome. Retrieved sperm are used with ICSI.<\/p>\n<\/details>\n<details>\n<summary>Does testosterone therapy cause infertility?<\/summary>\n<p>Yes. Exogenous testosterone (injections, gels, pellets) suppresses pituitary FSH and LH, shutting down natural sperm production. Recovery after stopping typically takes 6\u201318 months and is not always complete. Men wishing to preserve fertility should never start testosterone without discussing alternatives (clomiphene, hCG).<\/p>\n<\/details>\n<details>\n<summary>How much does a semen analysis cost, and is it painful?<\/summary>\n<p>A semen analysis is painless \u2014 the sample is produced by masturbation into a sterile container, ideally on-site. Costs vary widely by country but it is one of the least expensive tests in a fertility workup and should be done before any invasive testing on the female partner is escalated.<\/p>\n<\/details>\n<details>\n<summary>Can lifestyle changes really improve sperm?<\/summary>\n<p>Yes, and often more than men expect. Weight loss, smoking cessation, alcohol reduction, treatment of sleep apnoea, avoidance of scrotal heat, and correction of nutritional deficiencies (zinc, folate, vitamin D) can produce measurable semen improvement over 3\u20136 months \u2014 the time needed for a new spermatogenic cycle.<\/p>\n<\/details>\n<details>\n<summary>What is DNA fragmentation and does it matter?<\/summary>\n<p>DNA fragmentation index (DFI) measures the proportion of sperm carrying damaged DNA. Elevated DFI (typically &gt;25\u201330%) is associated with recurrent pregnancy loss, poor embryo development, and failed IVF\/ICSI. It is a useful adjunct test, especially in unexplained infertility and recurrent IVF failure.<\/p>\n<\/details>\n<details>\n<summary>When should a couple move to IVF or ICSI?<\/summary>\n<p>The decision depends on total motile sperm count, tubal patency, ovarian reserve, and duration of infertility. Correctable male-factor causes (varicocele, endocrine, obstruction) should generally be addressed first, because success may allow spontaneous or IUI conception and avoid the burden of IVF.<\/p>\n<\/details>\n<\/div>\n<div class=\"dci-author\">\n<div class=\"dci-author-photo\" aria-hidden=\"true\"><\/div>\n<div class=\"dci-author-text\">\n<p class=\"dci-author-name\">Op. Dr. Cem \u0130pek, MD<\/p>\n<p>Board-certified urologist and andrologist based in Istanbul, specialising in male infertility, microsurgical varicocele repair, microTESE, penile prosthesis surgery, and regenerative andrology. Treats patients from more than 20 countries at Androaesthe Clinic.<\/p>\n<p><a href=\"\/tr\/about-us\/\">About Dr. Cem \u0130pek \u2192<\/a> \u00b7 <a href=\"\/tr\/contact\/\">Book consultation \u2192<\/a><\/p>\n<\/div>\n<\/div>\n<div class=\"dci-refs\">\n<strong>References<\/strong><\/p>\n<ol>\n<li>World Health Organization. <em>WHO Laboratory Manual for the Examination and Processing of Human Semen<\/em>, 6th edition, 2021.<\/li>\n<li>European Association of Urology (EAU) Guidelines on Sexual and Reproductive Health, 2024 edition \u2014 Male Infertility.<\/li>\n<li>American Urological Association (AUA) \/ American Society for Reproductive Medicine (ASRM). <em>Diagnosis and Treatment of Infertility in Men: AUA\/ASRM Guideline<\/em>, 2021.<\/li>\n<li>Levine H et al. <em>Temporal trends in sperm count: a systematic review and meta-regression analysis.<\/em> Hum Reprod Update. PMID: 28981654.<\/li>\n<li>Schlegel PN et al. <em>Diagnosis and treatment of infertility in men.<\/em> Fertil Steril. PMID: 33471976.<\/li>\n<li>Krausz C, Riera-Escamilla A. <em>Genetics of male infertility.<\/em> Nat Rev Urol. PMID: 30089049.<\/li>\n<\/ol>\n<\/div>\n<\/article>\n<p><script type=\"application\/ld+json\">\n{\n  \"@context\": \"https:\/\/schema.org\",\n  \"@graph\": [\n    {\n      \"@type\": \"MedicalWebPage\",\n      \"@id\": \"https:\/\/drcemipek.com\/male-infertility-causes-tests\/#webpage\",\n      \"url\": \"https:\/\/drcemipek.com\/male-infertility-causes-tests\/\",\n      \"name\": \"Male Infertility: Causes, Tests, and What Your Results Mean\",\n      \"description\": \"A board-certified urologist explains what causes male infertility, the full workup (semen analysis, hormones, imaging, genetics), and what your results mean.\",\n      \"inLanguage\": \"en\",\n      \"isPartOf\": { \"@id\": \"https:\/\/drcemipek.com\/#website\" },\n      \"audience\": { \"@type\": \"PatientsAudience\" },\n      \"medicalAudience\": [\"Patient\",\"MedicalResearcher\"],\n      \"reviewedBy\": { \"@id\": \"https:\/\/drcemipek.com\/#physician\" },\n      \"author\": { \"@id\": \"https:\/\/drcemipek.com\/#physician\" },\n      \"lastReviewed\": \"2026-07-29\",\n      \"datePublished\": \"2026-07-29\",\n      \"dateModified\": \"2026-07-29\",\n      \"about\": { \"@id\": \"https:\/\/drcemipek.com\/male-infertility-causes-tests\/#condition\" },\n      \"mainContentOfPage\": { \"@id\": \"https:\/\/drcemipek.com\/male-infertility-causes-tests\/#faq\" }\n    },\n    {\n      \"@type\": \"MedicalCondition\",\n      \"@id\": \"https:\/\/drcemipek.com\/male-infertility-causes-tests\/#condition\",\n      \"name\": \"Male Infertility\",\n      \"alternateName\": [\"Male factor infertility\",\"Male subfertility\"],\n      \"code\": { \"@type\": \"MedicalCode\", \"code\": \"N46\", \"codingSystem\": \"ICD-10\" },\n      \"possibleTreatment\": [\n        { \"@type\": \"MedicalProcedure\", \"name\": \"Microsurgical varicocelectomy\" },\n        { \"@type\": \"MedicalProcedure\", \"name\": \"MicroTESE (microsurgical testicular sperm extraction)\" },\n        { \"@type\": \"MedicalTherapy\", \"name\": \"Gonadotropin therapy (hCG \/ hMG)\" },\n        { \"@type\": \"MedicalTherapy\", \"name\": \"Clomiphene citrate\" },\n        { \"@type\": \"MedicalProcedure\", \"name\": \"Intracytoplasmic sperm injection (ICSI)\" }\n      ],\n      \"signOrSymptom\": [\n        { \"@type\": \"MedicalSignOrSymptom\", \"name\": \"Failure to conceive after 12 months\" },\n        { \"@type\": \"MedicalSignOrSymptom\", \"name\": \"Abnormal semen analysis\" },\n        { \"@type\": \"MedicalSignOrSymptom\", \"name\": \"Low libido\" },\n        { \"@type\": \"MedicalSignOrSymptom\", \"name\": \"Testicular atrophy\" }\n      ]\n    },\n    {\n      \"@type\": \"FAQPage\",\n      \"@id\": \"https:\/\/drcemipek.com\/male-infertility-causes-tests\/#faq\",\n      \"mainEntity\": [\n        {\n          \"@type\": \"Question\",\n          \"name\": \"How is male infertility diagnosed?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"Diagnosis combines detailed history, physical exam, at least two semen analyses using WHO 2021 reference values, a hormone panel (FSH, LH, testosterone, prolactin), and scrotal Doppler ultrasound. 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