The causes of infertility may sometimes be identified and treated relatively easily, while in some cases the underlying problems can be more difficult to resolve. Among couples who are unable to conceive, approximately one-third of infertility cases are related to male factors, one-third to female factors, and one-third to factors involving both partners. However, despite comprehensive testing, no identifiable cause can be found in approximately 15% of couples. This condition is referred to as unexplained infertility.

What Are the Male-Related Causes of Infertility?

One of the leading male-related causes of infertility is the absence of viable male reproductive cells, known as sperm, in the semen or ejaculate. This condition is called azoospermia. Azoospermia may occur either because sperm cannot reach the ejaculate due to an obstruction in the male reproductive ducts, or because the testicles produce very few sperm or no sperm at all. In both situations, male patients should be evaluated without delay together with their partners. Depending on the underlying cause, sperm retrieval may be performed using MESA or PESA techniques in cases of obstruction, while TESE procedures may be required in cases where sperm production is absent or severely reduced.

In cases where sperm is absent due to ductal obstruction, sperm retrieval is usually easier. However, in cases where sperm production is very low or absent, the chance of finding sperm with micro-TESE can still be clinically promising. With micro-TESE, sperm may be found in approximately 50–60% of men in whom sperm could not previously be detected through biopsy. Male patients who are planning to undergo a biopsy or sperm retrieval procedure should pay close attention to the choice of clinic or center. Otherwise, sperm cells that are already difficult to obtain may be wasted if they cannot be frozen or if they are lost after diagnostic testing.

Varicocele surgery, which has commonly been performed to treat enlargement of the veins draining the testicles, should be evaluated carefully according to evidence-based medical criteria. Its benefit may vary depending on patient selection and semen parameters, and it is not considered necessary or beneficial in every case of male infertility. Apart from this, infections, tumors, and similar male reproductive system problems can be evaluated and treated by urology specialists.