Male Factor Infertility

Male Factor Infertility

Male factor subfertility occurs in 40% of couples attempting conception in our programme. This can range from mild to moderate or severe. Many couples with severe male factor infertility may still conceive naturally in our programme with appropriate medical intervention. Sometimes couples come to us already aware that male factor fertility is an issue for them. For all couples though, if conception has not occurred after 6- 12 months of regular intercourse during potentially fertile days, male factor subfertility may be a possible cause and is investigated at this stage.


In order to obtain a semen sample, we provide couples with the Male Factor Pack so the sample can be collected through normal intercourse. Abstaining from intercourse for 3 days prior to collection improves sperm concentration. Samples collected through normal intercourse with the male factor pack generally give more accurate and better results.


Semen Analysis Results

The above values from 2010 normal semen (middle column) represent the lowest 5% of samples collected from a cohort of couples where conception occurred within 12 cycles of trying to conceive. An average sample should be higher than these values. In clinical practice conception can occur with samples lower than the above threshold. The lowest level acceptable for natural conception has not yet been determined. If a sample is sub-optimal this can be due toa number of transient events for example, a recent flu, illness, period of stress or following heavy alcohol or caffeine consumption. It is wise to consider repeating a sample after 10-12 weeks following any intervention to see if there is an improvement. If the sample result is at or around these lower limits, interventions to optimise male factor are worth considering and implementing. In addition new medical and surgical treatment strategies are now available for men with a zero sperm count.


DNA Fragmentation Index

This is a new test to assess for DNA damage in sperm. It is not evaluated as part of routine testing and is not part of the WHO criteria to assess seminal fluid.  It is too early and too expensive to recommend this test for every couple trying to conceive. The DNA result is impossible to predict from history or routine semen results.


DNA fragmentation occurs due to oxidative stress causing free radical damage to the sperm cells which are poorly protected because of sperm cell design with minimal cytoplasm.  If you are older, a smoker, have a varicocele or chronic infection this will increase oxidative stress and therefore the DNA fragmentation index will be higher. There are several different kinds of DNA tests available with different reference ranges of normal values.

Generally if the DNA fragmentation index is

  • 15% or less natural conception is likely

  • 15-25% Acceptable

  • 25-50% Unsatisfactory

  • >50% Natural conception is unlikely


Anti-sperm Antibodies

With Neo Fertility we can achieve success even with 100% anti-sperm antibodies.




Treatment Plan
Lifestyle factors

For both the male and female we recommend

  1. No Smoking

  2. Alcohol – 7 units per week

  3. Caffeine – 2-3 per week (Tea, coffee, cola)

  4. Stress – control as far as possible

  5. Exercise – too much or too little

  6. Loose fitting cotton trousers

  7. Weight reduction

  8. Regular sleep – 7 hours minimum nightly


Various supplements are recommended, depending on what problems are identified.


Treatment of chronic low grade infection

Symptoms are not always obvious but a chronic low grade infection can result in lower semen parameters. Treatment may be given empirically or following PCR-DNA testing for silent infection including chlamydia, mycoplasma and ureaplasma.


Scrotal Ultrasound

We refer to a specialised radiologist to assess for possible varicocele. If found embolization can correct the varicocele and improve fertility.


Other treatments
  • Tamoxifen

  • Diclofenac

  • Maca- Peruvian Herb

Treatment Outcomes

In our clinical experience we estimate over 50% of couples will see an improvement in semen parameters with intervention.


We re-check semen analysis after intervention and if we do not see an improvement in semen parameters we alter our treatment strategy until all of our treatment options have been tried.

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