In the United States, millions of couples suffer from infertility ‒ and about one-third of all infertility is at least partially male based. While many people tend to think of infertility as a woman’s problem, it’s is an issue involving both sexes, so it’s critical to look at the entire couple when doing a comprehensive fertility evaluation.

What Doctors Look at in a Male Infertility Evaluation

There are numerous parameters doctors look at when evaluating male infertility. Broadly speaking, there could be a problem with hormones the brain is sending to the testicles to make sperm. Or, it could be the way the testicles actually respond to those brain signals. In some cases, the sperm itself may have problems with the way it’s made, affecting the shape, ability to move, or even the ability to recognize and bind to an egg. Even an old hernia repair, for example, can sometimes result in scarring, blockage, or other anatomical problems. So there are many aspects to male infertility that can cause problems ‒ not just one thing.

The Semen Analysis: A Snapshot in Time

The first thing doctors at Fertility Associates of Memphis typically do is look at a semen analysis. It’s important to remember that a semen analysis shows a snapshot in time, and sometimes these snapshots can differ on any given day. So if a semen analysis comes back abnormal, in many cases the semen analysis will be repeated to determine trends or get a bigger picture.

When the Semen Analysis is Abnormal

When abnormal semen analysis results come back, doctors typically follow up with hormone testing to evaluate hormone production in the brain and also evaluate the testicle itself to determine where any treatable problems may exist. A referral to a urologist is also sometimes helpful to rule out or treat specific anatomic problems that may exist. Specific genetic testing, such as making sure certain chromosomes are completely intact, may also be performed in certain men.

In many men with an abnormal semen analysis, a definitive cause is never found. But the good news is that even with abnormal semen production ‒ even in men who appear to have no sperm at all ‒ cutting edge techniques are often able to retrieve sperm through an outpatient procedure and produce a pregnancy through assisted reproductive technologies.

The prognosis of men with infertility has dramatically improved over the last 10 to 15 years, and for the vast majority of men with male factor infertility, physicians are ultimately able to provide a path toward pregnancy.

At the Cellular Level

Sometimes the sperm and egg fail to recognize and bind well to each other. While these egg-sperm interactions certainly are thought to be more common in men with an abnormal semen analysis, even men with a normal semen analysis may have this problem. Unfortunately, there is currently no definitive test to determine the likelihood of having sperm with binding problems past a semen analysis. Fortunately, in couples where this issue is suspected, specific assisted reproductive technology treatments are available that adequately correct this issue in most couples.

Common Male Infertility Questions

Many men want to know if a multivitamin will help boost sperm production, or if there are certain things to avoid like “tighty whitey” underwear, hot tubs, and stress. Generally speaking, a multivitamin is beneficial to your overall health, although in many cases this fails to significantly alter the results of a semen analysis.

Similarly, some men worry about activities that may increase the testicle temperature, such as wearing tight underwear or lounging in hot tubs and saunas. While these activities may be associated with a mild decrease in sperm production, in most men they would not be likely to solely cause infertility.


Male infertility is an extremely common cause of infertility. For many couples suffering from infertility, the semen analysis is the single highest yield test performed during a comprehensive fertility evaluation. The results of a semen analysis alone are often inadequate to determine an optimal treatment path, and further targeted testing may be necessary.

However, with treatment, the vast majority of men suffering from sperm production abnormalities will have an excellent chance of becoming a father through some form of assisted reproduction treatments.