Treatment for male infertility

Being diagnosed with male infertility can be a frightening and confusing time for many men. But nowadays, with a wide range of treatments available, it doesn’t have to mean the end of your plans to start a family. 

In this article, we will take an in-depth look at the treatments available for male fertility, what they involve and whether they may be right for you. 

The right course of treatment for you will depend on the cause of your infertility. Treatments for male infertility fall broadly into 3 types:

• Non-surgical treatments such as medication that do not involve having an operation 
• Surgical treatments where you have an operation to fix the cause of your infertility 
• Treatment for unknown causes of male infertility such as assisted reproduction techniques (ART) 

Non-surgical treatments range from lifestyle changes to medications and supplements. 

Some lifestyle changes you can make to improve your fertility include: 

• Losing weight and taking regular exercise
• Stopping smoking and reducing alcohol consumption 
• Having regular sex ( every 2 to 3 days) without contraception

Medications such as hormonal treatments, antibiotics, and some over-the-counter medications are used in the treatment of male fertility. The medications used will depend on the cause of infertility. Some medications used to treat male infertility include:

Hormonal treatments

These treatments aim to restore the balance of hormones in the body by increasing the male hormone testosterone and reducing the female hormone oestradiol (a type of oestrogen). 

Hormonal treatments include:

• clomiphene (Clomid) is normally prescribed for men with a low sperm count caused by low testosterone. Clomiphene works on the pituitary gland in the brain to stimulate the production of testosterone and increase sperm count.  
• anastrozole (Arimidex) works by blocking the enzyme that converts testosterone to oestradiol, increasing testosterone and reducing oestrogen levels. It reduces symptoms like low libido (sex drive) and erectile dysfunction and increases sperm count. 
• human chorionic gonadotropin (hCG) is given by injection 2 to 3 times a week and works by stimulating the testes to produce more sperm. 

Other medications 

• Antibiotics may be used where an infection, such as a sexually transmitted infection, is suspected as the underlying cause of infertility. Antibiotics will treat the infection, but depending on the damage to the testes, fertility isn’t always restored.
• Coenzyme Q10 is an over-the-counter supplement that has been shown to improve sperm motility (how well sperm move).
• Sudafed (pseudoephedrine) may be prescribed to men with retrograde ejaculation, a condition where semen goes backwards into the bladder instead of being ejaculated out of the body. It is helpful in around 25% of men with the condition. 

In some cases, it may be necessary to have an operation to treat the cause of your infertility. Some surgical procedures for infertility include: 

• Varicocelectomy 
• Azoospermia treatments
• Microsurgical vasovasostomy
• Vasoepididymostomy
• Transurethral resection of the ejaculatory duct (TURED)

Varicocelectomy 

Varicoceles are enlarged, swollen veins in the scrotum (the sac that contains your testicles), that can block the flow of blood to your reproductive organs and reduce sperm count. It is a common cause of male infertility.  The surgical procedure to remove these veins is called a varicocelectomy.  

Most varicocelectomies are performed laparoscopically meaning only small incisions (cuts) are made in the skin and the procedure is performed using a light and a camera. You will be given a general anaesthetic before the operation which will put you to sleep for the surgery. The surgery normally takes between 1 and 2 hours and is done as an outpatient, meaning you will be able to go home the same day. 

Azoospermia Treatments

Obstructive azoospermia is a condition where there are blockages or damage to the tubes that transport sperm. It is treated surgically with either microsurgery or endoscopic surgery. 

Microsurgery is performed under general anaesthetic. The surgeon makes a small incision in the scrotum and repairs the defect or blockage using special instruments and high-powered magnification. 

During endoscopic surgery, a thin, flexible tube called an endoscope is inserted into your urethra (the tube in your penis). Using a light, camera, and magnification the surgeon can repair the blockage. Endoscopic surgery is carried out under general anaesthetic. 

Microsurgical vasovasostomy

A vasectomy is where some of the tubes that transport sperm (the vas deferens) are cut as a method of birth control. In a microsurgical vasovasostomy, microsurgery is used to reverse the vasectomy and join the cut parts back together. 

Vasoepididymostomy

In this procedure 2 of the tubes (the vas deferens and epididymis) that transport sperm are joined together. It is commonly performed to treat blockages in the tubes. 

Transurethral resection of the ejaculatory duct (TURED)

If the blockage occurs in the ejaculatory duct, sperm cannot get into the seminal fluid (the fluid that normally transports sperm). During this procedure, a tube is passed into the urethra and a small incision is made in the ejaculatory duct allowing sperm to mix with seminal fluid. 

Sometimes the cause of male infertility is not clear. If the cause of your infertility is not known, or other treatments haven’t worked, your doctor may suggest assisted reproductive techniques. This is where the sperm and the egg are placed together to increase the chance of conception. There are various assisted reproduction techniques available. Which one is right for you will depend on the type of infertility you have. 

Types of assisted reproduction include: 

• Intrauterine insemination (IUI)
• In vitro fertilization (IVF)
• Intracytoplasmic sperm injection (ICSI)
• Sperm retrieval for assisted reproduction techniques (ART)  

Intrauterine insemination (IUI)

Intrauterine insemination (IUI) is a type of artificial insemination where your sperm are placed in your partner’s uterus (womb) in the hope that the sperm will fertilise an egg. This treatment works well for low sperm count, poor motility (movement of sperm), and retrograde ejaculation, as well as other causes of male infertility. 

In vitro fertilization (IVF)

This is where an egg is fertilised by a sperm in a petri dish before being transferred to the female`s uterus. It is often used to treat female infertility but can also be used when a man has a very low sperm count that cannot be treated by other means. 

Intracytoplasmic sperm injection (ICSI) 

In this technique, a single sperm is injected into an egg before being placed in the female’s uterus. This procedure may be used when sperm is of very poor quality, or if there is no sperm in the semen due to blockages or other factors. 

Sperm retrieval for assisted reproductive techniques (ART) 

For men with no sperm in their semen (azoospermia) sperm needs to be taken directly from the testes or epididymis. This is done using various techniques. 

Testicular sperm extraction (TESE) is used to extract sperm for examination to try to find the cause of azoospermia. A small incision is made into the testes and the tubes are examined for signs of sperm. If sperm is collected it is usually stored and frozen for future IVF or ICSI. Microscopic testicular sperm extraction (MicroTESE) is a more modern technique where tissue from the testes is examined under a microscope to look for areas where sperm is produced. 

Testicular fine needle aspiration (TFNA) is used to diagnose azoospermia or extract sperm from the testicles for IVF or ICSI. A needle is inserted into the testicle and sperm are extracted with a syringe. 

Percutaneous epididymal sperm aspiration (PESA) is where a needle and syringe are used to extract sperm from the epididymis. 

Microsurgical epididymal sperm aspiration (MESA) is a method of sperm retrieval where sperm are removed from the epididymis using a surgical microscope. This technique can collect high amounts of sperm that can be stored and frozen for future IVF or ICSI. 

There are many treatments available for male infertility and the right one for you will depend on your diagnosis and test results. If you have been diagnosed with male infertility, your fertility specialist will discuss your treatment options with you and recommend the best course of treatment. 

If you are worried about male infertility, the first step is to get a fertility test. This will test your semen to see how many sperm you are producing. You can also book an online appointment with one of our NHS-trained GPs.  Our doctors can help to address your concerns, interpret your test results, and advise on any further investigations or treatment.

NIH: What treatment options are available for male infertility? November 18th 2021 (Accessed August 18th 2022) 

Urology Care Foundation: What is Male Infertility?  

Imperial College Healthcare NHS Trust: Male Fertility  

NHS Treatment: Infertility February 18th 2020 

NHS: Low sperm count August 7th 2019

Health University of Utah: Male Fertility Drugs 

PubMed: Coenzyme Q10 effect on semen parameters: Profound or meagre? April 9th 2020

Healthline: What to expect from a varicocelectomy September 17th 2018 

John Hopkins Medicine: Sperm Retrieval Procedures