Male Infertility Treatment: Becoming a Father Is Not Impossible

What causes male infertility? How can sperm count and motility be increased? The most comprehensive guide to varicocele surgery, azoospermia treatment and the Micro TESE method.

Introduction: The Problem Is Not Only with Women

Infertility is diagnosed in couples who wish to have children but are unable to conceive despite having unprotected and regular sexual intercourse for one year. Although in our society the problem of not being able to have children is generally attributed to women, scientific data shows that 30-40 per cent of the problem stems solely from the man, and 20 per cent from both the man and the woman. In other words, the male factor plays a role in half of all cases.

In this guide, we will examine in detail why sperm count decreases, sperm morphology abnormalities, the silent threat of varicocele, and the Micro TESE procedure, which offers a glimmer of hope for those who have been told ‘you cannot have children.’

What is Male Infertility?

Male infertility is the inability of sperm, the male reproductive cells, to fertilise an egg due to insufficient numbers, low motility, or structural abnormalities.

Here, two concepts must be distinguished:

Infertility: The inability to conceive naturally, although treatment may offer a chance.

Sterility: The complete absence of sperm production and the impossibility of treatment (e.g. removal of both testicles). Today, even azoospermia (absence of sperm in the semen) is not sterility and can be treated.

Symptoms of Male Infertility

Male infertility is often ‘silent’. Most men do not realise they have a problem until they try to have children. However, upon careful observation, the following signs may be noticed:

Sexual Dysfunction: Erectile dysfunction (impotence) or premature ejaculation.
Pain and Swelling in the Testicles: Pain, feeling of fullness, or worm-like vein structures palpable in the testicles, especially in the presence of varicocele (vein enlargement).
Hormonal Symptoms: Hair loss, breast enlargement (gynaecomastia), and loss of muscle mass.
Low Semen Volume: Very little fluid is released during ejaculation.

Reasons: What Reduces Sperm Quality?

Sperm production depends on a delicate balance between the brain and testicles and a healthy body structure.

A. Varicocele (40% Most Common Cause)

It is the dilation and varicosity of the veins carrying the dirty blood from the testicles.

How does it affect? Dilated blood vessels increase testicular temperature and cause toxic substances in dirty blood to accumulate in the testicles. This damages sperm count, motility and, most importantly, DNA structure.

B. Hormonal Disorders

Low testosterone, imbalances in FSH and LH hormones, or high prolactin (milk hormone) levels can halt sperm production.

C. Infections

Sexually transmitted diseases (gonorrhoea, chlamydia) or a previous mumps infection (orchitis) can cause blockages or permanent damage to the sperm ducts.

D. Genetic Causes

Klinefelter Syndrome: A male having 47 chromosomes (XXY) instead of 46.
Y Chromosome Microdeletion: The absence of genes responsible for sperm production.

E. Lifestyle and Environmental Factors

Smoking and Alcohol: Fragments sperm DNA.
Obesity: Disrupts hormone balance.
Heat Exposure: Increased testicular temperature in bakers, foundry workers, or drivers who sit for long periods impairs production.
Laptop Use: Using a laptop on your lap heats the testicles.

Diagnostic Methods: Sperm Analysis (Sperm Test)

Diagnosing male infertility is much easier and less painful than diagnosing it in women. The gold standard test is a spermogram.

How is a Sperm Analysis Performed?

The patient abstains from sexual intercourse for 3 to 5 days (no intercourse and no ejaculation) and provides a sperm sample. According to World Health Organisation (WHO) criteria, normal values are as follows:

Volume: 1.5 ml and above.
Count (Concentration): 15 million and above per millilitre.
Total Count: 39 million and above.
Motility: 40% and above (Progressive motility is important).
Morphology (Shape): 4% and above (according to Kruger criteria).

Important: You cannot be declared infertile based on a single test result. If the values are low, the test should be repeated after 3-4 weeks because sperm production can be temporarily affected by stress or illness.

Treatment Methods: Solution Map

Treatment is determined according to the source of the problem.

A. Lifestyle Changes and Antioxidant TherapyIt is the first step in cases of low sperm count and motility.

Smoking should be stopped.

Weight loss is recommended.

Vitamin Supplements: Antioxidants such as Vitamin E, Zinc, Selenium, L-Carnitine, and Coenzyme Q10 may improve sperm quality.

B. Medication and Hormone Therapy

If the problem is a hormone deficiency (hypogonadotropic hypogonadism), sperm production can be restarted from scratch by replacing the missing hormones with external injections or pills. This treatment takes a long time (6 months to 2 years) but has a high chance of success.

C. Microsurgical Varicocele Surgery (Microscopic Varicocelectomy)

It is the most effective treatment for patients diagnosed with varicocele and impaired sperm values.

Method: A 2 cm incision is made in the groin area. Under a microscope, using a magnified image, only the impaired veins are ligated; arteries and lymph vessels are preserved.

Success: Following surgery, 60-70% of patients experience an improvement in sperm parameters, and 40-50% achieve spontaneous pregnancy.

D. Assisted Reproductive Techniques

Insemination (IUI): If the sperm count is slightly low, the sperm are washed in the laboratory and the highest quality ones are selected and injected into the woman’s uterus.
In Vitro Fertilisation (IVF / ICSI): This is used if the sperm count is very low or if there is no chance of pregnancy occurring naturally. With the microinjection (ICSI) method, even a single viable sperm is sufficient to fertilise the egg.

Treatment for Azoospermia (Absence of Sperm)

This is the scenario men fear most: a test result showing zero sperm. However, this does not mean that the chances of fatherhood are over.

Azospermia is divided into two types:

Obstructive: Sperm production occurs, but the sperm cannot be released because the ducts are blocked. This is resolved by opening the ducts or extracting sperm using a needle (PESA/MESA).
Non-Obstructive: There is a production defect in the testicle. This may be due to genetic or hormonal causes.

Solution: Micro TESE Surgery

It is a revolutionary method for patients with azoospermia.

How is it done? The testicle is opened and examined under a microscope at 20-25x magnification. Small chambers (tubules) within the testicle where sperm are produced are sought. The sperm found are collected and used in IVF.
Chance of Success: Even in men with no sperm, live sperm can be found in 40-60% of cases, enabling fatherhood.

Sperm DNA Damage: The Invisible Enemy

Sperm DNA damage is detected through testing.

Treatment involves quitting smoking, surgery if varicocele is present, and intensive antioxidant therapy.

Frequently Asked Questions (FAQ)

Question: When does sperm improve after varicocele surgery? Answer: Sperm production is approximately a 72-90 day cycle. The first effect after surgery is seen in the third month, but it may take 6 months, sometimes up to a year, for full recovery.

Question: What happens if sperm cannot be found with micro-TESE? Answer: If sperm cannot be found during the first TESE, treatment (e.g., hormone therapy) can be arranged based on the pathology results and retried after 6 months. Today, attempts are also being made with immature sperm using the ROSI (round sperm cell) technique.

Question: Does wearing tight underwear cause infertility? Answer: Wearing very tight clothing constantly increases the temperature by pressing the testicles against the body. For the testicles to produce healthy sperm, they need to be 1-2 degrees cooler than body temperature. Therefore, cotton and loose boxer shorts should be preferred.

Question: Do herbal ointments increase sperm count? Answer: Plants such as caper bush and cistanche may have a supportive effect, but they are not a substitute for primary treatment (e.g., varicocele surgery). Mixtures with unknown ingredients may damage the liver.

Result: Never Give Up, Technology is on Your Side

Male infertility is a condition that was once considered untreatable but is now largely treatable thanks to microsurgery and IVF technologies.

The count may be low, motility may be poor, or there may be no sperm at all in the test. Remember, only one healthy sperm is needed to conceive a baby.

Putting aside any feelings of embarrassment and consulting a Urology/Andrology specialist is the first step towards achieving the family you dream of.

Becoming a father is not a dream; with the right treatment, it is a reality.