After male infertility is diagnosed, there are three possible treatments. Medical therapy may be used to reverse or improve some types of inflammation or hormone deficiency. Surgery may be done to treat problems with the male anatomy, such as varicocele, ejaculatory duct obstructions, or reversal of a past vasectomy. Surgery may also be used to remove sperm from the testicles in some men. Assisted reproductive technologies (ART) may be advised for some men.

Medical Therapy


Hypogonadotrophic hypogonadism (HH) results when the testes do not receive the right hormone signals from the pituitary gland in the brain. This means that the testes cannot work normally.

The pituitary gland may be affected by tumors, medicines, or a congenital condition (physical conditions that someone is born with). If one of these is the cause of HH, the pituitary hormones (FSH and LH) can be replaced. This will restore the function of the testes.

Surgeries and Procedures


Varicoceles are large veins that allow the blood to flow backward. They can occur inside the spermatic cord and scrotum. Varicoceles are linked with low sperm count, poor motility, and abnormal morphology (physical structure).

Semen quality improves in about 2/3 of men who have surgery to repair varicoceles. Research shows that natural pregnancy rates increase after this treatment.

Of all the causes of infertility, varicoceles are the most easily corrected. Since they are very common, the surgery should be considered only if there are no other infertility risk factors.

Varicoceles can be treated in two ways:

  • With venous embolization, where a small catheter, guided by X-ray, is fed through the large veins of the neck or groin.
  • Through a small incision in the groin region.

Vas Deferens or Epididymal Blockage

Infection or injury can cause scarring and blockage of the male reproductive tract. The most common cause of a blockage that surgery can correct is having had a vasectomy. About 6% of men (6 out of 100) who have a vasectomy also have a vasectomy reversal (vasovasostomy or epididymovasostomy).

The success of a vasectomy reversal depends on many things. The most important factors are the skill of the surgeon and what is found at the time of surgery. If all goes well, 85% to 99% of men (85 to 99 out of 100) can expect a return of sperm after vasovasostomy. If you do not want to have this surgery, sperm extraction can be done along with ART.

Assisted Reproductive Technologies

Even when no sperm are found in the ejaculate (called azoospermia), sperm may be found in the vas deferens, epididymis, or testes. This sperm may be retrieved using minimally invasive techniques. After sperm is retrieved, intracytoplasmic sperm injection (ICSI) may be used to assist in pregnancy.

ICSI has changed how we treat male infertility. With this technology, only a small number of healthy sperm are needed to achieve pregnancy. This means we are often able to obtain healthy sperm for egg fertilization even from men who have a very low sperm count.

The underlying reason for azoospermia will decide where the sperm is taken from and the chances of retrieving it successfully. In vitro fertilization (IVF) must be done along with ICSI to achieve pregnancy. Success depends on a complex program of assisted reproduction for both partners.

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