Types of male infertility
Male infertility can be caused by different factors that are grouped as follows:
1. Pretesticular or endocrine factor: hormonal alterations that affect testicular development and/or function.
2. Testicular factor: direct involvement of the testicles.
3. Post-testicular factor: alterations in the release of sperm.
4. Sperm factor : alterations in sperm quality directly.
Although there are different causes, all of them affect the quality of ejaculated semen in one way or another. For a man to be considered to have good semen quality, he must meet minimum values regarding sperm concentration, motility, morphology, and viability.
The diagnosis of the cause of male infertility is made through various diagnostic tests. Among the tests for studying male fertility, the semen analysis (semen analysis) is particularly important.
1. Pretesticular or endocrine factor
This type of sterility is due to problems in the hormonal regulation of spermatogenesis, that is, the production of sperm.
The hormones secreted by the pituitary gland, LH and FSH, responsible for acting on the male reproductive function, can be altered for any of the following reasons:
- • Unhealthy lifestyle habits.
- • Diabetes.
- • Hypothyroidism and hyperthyroidism.
- • Hypogonadotropic hypogonadism.
- • Hyperprolactinemia.a
These alterations can be due to congenital problems or be caused by external factors such as certain substances or drugs (e.g., anabolic steroids), which can disrupt the entire hormonal regulation system and produce fertility problems.
2. Testicular factor
When we talk about a testicular factor, we are referring to any alteration or defect that directly affects the testicles.
- • Congenital testicular factors:
They are caused by genetic alterations at the chromosomal level (e.g., in Klinefelter syndrome). They can also occur at the genetic level, as in the case of Noonan syndrome, or if diseases caused by defects in genes on the Y chromosome appear. - • Acquired defects at the testicular level:
This section covers adverse effects caused by medications, such as chemotherapy, drug use, radiotherapy, trauma, infections, etc. The most well-known pathologies are varicocele, cryptorchidism, orchitis, and hydrocele.
3. Post-testicular factor
Male infertility due to post-testicular factors encompasses all cases caused by obstructions or abnormalities in the seminal tracts. The seminal tracts consist of the epididymis, vas deferens, and urethra, which sperm must traverse to be ejaculated after being produced by the testicles.
The causes of this obstruction can be diverse, such as infections, trauma, antisperm antibodies, hypospadias, or cystic fibrosis.
4. Sperm factor
Male infertility due to sperm factors is the most common. This category includes sperm abnormalities that directly affect their morphology, motility, viability, or concentration.
To analyze semen quality, a semen analysis is performed to diagnose the following abnormalities:
- • Oligozoospermia: low sperm concentration.
- • Asthenozoospermia: poor sperm motility.
- • Teratozoospermia: high number of sperm with abnormal morphology.
- • Necrospermia: high number of dead sperm.
- • Azoospermia: absence of sperm in the ejaculate.
Symptoms of infertility in men
Male infertility does not cause any symptoms that a man can perceive. This can only be discovered when, after a long period of unprotected sex, pregnancy has not been achieved and the couple begins to undergo testing.
Furthermore, there are some signs that can alert a man to possible infertility. We discuss them below:
- Low libido and erection problems.
- Semen altered with an abnormal color, strong odor, very watery or very thick, etc.
- Having testicles smaller than normal.
- Changes in voice, loss of body hair, or decreased muscle mass indicate possible hormonal imbalances.
- Changes in urine or pain when urinating that may indicate a possible infection.
- Appearance of varicose veins in the testicles.
If these symptoms appear while trying to conceive, the man should undergo a study that includes the necessary tests to confirm whether it is a case of male infertility.
Which is the treatment?
To address male infertility, it's essential to identify the underlying cause preventing pregnancy. In some cases, male fertility can be restored through medication or surgery. In more severe cases, assisted reproductive technology may be the only option.
The following are some possible treatments for male infertility:
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- natural treatment: A healthy lifestyle with a balanced diet combined with vitamin supplements can help improve semen quality in milder cases. Antioxidants such as selenium, carnitine, and vitamins E, A, C, and B12 are particularly important.
- Hormonal drugs: Gonadotropins and clomiphene citrate, for example, are administered to men with hypogonadotropic hypogonadism.
- Surgical intervention: for testicular conditions such as cryptorchidism or varicocele.
- Assisted reproduction: When the previous options are not possible or have not been successful, ICSI (intracytoplasmic sperm injection) is the technique that offers the best success rates in cases of severe male factor infertility.
Original article by: Dr. Elena Izquierdo Trechera and collaborators | www.reproduccionasistida.org | August 13, 2026
