Male Fertility

Causes of Male Infertility

As with female fertility, male fertility can be affected by hormone imbalance, stress, weight, illness, medications, lifestyle factors (e.g., drug use, smoking, etc.), and exposure to environmental chemicals. At the Kaiser Permanente Centers for Reproductive Health, we offer a range of male infertility tests and treatment options in the SF Bay Area and Sacramento.

Male infertility occurs when a man has one or more of these factors:

  • Inability to produce sperm with normal shape and movement (motility)
  • Low sperm count in the semen
  • Neither testicle functions normally; at least 1 of the 2 testicles must function so that sperm can develop and mature

Some men have large veins in the scrotum (varicocele), which can overheat the testicles and affect the shape or number of sperm.

Other possible causes include:

  • Exposure to high temperatures, heavy metals, or industrial chemicals
  • Inability to have or maintain an erection (impotence)
  • Semen entering the bladder instead of the urethra and going out the penis (retrograde ejaculation)
  • Inability to ejaculate (anejaculation) due to testicular cancer surgery or other nerve problems
  • Infection, injury, or medical conditions such as diabetes, mumps, or cystic fibrosis

Less common causes include:

  • Being born with problems that affect sperm count and motility
  • Having a reproductive tract blockage that prevents sperm release

Common Male Fertility Tests

The following methods may be used to diagnose male infertility:

Semen Analysis

Semen analysis is one of the most basic fertility laboratory tests. A semen sample is requested to determine the quality and quantity of sperm.

Kaiser Permanente follows the World Health Organization (WHO) guidelines for normal values when analyzing:

  • Volume
  • Sperm count
  • Motility (percentage of moving sperm)
  • Morphology (shape of the sperm)
  • White blood cells

Your provider will be able to interpret your results. The combination of volume, sperm count, and percentage of motile sperm determines the amount of active sperm. A repeat semen analysis may be needed to confirm an abnormal count. If needed, you may be referred to a urology specialist or have other blood tests done.

How are low or abnormal semen analysis counts treated?

Usually the treatment for a mildly abnormal semen analysis is to do intrauterine insemination (IUI) where the sperm is prepared (washed) and placed directly into the woman’s uterus.

If the sperm count is extremely low, your provider may suggest in vitro fertilization (IVF) with the sperm injected directly into the egg, a process called intracytoplasmic sperm injection (ICSI). Depending on your situation, your provider may also discuss using donor sperm as an alternative option. Your provider will discuss options if male factors are identified as contributing to your ability to conceive as a couple.

Blood Tests

Blood tests may be ordered to check for:

  • Hormone levels, such as testosterone level
  • Sperm antibodies, which would indicate that the immune system is attacking the sperm
  • Sperm in the urine, which would indicate that sperm are traveling into the bladder rather than the urethra

Blood tests can also detect if you have a genetic condition that affects fertility, such as:

  • Cystic fibrosis, which may cause obstructed or missing tubes that carry sperm
  • An extra chromosome (Klinefelter syndrome), which causes low testosterone production
  • A missing gene in the Y chromosome (Y-chromosome microdeletion), which causes infertility in men


An ultrasound (an instrument that uses high frequency sound waves to create a picture of the internal organs) may be used to determine if there is blockage in the testicles or tubes that carry semen.

The test can also detect cryptorchidism, a condition in which the testicles didn’t drop into the scrotum during infancy. This reduces sperm production.


If needed, a sample of tissue is removed from the testicles to check whether sperm are present.

Common Male Fertility Treatment Options

Testicular Sperm Extraction (TESE)

Microscopic testicular sperm extraction is the microsurgical retrieval of sperm directly from the testicles via surgical biopsy of the testicular tissue. TESE is a revolutionary treatment for severe male factor infertility caused by the absence of sperm (azoospermia) in the semen due to anatomical obstructions or low/no sperm production.

Microsurgical Epididymal Sperm Aspiration (MESA)

Epididymal sperm aspiration refers to retrieval of sperm-containing fluid from optimal areas of the epididymis (gland that carries sperm from testicle to vas deferens) by dissection of the tissue. MESA is recommended for men with zero sperm count due to blockage. It allows for the retrieval of a larger volume of sperm.

Percutaneous Epididymal Sperm Aspiration (PESA)

Percutaneous epididymal sperm aspiration is a non-surgical method of sperm retrieval. A needle is inserted directly into the epididymis and fluid containing sperm is drawn out.

Varicocele Surgery

Varicocele surgery a minor procedure to correct swollen, enlarged veins in the scrotum. This can result in more mobile sperm.

Vasectomy Reversal

Vasectomy reversal is an outpatient surgical procedure that restores fertility by reconnecting the tubes that carry sperm into semen. This enables semen to contain sperm again and can lead to natural conception and pregnancy. After surgery, soreness for several days is common and sexual activity must be avoided for 3 to 6 weeks, depending on your provider’s instructions.

About 3 out of 50 men who have a vasectomy later change their minds and want to father biological children. While most vasectomies can be reversed, the chance of conceiving a child depends on the type of vasectomy that was done and the length of time since the vasectomy.

Learn More

Visit our Male Infertility Services page for more information.

Source: Male Infertility Overview, Kaiser Permanente, The Permanente Medical Group