Fertility conversations often focus on women, but male-factor infertility is involved in around half of all cases where a couple struggles to conceive — either as the sole cause or alongside a female-factor issue. Understanding what’s involved can make the process feel far less daunting.
The most common causes relate to sperm production or function: a low sperm count, poor motility (how well sperm move), or abnormal sperm shape can all reduce the chances of natural conception. A varicocele — enlarged veins in the scrotum — is a frequent and treatable cause. Hormonal imbalances, genetic factors, previous infections, certain medications, and lifestyle factors like smoking, excessive alcohol, or high scrotal temperature can also play a role.
Testing usually starts with a semen analysis, a straightforward test measuring sperm count, motility and morphology. Depending on the results, further investigation might include hormone bloodwork, a physical examination, or genetic testing. It’s a much less invasive starting point than many men expect, and it’s often the fastest way to get a clear answer.
There’s one factor a standard semen analysis doesn’t capture, and it’s becoming a much bigger focus in fertility investigations: sperm DNA fragmentation. A man can have a completely normal, even excellent, semen analysis — good count, good motility, good morphology — and still have significant DNA damage inside the sperm itself. Standard analysis looks at how sperm look and move; it says nothing about the integrity of the genetic material they’re carrying. This matters because a sperm with fragmented DNA can still look and swim perfectly well, and can still fertilise an egg — including via ICSI, which selects sperm based on appearance and motility, not DNA quality. The embryo can start developing normally and then fail early, often showing up as an early miscarriage or a pregnancy that doesn’t progress, with no obvious explanation.
This is a meaningful piece of the picture that’s historically been missed. For years, recurrent early pregnancy loss was investigated almost entirely from the woman’s side — her hormones, her uterus, her egg quality — while a male partner with a ‘normal’ semen analysis was quietly ruled out as a factor, sometimes leaving women carrying the weight, and the blame, of repeated losses that were never actually about them. Sperm DNA fragmentation testing, most commonly done through a test called SCSA (Sperm Chromatin Structure Assay), is now increasingly used specifically to close this gap, particularly for couples with unexplained recurrent miscarriage or repeated IVF failure despite good-looking embryos.
Where DNA fragmentation is found to be elevated, there are meaningful options: lifestyle changes (reducing heat exposure, smoking, and oxidative stress; antioxidant supplementation is sometimes recommended), treating underlying causes like a varicocele, or, for IVF and ICSI cycles, using specialised sperm selection techniques or a fresh rather than frozen sample to improve the odds of using sperm with intact DNA. In some cases, using a testicular sperm sample rather than an ejaculated one can also reduce fragmentation levels significantly.
Treatment depends heavily on what the standard testing reveals. Some causes respond well to lifestyle changes or medication. Where sperm quality is reduced but present, intracytoplasmic sperm injection (ICSI) — where a single sperm is injected directly into an egg during IVF — dramatically improves the odds of fertilisation, even with low counts or motility. Where no viable sperm can be retrieved at all, donor sperm becomes an option.
For couples pursuing surrogacy, male-factor infertility doesn’t change the fundamentals of the process — it simply shapes how the embryo is created. ICSI is used routinely within IVF cycles at Clavis IVF clinic, and where needed, donor sperm can be incorporated smoothly into your surrogacy plan.
If you or your partner have questions about male fertility testing — including whether sperm DNA fragmentation testing makes sense for your situation, particularly after unexplained miscarriage or failed IVF cycles — the Ceres Fertility North Cyprus team can talk you through the options in plain terms, working alongside Clavis IVF clinic. This is a conversation we have often, and there’s no need to feel awkward raising it.
Ready to talk through your own journey? Contact Ceres Fertility North Cyprus for a confidential consultation.
