Male infertility: everything you need to know, from an exceptional Madrid-based clinic

With today marking Father’s Day in the UK – a particularly difficult time for many who are trying to conceive – team TRB want to shine a light on fathers-in-waiting. With this in mind, we’ve taken your brilliant questions and put them to our partner fertility clinic in Madrid, Spain – Clínica Tambre.

Below, you’ll find answers to some of the most pressing questions around male infertility, straight from fertility specialists. If you’d like to know more, feel free to reach out to us or contact Clínica Tambre directly for tailored fertility help and advice.

Male infertility: causes and signs

How common is male factor infertility?

Answered by Dr. Marta Zermiani

Male factor infertility is estimated to be present in around 50% of cases – being the sole cause in 30% of cases and co-occurring with female factors in a further 20%.

The causes can vary widely and may include anatomical or genetic abnormalities, systemic or neurological diseases, infections, trauma, iatrogenic injury, gonadotoxins, or the development of sperm antibodies. In 30-40% of cases, however, no specific cause is identified.

What are the signs of male infertility?

Infertility is typically defined as the inability to conceive after at least one year of regular, unprotected intercourse.

A screening evaluation of the male partner is recommended when a couple haven’t conceive after 12 months of regular, unprotected sex (or after just six months if the female partner is over 35 years old).

What is azoospermia?

Answered by Dr. Rachele Pandolfi & Carolina Andrés

Azoospermia is the complete absence of sperm in the ejaculate. Among infertile males, approximately 15% are affected by this condition.

Azoospermia can be divided into two categories:

• Obstructive azoospermia (OA): caused by a blockage in the duct system that prevents sperm from entering the semen. For example, mutations in the CFTR gene can lead to congenital bilateral absence of the vas deferens in males who are homozygous for these mutations.
• Non-obstructive azoospermia (NOA): results from primary, secondary, or incomplete testicular failure. Causes can include hormonal problems, certain genetic conditions, previous vasectomy or other surgeries, and some cancer treatments.

Among men with azoospermia, about 60% of cases are due to OA and 40% to NOA. Between the two, NOA is typically more challenging for conception, even with assisted reproductive technologies like IVF or intracytoplasmic sperm injection (ICSI), as it is often linked to failure of spermatogenesis (the process of sperm production).

Azoospermia can lead to sterility, meaning natural conception may not be possible. However, other paths to parenthood remain open, including the use of donor sperm.

Age, weight & other factors

Does age affect male infertility? What happens to sperm as men get older?

Answered by Dr. Laura Garcia

From their 60s onwards, men may experience a decline in both sperm quality and concentration. Advanced paternal age has also been linked to an increased likelihood of fathering children with autism.

What about male infertility and obesity?

Answered by Dr. Marta Zermiani

Obesity is strongly associated with male infertility, most likely due to hormonal changes caused by excess adipose tissue. Obese men show higher rates of azoospermia (absence of sperm) and oligospermia (low sperm count) compared with men who are at a healthy weight.

In addition, couples in which the male partner is overweight or obese and the female partner has a normal BMI tend to take longer to conceive than couples where the male partner is of a healthy weight.

Can alcohol consumption and smoking affect sperm count?

Answered by Dr. Rachele Pandolfi & Carolina Andrés

Extensive research has shown that smoking and alcohol intake can negatively impact male fertility, sperm parameters, and overall reproductive outcomes.

• Smoking: Several robust studies link tobacco use with male infertility and suboptimal sperm production. Heavy smoking, in particular, is associated with reduced sperm counts.
• Alcohol: Regular, heavy drinking and binge drinking (defined as five or more drinks for men within a two-hour period) have been shown to impair sperm health.

Alcohol affects fertility in men by:

• Lowering testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH), while raising estrogen levels – all of which reduce sperm production.
• Shrinking the testes, which may cause impotence or infertility.
• Altering gonadotropin release, which disrupts sperm production.
• Causing early ejaculation or decreased ejaculation.
• Increasing the number of morphologically abnormal sperm (changes in shape, size, and movement).

Can male infertility be reversed or treated?

The good news is that male infertility can sometimes be reversed. Research shows that healthy sperm production may return within three months after stopping alcohol consumption.

A review of observational studies on smoking and semen quality found that 20 out of 25 studies reported an increased risk of lower sperm concentration in smokers compared to non-smokers. On average, smokers had a 13% lower sperm concentration. They also had a lower proportion of motile sperm (those able to swim effectively) and morphologically normal sperm (those with the correct structure).

For men trying to conceive (or those wishing to protect sperm health for the future), avoiding alcohol, tobacco, and other drugs is strongly advised.

That said, some studies report no significant impact of smoking or alcohol on sperm parameters (such as semen volume, sperm count, motility, morphology, or pregnancy outcomes). As a result, there is still no conclusive agreement and no universally accepted guidelines.

Can certain foods increase male fertility?

Answered by Dr. Laura Garcia

Yes. Antioxidant-rich foods – such as vegetables, fruits, nuts, fish, and berries – can improve male fertility and increase the chances of conception.

What about male fertility supplements?

Answered by Dr. Laura Garcia

Supplements may also help. Good baseline options include antioxidants and vitamins such as zinc, selenium, vitamin D, CoQ10 and melatonin (which can improve sperm fragmentation). Turmeric may also help reduce double fragmentation in sperm.

Male factor treatment

What’s available?

Answered by Dr. Marta Zermiani

• Varicocele correction: Surgical correction is recommended for patients with a clinically detectable varicocele and abnormal semen analysis, as it can improve pregnancy rates.
• Obstructive azoospermia: Surgery is indicated in these cases.
• Hormonal treatment: In patients with hormonal alterations, treatment with gonadotropins may be prescribed.
• Cryopreservation: Freezing semen is advised for patients who wish to preserve fertility before undergoing chemotherapy, radiotherapy, or surgery that may impact reproductive function.

For many couples, assisted reproductive technologies are required:

• In vitro fertilization (IVF): Involves ovarian stimulation, egg retrieval, and fertilisation outside the body.
• Intracytoplasmic sperm injection (ICSI): A single sperm is injected directly into the egg to promote fertilisation.

In approximately 40-50% of patients with non-obstructive azoospermia, sperm can be retrieved using microTESE (Microsurgical Testicular Sperm Extraction).

Success rates

What are the success rates of male infertility treatments?

Answered by Dr. Rachele Pandolfi & Carolina Andrés

It’s important to note that treatment success rates are influenced by many factors, making it difficult to isolate the impact of the male factor alone.

For couples with male factor infertility, ICSI (sperm microinjection) is typically the treatment of choice, especially in cases of low sperm quality.

• Women under 37: If the female factor is minimal, around 60% of couples will have a baby within four ICSI cycles.
• Women over 37: Success rates decrease significantly, to around 20%.

A huge thank you to the knowledgeable fertility specialists at Clínica Tambre for answering all our readers’ questions.

Book a consultation with their team for further advice and support, specific to male factor.