The male factor in fertility

There are many reasons why men may have trouble conceiving, so we decided to write out what they are and explain them to you.

Low sperm count 

This is the most common reason for infertility in men. The majority of calls we get at TCM Healthcare when it comes to male fertility is to arrange a sperm test. But while sperm count is clearly important, sperm quality can also significantly impact fertility. This is why a comprehensive semen analysis should be carried out, which will test not only sperm count, but also sperm motility (movement), vitality (survival rate), and morphology (shape).

The way to read a sperm test is that all major parameters (as listed above) should meet the minimum requirements the World Health Organisation (WHO) stipulates. According to the WHO, if all these minimum requirements are met, a man is likely to get his partner pregnant within a year, assuming there are no issues on the female side.

It is worth noting, though, that our decades of clinical experience tells us that one’s sperm count does not need to meet the minimum requirement for a man to be able to father a child within a year: We have seen many men who have low sperm count, practically borderline, but managed to successfully get their partners pregnant.  

Low sperm quality

As said above, a comprehensive semen analysis will test major quality parameters: motility, vitality and morphology.

  • Motility refers to the movement of sperm — the more sperm that can move progressively (moving forward), the better
  • Vitality refers to the survival of sperm after ejaculation — the more sperm that can survive, the better
  • Morphology refers to the shape of the sperm — the more sperm with a normal shape, the better, as they are most likely to fertilise an egg. When a sperm with poor morphology successfully fertilises an egg and results in a child born, this does not necessarily mean a disabled child will be born. Poor morphology does not imply there is a genetic disorder or deformity. It is only a statement about the shape of the sperm.

Just like with sperm count, our clinical experience shows that borderline sperm quality is usually fine for male fertility, as long as there is nothing wrong on the female side.


Azoospermia is a serious condition that is diagnosed when no sperm is found in a comprehensive semen analysis. There are two broad types: obstructive and non-obstructive.

  • Obstructive azoospermia means that there is a blockage somewhere in a man’s reproductive system that is blocking the sperm coming out. This means that sperm is produced by the body, but it remains inside the body after ejaculation, so they simply cannot be found in a semen analysis.
  • Unobstructive azoospermia means that sperm production is not happening or is severely disrupted. As a result, no sperm is produced at all.

Potential causes of low sperm count, low sperm quality and non-obstructive azoospermia

Some of the conditions we describe below run from more common to the rarer cases. While they can affect your sperm count and quality, it does not mean that you are unable conceive, but we would have to run male hormone tests first to see if anything can be done.

Testicular failure

Testicular failure is the most common reason for azoospermia. Normally, the pituitary gland in the brain is in constant communication with the testicles. However, there is occasionally a communication breakdown between the brain and the testicles and this can disrupt, or completely stop sperm production.

This communication breakdown is reflected in hormonal changes, where follicle-stimulating hormone (FSH) and luteinising hormone (LH) levels are elevated. A simple male hormone test will find out if testicular failure is the issue.

Mumps-related orchitis

Up to 1 in 3 males who get mumps after puberty can get orchitis, which is pain and swelling in the testicles. Just under half of all those notice some shrinkage of their testicles, and an estimated 1 in 10 men experience a drop in their sperm count (the amount of healthy sperm their body can produce). It is commonly assumed that the shrinkage will not result in a complete failure for the man to produce sperm. However, we have come across a few cases where azoospermia patients told us that they have a history of mumps-related orchitis.

Chemotherapy, hormone therapy and radiotherapy

In extreme cases, these treatments can induce azoospermia.

  • Chemotherapy (especially with drugs called alkylating agents) can damage sperm and sperm-forming cells (germ cells) in young boys
  • Hormone therapy (also referred to as endocrine therapy) can decrease the production of sperm
  • Radiotherapy to the reproductive organs, as well as radiation therapy near the abdomen, pelvis or spine may lower sperm counts and testosterone levels, causing infertility. It may also destroy sperm cells and the stem cells that make sperm. Radiation therapy to the brain can harm the pituitary gland and decrease the production of testosterone and sperm. 

Genetic disorder —Klinefelter syndrome

Klinefelter syndrome is a genetic disorder in which a male has one extra copy of the X chromosome. Most male have 23 pairs of chromosomes, making a total of 46 chromosomes (22 pairs with an X and a Y). A male with Klinefelter syndrome has 47 chromosomes (the 22 pairs, but with two Xs and a Y). Male patients with Klinefelter syndrome are likely to have low sex drive, small firm testicles, erection problems and an inability to produce sperm.

Erectile dysfunction

Erectile dysfunction (ED) is clearly a problem for fertility. Many patients, including ours, have tried western medicine such as Viagra or Cialis, but they do not like the side effects and they want to know whether we can help.

ED has multiple causes, these include: high blood pressure, cardiac disease, diabetes, prostrate disorder. A hormone test may help us to isolate some of the potential causes for which we may be able to treat with our natural remedies.

Premature ejaculation

While this may cause frustration both on the part of male and female, premature ejaculation is not necessarily a problem for conceiving, for the simple reason that sperm is ejaculated into the vagina, so an egg can still be fertilised. Some patients still come to us for premature ejaculation treatment, but, strictly speaking, this is not for fertility reasons.

Delayed ejaculation

Delayed ejaculation occurs when a man needs more than 30 minutes of sexual stimulation to reach orgasm and ejaculate. The causes for delayed ejaculation include anxiety, depression, brain disorder, and reactions to medications. 

In extreme cases, delayed ejaculation means the man cannot ejaculate during sexual intercourse, posing a significant problem for fertility. 

Sperm DNA fragmentation

Another cause of infertility can be high sperm DNA fragmentation, which is when there is damage in the sperm’s genetic material. Because of this, it can either make natural pregnancy more difficult or miscarriages more likely to happen. When causes for infertility cannot be found on the female side, a comprehensive sperm test and sperm DNA fragmentation test may be a good idea. It is a condition that can’t be found with standard sperm tests, which is why we offer a separate DNA fragmentation test.

At TCM Healthcare, we offer tests for most of the above male fertility conditions. We have also treated all of these conditions successfully with a good track record — except for Klinefelter syndrome, which we don’t treat.

To book male fertility tests, click here.

Check our testimonials and Google reviews to see what our past patients have had to say.

Book an appointment!

A booking fee of £100 (refunded when you attend) will be processed at booking. 

Late cancellation fee £50
We appreciate that you might not be well or have urgent matters to attend. As a result you may have to postpone the appointment. We would like to have at least 24 hours’ advance notice. A late cancellation fee of £50 is payable if advance notice is not given.

Are there patients we cannot help?

Yes. No medical system is foolproof and medical practitioners, however good, are not omnipotent. As great as our success rates are, they are not 100%. There are times patients do not respond to our treatments despite our best efforts.

Delayed improvements are possible when patients rest a little. However, even with rest, patients may still not respond well. Fortunately, these cases are in the minority. We minimise the number of these cases by trying to understand our patients’ conditions as much as possible before taking them on. We minimise time and financial commitments from patients by insisting they have hormone or sperm test results prior to treatment, and to get retested after 3 months — following our evidence-based approach.

At TCM Healthcare, we will always have your best interests in mind and we will do our best.