Barren marriage: the male factor

Health Tips

I always advise starting the study of “barren marriage” with a man: it is easier, faster and immediately allows you to work out the right tactics for further actions. A man needs to do a spermogram. And that’s all. If the sperm is of good quality in all respects, then the man is fertile. And, if the man is doing well, then the woman needs to go to the gynecologist and start the examination.

What is “sperm quality”

Positive spermogram results are approximately 25-30 million spermatozoa per milliliter of semen. If their number is slightly lower than optimal, then it can be treated and the effectiveness of therapy can be observed within six months. If we see a positive trend, then we can plan a natural pregnancy. And this often leads to good results.

If the sperm concentration is low (5-10 million per milliliter or even less), then, regardless of the health of the woman, the couple needs to prepare for assisted reproductive technologies (ART). In this case, an additional examination is carried out. It is necessary to exclude genetic pathology and gross hormonal disorders. All this needs to be adjusted before IVF.

It must be understood that IVF is not a panacea, it does not give one hundred percent probability that the desired pregnancy will occur. The cell needs to be healthy. Let there be few spermatozoa, but they must be ideal so that the embryologist can choose a good cell for fertilization.

Causes of male infertility

They can be conditionally divided into four groups: external, internal, genetic, immunological.

The main external factor – this is an unhealthy lifestyle (smoking, alcohol, unhealthy diet, inactivity, etc.).

To internal factors include organ dysfunction. For example, diabetes, hormonal imbalance.

Genetic factors may be acquired or congenital. Acquired is a violation of the DNA structure of spermatozoa due to the large number of free radicals in the body. This may be due, for example, to work in hazardous industries. Congenital – a violation of the structure or number of chromosomes responsible for reproductive function (Klinefelter’s syndrome, Down’s syndrome).

Immunological factor – when, after an illness (for example, gonorrhea), antibodies appear that negatively affect spermatozoa.


In any case, you should not immediately resort to IVF. If a fruitless marriage lasts a year or more, you need to start an examination, identify the cause and resort to conservative treatment. It makes sense to be treated conservatively when an andrologist (namely an andrologist, not just a urologist!), having deciphered the spermogram, having looked at the sex hormones, understands that it is possible to improve sperm quality within three months.

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Sometimes it is enough to make insemination – the introduction of specially processed sperm into the uterine cavity at the time of ovulation. If these procedures fail, you can resort to in vitro fertilization.

It is necessary to switch to ART programs immediately in cases where there are genetic abnormalities, a gross hormonal pathology, or when a reduced sperm concentration is pronounced. In the presence of male infertility factors, the conclusion on the inclusion of an infertile couple in the IVF program is drawn up not by a reproductive specialist, but by an andrologist.

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