Male factor infertility accounts for 40–50% of all infertility cases (WHO, 2021). Most cases are treatable — even azoospermia (zero sperm in ejaculate) can be treated with surgical sperm retrieval (TESE/PESA) in 50–60% of men. TESE + ICSI costs $3,000–$6,000 abroad versus $10,000–$20,000 in the US. Turkey, Czech Republic, and Spain are leading destinations.
Medically reviewed by Dr. Murat Ustun, M.D., Founder & Medical Director, Flytocure Healthcare.
Male infertility is the inability to achieve pregnancy due to abnormalities in sperm production, function, or delivery. Diagnosis requires semen analysis: normal parameters are count ≥16 million/mL, motility ≥42% (total) / ≥30% progressively motile, and morphology ≥4% normal forms (Kruger criteria). Azoospermia (no sperm in ejaculate) affects 1% of all men and 10–15% of infertile men. Causes: obstructive (epididymal blockage, vasectomy) or non-obstructive (hormonal, genetic, chemotherapy-related).
| Category | Criteria | Recommended Treatment |
|---|---|---|
| Mild male factor | Count >5M/mL; motility >20%; morphology >2% | IUI (3 cycles); if unsuccessful — IVF with ICSI |
| Moderate male factor | Count 1–5M/mL; poor motility; poor morphology | IVF with ICSI (standard first-line) |
| Severe male factor | Count <1M/mL (cryptozoospermia) | IVF with ICSI; sperm banking before further decline |
| Obstructive azoospermia | No sperm in ejaculate; obstruction (vasectomy, epididymal blockage) | PESA/TESE surgical sperm retrieval + IVF with ICSI; or vasectomy reversal |
| Non-obstructive azoospermia (NOA) | No sperm; testicular failure or hormonal cause | Micro-TESE (50–60% sperm retrieval success) + IVF with ICSI |
| Hormonal (hypogonadotropic hypogonadism) | Low FSH/LH; treatable | Gonadotropin therapy for 3–6 months; may restore natural fertility |
Yes, in many cases. Obstructive azoospermia (caused by vasectomy, epididymal blockage, or absent vas deferens): PESA/TESE surgical sperm retrieval succeeds in 90–95% of cases. Non-obstructive azoospermia (testicular failure, genetic, chemotherapy): micro-TESE retrieves sperm in 50–60% of men. Retrieved sperm is used with ICSI for IVF. When no sperm is retrieved, sperm donation is the alternative.
Standard male pre-IVF testing: full semen analysis (count, motility, morphology, volume, pH); semen culture (infection screen); FSH, LH, testosterone, prolactin; karyotype (chromosomal analysis) if severe factor; Y-chromosome microdeletion test if severe oligospermia/azoospermia; sperm DNA fragmentation index (DFI) — elevated DFI (>25%) reduces IVF success and may indicate need for TESE. Most tests can be done at your local andrology lab and results sent to the overseas clinic.
TESE is performed under local anaesthesia or sedation. The procedure takes 15–30 minutes. Post-procedure: mild scrotal discomfort for 3–5 days manageable with paracetamol. Micro-TESE (for non-obstructive azoospermia) takes longer (1–2 hours) under general anaesthesia and requires 5–7 days of recovery. Patients can fly home 3–5 days after PESA and 7–10 days after micro-TESE.
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