Is it Possible to Father Children with Male Sub-Fertility?

Around 15% of couples are infertile or are experiencing some form of difficulty conceiving a child, despite frequent and unprotected sexual intercourse across an extended period of time. There are many causes and influences in this area, including male sub-fertility. What does this mean?

The term ‘male sub-fertility’ is used, generally speaking, to describe any form of reduced male fertility with prolonged periods of unwanted non-conception. In almost a half of all cases of couples experiencing infertility issues, male sub-fertility is a factor, yet the causes were historically unknown or difficult to pinpoint.

Situations like this are often stressful, causing strains and frustration between partners and an overall feeling of depression. Nevertheless, with modern medical advancements and technology, a number of causes of male infertility can now be identified and, in many cases, treated successfully. Couples stand a better chance of conceiving through methods identified by doctors and medical professionals – and it all starts with a simple test.

Initial Tests: Sperm Production

If you are an ‘infertile’ male it does not necessarily mean you cannot, or you are unable to, produce sperm. And vice versa, if you have abnormal sperm, this does not directly correlate with you being infertile.

If you are having difficulties conceiving a child naturally across a period of 1-2 years, a medical professional may take a semen sample from you to perform a sperm test. If sperm is present but showing abnormalities this proves there are some health issues affecting the quality and quantity levels of the sperm in your semen; but it does not prove you are infertile. This will need to be investigated further, so medical professionals can treat the underlying health cause (if and when possible).

If, after treatment, the quality of sperm does not improve it will be difficult (as it has been up until this point) for the couple in question to conceive naturally – but not impossible.

What are the Options?

Most couples at this point will have two options:

  1. Carry on Trying – Couples can continue trying to conceive naturally while the man receives treatment.
  2. Assisted Reproduction – The suitability of this will depend on the man’s underlying condition. Further investigation into the cause should be undertaken first and treated if possible. If sperm can be extracted from the man, impregnation may take place.

Assisted Reproduction: Sperm Retrieval

There are a number of ways that assisted reproduction can be achieved. The most suitable and effective solution will depend on each individual patient. Impregnation is often achieved through sperm retrieval using intracytoplasmic sperm injection (ICSI).

ICSI is quite literally taking sperm and injecting them directly into an egg to enable fertilisation, the fertilised egg can then develop in the women as with other pregnancies. Fresh sperm is often used for the procedure, although excess sperm can also be frozen and used again later if needed.

Sperm retrieval methods include:


Excess sperm is stored in the epididymis, which is a duct found just behind the testicles. Retrieving fresh sperm from this duct is the least complicated and most common method of sperm retrieval. This procedure is known as a percutaneous sperm aspiration and it will often provide a good quantity of sperm to work with. If this method is not possible, then there are still other options that can be attempted. The PESA procedure is fairly straightforward and is usually carried out under a local anaesthetic.


TESA (testicular sperm aspiration) involves removing sperm directly from the testicles and is usually only carried out when percutaneous sperm aspiration is not possible. The procedure involves extracting sperm from the tubules using a needle that is inserted through the scrotal sac. The TESA procedure is a fairly straightforward procedure and is usually carried out under a local anaesthetic.


Micro epididymal sperm aspiration is very similar to percutaneous sperm aspiration as it involves taking sperm directly from the epididymis. In this case, though, the epididymis is exposed to make it clearly visible for the procedure to be performed. The MESA procedure is usually carried out under a local anaesthetic.


TESE, or micro-dissection sperm retrieval, involves opening the testicles and operating to remove tubules that contain sperm. This procedure is not as straightforward as some of the other options and is usually carried out under a general anaesthetic.

Every Case and Each Patient is Different

The key thing to remember here is, although there are many similarities across the board, most cases of male sub-fertility differ from one another. They affect each patient differently, have altering ramifications and may be treated with alternative methods depending on the issues being experienced. If you are finding it extremely difficult to conceive naturally, do not fret, there is still a very good chance that you will be able to achieve your goal. You just need to identify what the problem is so that a medical professional can apply the right treatment. Every case can be very different from others, though, and procedures are not always as straightforward as we would like them to be. This means that you might have to wait for some time, so it is important to remain patient. The wait and any inconvenience caused will be well worth it should you achieve your goal!

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