When a couple is told they are struggling to conceive, the conversation almost always centres on the woman. Yet male factor infertility accounts for roughly 40 to 50 percent of all infertility cases. It is one of the most underdiagnosed and undertreated aspects of reproductive medicine — not because it is rare, but because it is rarely talked about. At Yellow IVF, we believe the fertility journey belongs to both partners equally, and understanding male infertility is not just medically important — it can unlock solutions that change everything.

Key Takeaways

• Male factor infertility is common: Nearly half of all infertility cases involve a male factor, either alone or alongside female-factor issues.
• A semen analysis is the essential starting point: Most male infertility is identified through a semen analysis that measures count, motility, and morphology.
• Azoospermia (no sperm in semen) is not the end: TESA and PESA procedures can retrieve sperm directly from the testis or epididymis for use in IVF-ICSI.
• IVF with ICSI is highly effective for male factor infertility: A single healthy sperm retrieved through surgical methods can fertilise an egg and lead to a healthy pregnancy.

What Causes Male Infertility?

Male infertility is typically divided into three categories based on where the problem originates: pre-testicular (hormonal), testicular (production), and post-testicular (delivery). Common causes include:

• Low sperm count (oligospermia): Fewer than 15 million sperm per millilitre of semen, which reduces the chances of one reaching and fertilising an egg.
• Poor sperm motility (asthenospermia): Sperm that cannot swim effectively and therefore cannot reach the egg.
• Abnormal sperm morphology (teratospermia): A high proportion of sperm with abnormal shape, which impairs their ability to penetrate an egg.
• Azoospermia: No sperm present in the ejaculate at all. This can be obstructive (a blockage preventing sperm from reaching the semen) or non-obstructive (the testes are not producing sperm).
• Varicocele: Enlarged veins in the scrotum that raise testicular temperature and reduce sperm quality.
• Hormonal imbalances: Low testosterone or high FSH can impair sperm production.
• Genetic conditions: Klinefelter syndrome and Y-chromosome microdeletions are important genetic causes.

Understanding which category applies to you determines which treatment path is appropriate. This is why a thorough evaluation — including semen analysis, hormone tests, and in some cases genetic testing — is always our first step.

What Is Azoospermia and Why Does It Matter?

Azoospermia — the complete absence of sperm in ejaculated semen — affects approximately 1 percent of all men and up to 15 percent of infertile men. It is the diagnosis that, understandably, causes the most distress. However, what many couples do not realise is that azoospermia does not necessarily mean no sperm exists. In many cases, sperm are being produced in the testes but are simply unable to reach the semen — or are being produced in small quantities that can still be retrieved surgically.

This is where TESA and PESA become transformative procedures.

What Is PESA? (Percutaneous Epididymal Sperm Aspiration)

PESA is recommended for men with obstructive azoospermia — where sperm is being produced normally but cannot reach the ejaculate due to a blockage. Common causes include a previous vasectomy, congenital absence of the vas deferens (CBAVD), or infection-related scarring.

In a PESA procedure, a fine needle is passed directly into the epididymis (the coiled tube behind the testis where sperm mature and are stored). Sperm-containing fluid is aspirated, and our embryology team separates and selects viable sperm for use in IVF-ICSI. The procedure takes approximately 15 to 20 minutes under local anaesthesia and is minimally invasive.

Who Is PESA Suitable For?

• Men who have had a vasectomy and reversal is not desired or has failed
• Men with congenital bilateral absence of the vas deferens (CBAVD), often associated with cystic fibrosis gene mutations
• Men with epididymal obstruction from previous infection or surgery

What Is TESA? (Testicular Sperm Aspiration)

TESA is used when sperm cannot be found in the epididymis, or when the cause of azoospermia is non-obstructive — meaning the testes are producing few or no sperm due to a production problem rather than a blockage. In this procedure, a needle is inserted directly into the testicular tissue and sperm are aspirated from within the testis itself.

Because sperm production in non-obstructive azoospermia is patchy, success depends on where the needle samples are taken. If TESA does not yield enough viable sperm, a more detailed procedure called Micro-TESE (microscopic testicular sperm extraction) may be recommended. Micro-TESE involves a more thorough surgical exploration under an operating microscope to locate areas of active sperm production within the testis.

“We were told our only option was donor sperm. Our AMH was fine, her tubes were clear — the issue was my azoospermia. Yellow IVF recommended Micro-TESE. They found sperm. Three months later, my wife had a positive beta HCG.” — Vikram, 38, Gurgaon.

How Are TESA / PESA Used with IVF?

Sperm retrieved through TESA or PESA are almost always used in combination with ICSI (Intracytoplasmic Sperm Injection). In standard IVF, thousands of sperm are placed around an egg and fertilisation occurs naturally. In ICSI, a single sperm is selected under high magnification and injected directly into the egg. This makes ICSI ideal when sperm numbers are very low, motility is poor, or the sperm have been retrieved surgically.

Emotional Aspects of Male Infertility

It would be incomplete to discuss male infertility without acknowledging the emotional dimension. Men are less likely to discuss fertility struggles, and a diagnosis of azoospermia or severe male factor infertility can be profoundly isolating. At Yellow IVF, we work with both partners throughout the process. A fertility diagnosis is a couple’s challenge — and the treatment path, the decisions, and the emotional support belong to both of you.

We also strongly encourage early male evaluation. If a couple has been trying to conceive for over a year without success, a semen analysis should happen at the same time as female investigations — not as an afterthought. Early diagnosis of male factor issues dramatically expands the treatment options available.

Conclusion: Male Infertility Is Treatable — Often More Than You Think

If you or your partner have received a difficult semen analysis result — or a diagnosis of azoospermia — please know that modern reproductive medicine offers real, effective solutions. TESA, PESA, Micro-TESE, and ICSI have collectively helped thousands of men who were told they could never father a biological child do exactly that.

At Yellow IVF, our urology and embryology teams work together to evaluate each case thoroughly and find the most appropriate path — whether that is sperm retrieval, hormonal treatment, or, where appropriate, a compassionate conversation about donor sperm options.

Don’t let uncertainty stop you from exploring what is possible.
Book a consultation with our male infertility specialists today — both partners are welcome.