Male Infertility: Sperm Testing, ICSI & What Every Couple Should Know

Dr. Sherman Silber challenges the long-standing tendency to treat infertility primarily as a women’s issue. He explains that male-factor infertility contributes to a substantial share of cases and argues that semen analysis should often be one of the first tests performed because it is simple, fast, and highly informative.

Dr. Silber discusses sperm count, motility, morphology, age, genetics, and environmental influences. Unlike women, who are born with a finite number of eggs, men continually produce new sperm from spermatogenic stem cells. He says male fertility therefore generally changes far less dramatically with age, although genetics and certain medical or lifestyle factors can significantly affect sperm production.

One major concern is testosterone and anabolic-steroid use. Dr. Silber explains that externally supplied testosterone can suppress the pituitary hormones responsible for sperm production, sometimes reducing the sperm count to zero. He also discusses obesity, infrequent ejaculation, supplements with hormonal activity, and misconceptions about tight underwear, hot tubs, and other commonly blamed factors.

The conversation then turns to severe male infertility. Dr. Silber describes how intracytoplasmic sperm injection (ICSI) transformed treatment by allowing embryologists to inject a single sperm directly into an egg. Even when no sperm appears in the ejaculate, he explains that sperm can often still be retrieved from the testes and used for IVF.

Genetic testing may also reveal causes of extremely low or absent sperm production, including Y-chromosome deletions and chromosomal conditions such as Klinefelter syndrome. Dr. Silber emphasizes that a low sperm count does not automatically mean natural conception is impossible; rather, it may increase the time required to achieve pregnancy.

The broader message is that infertility belongs to the couple, not one partner. Evaluating male fertility early can prevent unnecessary testing, reduce blame, identify treatable problems, and help couples understand the reproductive options still available to them.