Male factor infertility
Male factor infertility treatment in Ireland
Medically reviewed by Dr. Phil Boyle, MICGP, MRCGP · Last reviewed July 2026
Male factor contributes to impaired fertility in approximately 40% of couples. At NeoFertility, we investigate and treat both partners from the first appointment. Male factor is a shared issue, and NeoFertility treats it that way.
Why both partners are investigated from day one
Male factor infertility accounts for roughly 40% of cases where conception is not happening.
That is the technical term for reduced sperm quality or quantity contributing to a couple's difficulty conceiving. In another significant proportion of couples, both partners have a contributing factor. So from the first day a couple comes to see us, we investigate both.
A standard semen analysis covers count, motility, and morphology against WHO 2021 reference ranges. Those thresholds represent the fifth percentile of men whose partners conceived within 12 cycles. Bear in mind: the threshold is not the average.
A result at the lower end of the normal range is not necessarily optimal. A result below threshold does not rule out conception. What it tells us is that the couple is at greater risk of infertility or delayed conception and it warrants more investigation.
Semen collection: why the method matters
The collection method matters more than most couples are told.
The sample is collected via a non-spermicidal, perforated latex-free condom during normal intercourse, with three days of abstinence before collection. This gives a more accurate picture of the sperm that actually reach the egg.
If a first result is sub-optimal, a repeat test is done after 10 to 12 weeks. A single sample can be affected by recent illness, stress, or heavy alcohol intake. One result does not define the situation.
What a male fertility workup covers
So what we do is we look at the whole picture, not just one test.
We look at the semen analysis, we look at the DNA fragmentation index, we look for evidence of chronic low-grade infection, and we look at whether a varicocele is present. Each of those opens up a different treatment pathway.
Chronic low-grade infection
Chronic low-grade infections often cause no symptoms and are not picked up by routine screening, so they may go undetected.
Chlamydia and Mycoplasma both have published evidence for elevated DNA fragmentation. Gallegos et al. (Fertil Steril, 2008) found substantially higher fragmentation in men with Chlamydia trachomatis and Mycoplasma co-infection compared to fertile controls. Ureaplasma may also play a role.
When an infection is found and treated, sperm parameters often improve at the next assessment.
Varicocele
A varicocele is a collection of enlarged veins around the testicle. It raises scrotal temperature and increases oxidative stress on sperm-producing tissue. Where clinical assessment suggests one may be present, a scrotal ultrasound is arranged.
Where a varicocele is confirmed and contributing to poor parameters, we recommend surgical varicocelectomy. This is the recommended treatment in current Urology guidelines. Embolization is a less invasive option for patients who prefer it.
Lifestyle and supplementation
NeoFertility recommends no smoking, alcohol no more than 10 units per week, and caffeine limited to one drink per day. Balanced exercise, loose cotton underwear, weight reduction where relevant, and at least 7 hours of sleep are also advised.
These directly reduce oxidative stress on sperm-producing tissue.
For supplementation, the protocol is tailored to each man's specific results. Bear in mind, excessive supplementation can itself damage sperm quality. The approach is deliberate and targeted rather than a standard stack.
Targeted medical treatment and anti-sperm antibodies
Where hormonal factors are contributing, tamoxifen is part of our toolkit. Maca, a Peruvian herb, is also used where the clinical picture supports it.
Anti-sperm antibodies are another finding we investigate. In our clinical experience, even couples with 100% anti-sperm antibodies can still achieve natural conception with treatment.
How sperm parameters improve with treatment
In our clinical experience, many men see measurable improvement in sperm parameters or DNA fragmentation with targeted treatment.
A 2025 multicentre study in Andrology (Grande G et al.) documented outcomes of a restorative approach to male factor infertility aimed at restoring natural conception. 233 couples had isolated male factor infertility. Out of 209 suitable patients, 32% (68/209) achieved a spontaneous pregnancy with treatment. The most common treatable factors were infection, inflammation and hypospermatogenesis. Semen parameters significantly improved when a clear diagnosis was established and appropriate treatment was provided.
In round figures, 10% of men with male factor infertility have untreatable conditions. This can only be confirmed after a complete evaluation of the male and cannot be assumed simply from a semen analysis alone. Of those amenable to treatment 1 in 3 will be successful. Complete assessment includes blood tests for FSH, LH, Testosterone, Thyroid function, Liver and Kidney function and genetic testing. Sperm culture is advised to check for bacterial or HPV infection. Ultrasound imaging using specialised scrotal and transrectal scans can identify inflammation. Finally, fine needle aspiration of the testes can confirm if the testes are amenable to medical treatment.
Currently, comprehensive male assessment and treatment is not available in Ireland and NeoFertility can refer men to Padua, Italy, if needed.
Treatment is a process over time. The couple comes in together, we investigate together, and we adjust the plan as results come in. This is multi-factorial medicine applied to both people in the partnership.
A couple's fertility is a shared picture. Clinical principle
Both partners, one treatment plan
NeoFertility does not treat female fertility on one side and male fertility on another.
Where the male partner has a significant finding, it changes the entire treatment plan. It changes how we support the female cycle, when we time intercourse, and what we look for in the hormonal picture.
A single round of IVF in Ireland typically costs EUR 5,000 to EUR 8,000 per cycle.
For couples with male factor, ICSI, that is intracytoplasmic sperm injection, adds further cost. And it bypasses the underlying cause rather than addressing it. NeoFertility's full treatment programme is a fraction of that cost, and it aims for natural conception.
Getting started
Your first appointment is a 45-minute consultation with Dr. Boyle or Dr. Toth.
No GP referral is needed, and we ask that both partners attend from day one. You do not need to have been trying for any set period of time before coming.
We can identify at-risk cycles even before you try to conceive. The sooner we have a full picture of both partners, the clearer the treatment path.
See how our full treatment plan works, read our unexplained infertility page if male factor may be sitting behind that diagnosis, or learn how we investigate men's fertility.
Frequently asked questions
Does a normal semen analysis mean there is no male factor?
Not necessarily. A standard semen analysis measures sperm count, motility, and morphology. It does not measure inflammation, infection or sperm DNA fragmentation, which is damage to the genetic material inside the sperm cell.
High DNA fragmentation can impair fertilisation and early embryo development. It can also cause early pregnancy losses that register simply as 'not getting pregnant.' A normal semen analysis can co-exist with significant DNA fragmentation.
We include fragmentation testing as part of our standard male evaluation.
What is the DNA Fragmentation Index?
The DNA Fragmentation Index, or DFI, measures the percentage of sperm in a sample with damaged DNA. Reference ranges vary by assay, but in our clinical experience, the threshold for concern is around 15%.
Above that level, fragmentation begins to predict a lower live-birth rate and a higher miscarriage risk. We use SCSA testing for this analysis.
The good news is that sperm production renews roughly every 10 to 12 weeks. That means a high DFI result today is a starting point, not a fixed outcome.
Can male factor be treated without IVF or ICSI?
In many cases, yes. In our clinical experience, the majority of men see measurable improvement in semen parameters or DNA fragmentation with targeted treatment.
For men with low sperm counts, we have seen a consistent response to hormonal treatment with clomiphene citrate, especially if we have identified and treated for infection or inflammation. Other approaches include treating a varicocele with surgery or embolization, specific supplements, and lifestyle changes.
Our approach is to find the underlying cause and correct it where possible. A restorative approach aims for natural conception rather than bypassing the problem with assisted reproduction.
What does the semen collection method have to do with accuracy?
It matters more than most couples are told. Standard masturbatory collection can give a result that differs significantly from what happens during normal intercourse. We collect via a non-spermicidal, perforated latex-free condom during normal intercourse, with three days of abstinence before the sample.
Research and clinical experience support this as giving a more accurate picture of the sperm that actually reach the egg.
If a result looks sub-optimal, we repeat it after 10 to 12 weeks. A single sample can be affected by illness, stress, or heavy alcohol intake.
My partner has been told she has an issue. Does the male partner still need investigation?
In virtually every case, yes. We evaluate both partners from the outset, without exception. Male factor is found in roughly 40% of couples with impaired fertility, and in many couples both partners have a contributing cause.
Looking only at the female partner and attributing everything to her test results is not a complete picture.
Of equal importance to us is what is happening for the male partner, because that changes the treatment plan for both.
