Male infertility is a common cause of infertility among couples and contributes to nearly 40–50% of infertility cases worldwide. Accurate diagnosis and appropriate treatment play a crucial role in achieving natural pregnancy or improving the success of assisted reproductive technologies. This article reviews the main methods for diagnosis and treatment of male infertility based on the recommendations of the World Health Organization (WHO).
Semen Analysis
The cornerstone of diagnosing male infertility is semen analysis. This test evaluates key parameters such as sperm concentration, motility, morphology, and semen volume.
WHO Recommendations for Repeating Semen Analysis
🔹 The latest WHO Laboratory Manual for the Examination and Processing of Human Semen provides standardized reference values and detailed protocols for semen collection and analysis, ensuring accurate diagnosis of male infertility.
When Is Unexplained Infertility Diagnosed?
WHO suggests diagnosing unexplained-factor infertility in a couple when all of the following conditions are met:
In these cases, no obvious cause of male infertility or female infertility can be identified despite thorough evaluation.
Use of Antioxidant Supplements
For men with male infertility who have one or more abnormal semen parameters and are attempting conception—either naturally or through assisted reproductive technologies (ART)—the WHO Guideline Development Group does not make a recommendation for or against the use of antioxidant supplements.
🔹 While adequate nutrition during the preconception period is important for both partners, the specific benefits of antioxidant supplementation in men with defined male infertility pathologies remain uncertain.
Indications for Varicocele Treatment
For men with:
WHO suggests that surgical or radiological treatment of varicocele should be preferred over expectant (no-treatment) management.
🔹 Men with clinical varicocele and abnormal semen analysis are more likely to benefit from treatment compared to those with normal semen parameters. These recommendations apply to men who are not undergoing ART.
Choice of Varicocele Treatment Method
WHO recommends either:
The choice of treatment should consider:
Surgical Management of Varicocele
For men undergoing surgical treatment of varicocele, WHO suggests the use of microsurgical techniques rather than non-microsurgical approaches.
🔹 Microsurgical subinguinal varicocelectomy is the most commonly recommended technique due to lower complication and recurrence rates.
If microsurgical expertise is unavailable, alternative methods may be used, including:
These recommendations apply to infertile men with varicocele who are not using ART.
Expectant Management
For couples diagnosed with unexplained infertility, WHO suggests expectant management over unstimulated intrauterine insemination (IUI).
Expectant management includes:
⏱ In most studies, the duration of expectant management ranged from 3 to 6 months.
The diagnosis and treatment of male infertility require a systematic and evidence-based approach. Semen analysis remains the primary diagnostic tool, while treatment strategies should be tailored to the underlying cause. Following WHO guidelines helps optimize outcomes and improves the chances of successful conception.
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