Subfertility

• Genetic defects
  
• Scrotal/testicular conditions: Varicocele (engorged veins within the scrotum affecting quality of sperm), previous undescended testis or testicular torsion (twisting of the testis, which affects blood flow and causing damage)
• Hormonal imbalances such as low testosterone levels, which can contribute to impairments in sperm production
• Drugs like anabolic steroids, certain antibiotics, or marijuana, as well as some medical treatments for cancer, like radiotherapy or chemotherapy can also affect sperm production

Lifestyle modifications: Alterations to lifestyle and/or environmental exposures can have a positive effect on sperm parameters, including -

• Physical exercise: Regular moderate-to-high intensity exercise is recommended, as it has not only been shown to result in better sperm parameters, but improves a man’s hormonal profile as well. It also has an added benefit of decreasing the risk of several long-term chronic diseases.
• Weight loss: Weight loss, especially for obese individuals, can have a positive effect on both sperm parameters and testosterone levels.
• Smoking cessation
  
• Moderate alcohol consumption: Heavy long-term alcohol consumption negative affects hormone levels, and should be moderated.

• Antioxidants: There might be some improvements with sperm parameters with use of antioxidants like Vitamin C and E and coenzyme Q10, and can be taken.
• Hormone medications: These medications are generally prescribed if the hormone evaluation is abnormal; they aim to modulate hormone levels which then improves testicular function and induces sperm production.

• Sperm retrieval: These are techniques to obtain sperm directly from the testis or epididymis when sperms are absent in the semen. This is done via a surgical procedure, and a biopsy of the testis is usually also performed at the same time.
• Varicocelectomy: For patients with varicocele, the blood present within the engorged veins increases the temperature of the scrotum, which compromises sperm production and fertility. A varicocelectomy might be performed, where the engorged veins are cut through a small incision in the scrotum.

• Intrauterine insemination: Involves introduction of sperms directly into the womb of the female at the time of ovulation.
• In-vitro fertilisation (IVF): Involves retrieval of eggs from the female, which are then inseminated with sperms obtained from the male. The fertilised embryos are then implanted into the uterus.