Written by Dr. Tímea Buzder, laboratory director, clinical embryologist
Having a child is a natural wish in many couples’ lives, yet it may happen that the long-awaited blessing of a child does not arrive. If pregnancy does not occur after one year of regular, unprotected intercourse, it is advisable to consult a specialist. In such cases, parallel evaluation of both partners is recommended – in men this is performed by an andrologist.
Male infertility is not rare
In approximately half of infertility cases, a male factor is present. During the evaluation of male fertility, semen parameters – such as sperm count, motility, and morphology – and functional tests (e.g., DNA fragmentation) are assessed in order to determine which assisted reproductive technique is most appropriate.
Milder cases: Insemination
If semen parameters show only mild or moderate abnormalities, intrauterine insemination (IUI) may be the first step. This is a relatively simple procedure in which, after mild ovarian stimulation, the gynecologist or fertility specialist places a purified sperm sample directly into the uterine cavity. This increases the chance that sperm reach the egg and fertilization occurs.
More complex cases: IVF and ICSI
If several insemination attempts fail or semen parameters show moderate or severe abnormalities, an IVF (in vitro fertilization) program is recommended. In this procedure, eggs are fertilized in laboratory conditions by embryologists.
Two main methods exist:
Conventional IVF, a more natural process, where the concentrated sperm sample is placed onto the eggs and fertilization occurs spontaneously.
ICSI (intracytoplasmic sperm injection), in which a single sperm cell is injected directly into the egg using micromanipulation.
ICSI is especially recommended when male infertility is severe – for example, when very few or poor-quality sperm are present.
Sperm freezing – a safety reserve
If a small number of sperm are found during evaluation, the sample can be frozen and later used for fertilization, even years later. This is particularly important before cancer treatments that may damage fertility.
Surgical sperm retrieval – when no sperm are found in the semen
Sometimes there is no sperm present in the ejaculate. In such cases, sperm can be retrieved surgically from the testicle (TESE) or epididymis (MESA). The procedure is performed by an andrologist, and embryologists examine the sample after processing. If suitable sperm are found, they can be frozen for future use. Surgical sperm retrieval can also be performed synchronously, with the female partner’s hormonal preparation and egg retrieval occurring at the same time as the man’s surgery.
Donor sperm – when no other option exists
If the man’s own sperm is not suitable for fertilization – for example, if no viable sperm are present or repeated attempts fail to produce transferable embryos – donor sperm may be considered. In Hungary, sperm donation is strictly regulated, anonymous and used only when all other options are failed.
What if no sperm sample is available on the day of fertilization?
In rare cases, the male partner cannot provide a semen sample on the day of fertilization, or no viable sperm are found. Freezing the eggs may be considered, but this is time-sensitive: freezing must occur within 2–3 hours after egg retrieval. Since sperm retrieval from testicular biopsy may take 5–6 hours, egg freezing is unfortunately often not feasible in this scenario.
If you or your partner are affected by any of the above, do not hesitate to consult a specialist. Andrological evaluation and assisted reproductive techniques today help many couples achieve their dream of having a healthy baby.