By Cristina Mestre Ferrer BSc, MSc (embryologist).
Last Update: 12/31/2014

There are many problems that may cause male infertility, but mainly four different factors may be affected: pre-testicular or endocrine factor, testicular factor, post-testicular factor and spermatic factor, which is the one that refers to the quality of the spermatozoa.

The different sections of this article have been assembled into the following table of contents.

Indications of the treatment

A sperm analysis is needed to check the degree of infertility in men. Depending on the result of this test, the degree of infertility of the man will be determined, as well as the most recommended treatment. How long the infertility has last and the state of the couple must be taken into account. But focusing on the man there are:

Artificial insemination (AI)

It’s indicated for cases in which a mild pathology is suffered:

  • Total motile sperm count between 30-50 million.
  • Mild oligozoospermia with a motile sperm count after capacitation > 3 million.
  • Morphology of the spermatozoa with Kruger criteria > 4% with normal morphology.

In vitro fertilisation (IVF)

It’s indicated for cases of severe pathology, be it for problems with the quantity of spermatozoa, or sperm morphology or motility.

  • Severe oligozoospermia, less than 3 million spermatozoa per ml.
  • Mild teratozoospermia with less than 4% of normal spermatozoa.

Fertilisation of the egg with IVF


It’s recommended as a treatment for the most severe cases of male infertility:

  • Oligoteratozoospermia: with three million motile spermatozoa per millilitre and normal morphology between 1-4%.
  • Extremely severe oligozoospermia, with less than 3 million spermatozoa per millilitre.
  • Testicular biopsy.
  • Epididymal aspiration of spermatozoa.
  • Astenozoospermia: severe alterations in the motility of the spermatozoa.


It’s a procedure similar to ICSI but with a microscope magnification, which means that choosing the spermatozoa is easier. It’s indicated for cases of severe teratozoospermia and failures in previous ICSI.


It’s also named annexin V colums. It’s indicated for severe problems of male fertility, since it allows a better filtration of the spermatozoa, and with these spermatozoa without problems an ICSI would be carried out. It’s indicated for men with a high degree of spermatic fragmentation or previous repeated failures with ICSI.


It’s also known as physiological ICSI. The same procedure as in a conventional ICSI is carried out. The difference lies in the fact that, before performing the micro-injection, a special selection of the spermatozoa is carried out. The spermatozoa are set in a special dish that contains areas with a high content of hyaluronan. The spermatozoa that adhere to these areas are the ones used for the microinjection. With this technique is assured that these spermatozoa are able to recognize the molecule that covers the oocyte and fuse with it.

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Authors and contributors

 Cristina Mestre Ferrer
BSc, MSc
Bachelor's Degree in Biological Sciences, Genetics & Human Reproduction from the University of Valencia (UV). Master's Degree in Biotechnology of Human Assisted Reproduction from the UV and the Valencian Infertility Institute (IVI). Embryologist at IVI Barcelona. More information
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    1. Vishal

      I am married for 4 yrs now and we are planning a child for an year now… But unfortunately the things didn’t go in favour. So both me and my partner went for thorough check up. I was diagnosed with OLIGOTERATOZOOSPERMIA with sperm count of 12mil/ml and morphology 3%. Can you tell what should we do? My partner’s reports were all normal.

    2. Shamili

      Hi sir/madam,

      My husband (32 years old) has oligoteratozoospermia. We have been married for 3 years. We have visited 5 doctors and everyone has told us that I have PCOS but after checking me for two to three cycles they all told me there was nothing serious, that everything is fine. Then all doctors told me to check my husband. Now he has oligoterazoospermia. What is that mean? Is there any remedy? Could you help me with my queries?

      • Sandra FernándezBA, MA

        Dear Shamili,

        the pregnancy success rates for men having oligoteteratozoospermia depend on the exact values for sperm concentration and sperm morphology; therefore, by “oligoteteratozoospermia” we mean that both sperm parameters (sperm concentration and sperm morphology) are below the normal values.

        There exist certain vitamin supplements that may be helpful, but in case the minimum values are not reached, you are advised to start a fertility treatment. Depending on the severity of your husband’s pathology, you will be recommended to undergo intrauterine insemination (IUI) or in vitro fertilization (IVF). Your own values will also be determinant when choosing between the former treatment or the latter.

        The following websites may be of interest:

        Information about PCOS:
        Information about IUI:

        I hope I have been able to help


    3. Chanchal Saha

      My testicular biopsy reported oligoteratozoospermia and the semen analysis azoospermia. What can I do now? FSH report 24.

      • Sandra FernándezBA, MA


        If some sperm have been found after the testicular biopsy even though you were diagnosed with azoospermia, you can try with an ICSI.

        Best wishes