What I treat · Male fertility

Male fertility, investigated properly

Half of all fertility problems involve the man, and a single abnormal semen analysis is a starting point rather than a verdict. A great many couples are sent straight to IVF without the male side ever being examined.

Even where no sperm appear in the ejaculate, sperm are often still being produced inside the testis. Micro-TESE uses an operating microscope to find the few tubules that are working — and a vasectomy done years ago can usually be reversed microsurgically, with patency and pregnancy being two very different numbers worth asking about separately.

The honest trade-off Patency and pregnancy are different figures. A reversal can restore sperm to the ejaculate in the great majority of men and still not produce a pregnancy, because that depends on the interval since vasectomy, on female age and on other factors entirely. Any surgeon quoting one number without the other is quoting the flattering one.

The Micro-TESE guide → Vasectomy reversal Understanding your semen analysis Fertility questionnaire

Treatments offered

Microdissection TESEBAUS leafletA24/045
No-scalpel vasectomyBAUS leafletA24/049
Microsurgical vasectomy reversalBAUS leafletA24/044
Varicocele surgeryBAUS leafletA24/048
Hormonal and genetic assessmentBAUS leafletA23/041
Sperm retrieval for IVF and ICSI

The leaflets above are published by the British Association of Urological Surgeons (BAUS) and open in a new tab. They are linked, not hosted or altered.

Written and reviewed by Mr Musaab Yassin, Consultant Urological Surgeon & Andrologist. FRCS (Urol) · GMC 6118378 · Reviewed September 2026

An operating microscope beside a monitor displaying a magnified spermatozoon and its analysis. — The two halves of the work: the laboratory that counts and grades the sperm, and the microscope that goes looking for them.

A single spermatozoon, rendered against a dark field. — A single sperm cell. In non-obstructive azoospermia, production survives in islands rather than throughout the testis — which is why the search is done under magnification rather than with a needle.

Evidence Notes · Male fertility

Read the case against a treatment, before you agree to it.

Every device company publishes its best trial and every clinic quotes the most flattering figure from it. These are the appraisals that belong to this condition — two of the twelve — including the unflattering findings, and the places where good studies disagree with one another.

Male fertility

No. 10 · Sperm Retrieval

No sperm in the ejaculate is not the end

Close to 100% retrieval where the cause is a blockage; 40–60% with Micro-TESE where the testis is failing. The tests come first.

Read the note → No. 11 · Dna Fragmentation

What a semen analysis cannot see

Varicocele repair cuts fragmentation by 12.4% at six months. Antioxidants manage 3–4%, and are what most men have already bought.

Read the note →

StrongRandomised trials and systematic reviews agree.

ReassuringConsistent, but resting partly on observational work.

ModerateReal, from smaller or less rigorous studies.

LimitedToo little evidence to rely on. Said plainly.

The full collection, all twelve → How to read a trial result

Common Questions · Male fertility

The ten questions men ask before they book.

Short, referenced answers to the questions that come before a diagnosis exists — written to be read at eleven at night, by someone who has not told anyone yet. Each is referenced to guidelines, systematic reviews and trials, with the studies listed at the foot of its page.

Male fertility

Semen analysis, azoospermia, varicocele, and being investigated at all.

24% of clinicians never physically examine the male partner.

All fifty-five, across every condition, are on the practice page.

Before your visit

Fifteen minutes now saves twenty in the room.

Complete the questionnaire before you come. Nothing is saved or transmitted — you print the summary or copy it into an email, and it stays entirely in your control.

02 · Fertility

Fertility assessment

How long you have been trying, previous results, surgical history, partner factors.

Open the questionnaire →

What to bring Three things

Any previous scans or reports, a list of your current medication, and the completed questionnaire if you have had time.

How long Allow up to an hour

The consultation itself takes at least twenty minutes. Allow up to an hour if you are having a flow test, a scan, bloods or a urine test on the day.

Coming with someone Welcome

Partners are welcome throughout, and for fertility discussions it is often better if you both come.

The other areas

Each area has a page of its own.

Booking, fees and the four ways to get in touch are on the practice page.

Prostate & urinary flowEnlarged prostate Male fertilityMale fertility Peyronie’s diseasePeyronie’s disease Erectile dysfunctionErectile dysfunction Continence after prostate treatmentContinence What I treatEveryday urology