Male Infertility Testing & Treatment in St. Louis
Our Approach to Treating Male Infertility
Male infertility is a contributing factor in approximately 30–50% of all infertility cases, yet sadly, it's often the last thing evaluated. If you and your male partner have been trying to conceive without success, or if you simply want to understand your reproductive health before you begin trying, you've come to the right place!
STL Fertility's double board-certified, fellowship-trained fertility specialists provide comprehensive male infertility evaluation and treatment right here in St. Louis — with the compassionate, individualized care we bring to every patient we serve.
Signs and Symptoms of Male Infertility
The most common sign of male infertility is being unable to conceive after 6 months of regular, unprotected intercourse. In many cases, there are no other outward symptoms, which is why a semen analysis is always part of the recommended first step — even when everything else seems normal.
Physical symptoms that may indicate an underlying concern worth discussing with a specialist:
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Low sex drive or changes in sexual function
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Difficulty achieving or maintaining an erection (erectile dysfunction)
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Pain, swelling, or a lump in the testicle area
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History of testicular trauma, surgery, or undescended testicles
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Recurrent respiratory infections (linked in some cases to conditions affecting sperm motility)
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Gynecomastia (abnormal breast tissue growth in men), which can indicate a hormonal issue
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A history of prostate, sexual health, or reproductive system concerns
Don't wait for symptoms. Many men with clinically significant infertility have no outward symptoms at all. A semen analysis is a simple, affordable test that provides an immediate picture of your reproductive health — and you don't need a referral to schedule one at STL Fertility.
Causes of Male Infertility
Male infertility can result from a wide range of physical, hormonal, genetic, and lifestyle-related factors. Identifying any underlying cause is the foundation of every effective treatment plan — which is why our diagnostic approach at STL Fertility is thorough, individualized, and never rushed.
Common causes include:
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Varicocele: An enlargement of the veins within the scrotum, similar to varicose veins, that raises scrotal temperature and impairs sperm production. Varicoceles are found in approximately 15% of all men and about 40% of men evaluated for infertility. The 2025 WHO infertility guidelines reaffirm that surgical repair is an option for men with clinical varicocele, infertility, and abnormal semen parameters.
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Hormonal Imbalances: Imbalances in levels of testosterone, FSH, LH, and other hormones can impact sperm production.
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Genetic Factors: Chromosomal abnormalities (Klinefelter syndrome, Y chromosome microdeletions) and sperm DNA fragmentation can affect fertility and in some cases contribute to recurrent pregnancy loss.
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Blockages or Structural Abnormalities: Obstructions in the vas deferens, epididymis, or ejaculatory ducts prevent sperm from reaching the ejaculate.
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Retrograde Ejaculation: When semen travels backward into the bladder rather than forward during ejaculation. Causes include diabetes, spinal cord injuries, certain medications, and prior prostate surgery.
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Infections and Prior Illness: STIs, mumps orchitis (after puberty), UTIs, and prostate infections can damage sperm or cause blockages that affect fertility.
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Undescended Testicles (Cryptorchidism): When one or both testicles fail to descend before birth, it can impair sperm production in adulthood — even if surgically corrected in childhood.
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Lifestyle Factors: Testosterone Replacement Therapy (TRT injections), Tobacco use, heavy alcohol consumption, recreational drugs (including marijuana), anabolic steroid use, obesity, chronic stress, elevated scrotal temperature (hot tubs, laptops on the lap), and exposure to environmental toxins can all negatively impact sperm count and quality.
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Prior Cancer Treatment or Surgery: Chemotherapy, radiation, vasectomy, hernia repair, and certain pelvic surgeries can affect fertility either temporarily or permanently.
If any of these apply to you, schedule a visit!
Male Fertility Testing & Diagnosis in St. Louis
Getting answers starts with getting tested. Male fertility evaluation is straightforward, minimally invasive, and often faster than patients expect. In most cases, the initial picture is clear within one to two weeks of your first appointment at STL Fertility.
Common Male Fertility Tests
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Semen Analysis: The cornerstone of male fertility testing. A semen analysis evaluates sperm count (concentration), motility (movement), morphology (shape), total semen volume, and several other key indicators of reproductive health. You'll provide a masturbatory sample at our office in a private, comfortable setting OR pick up a sterile cup and collect at home, ensuring you are able to drop off the cup within an hour of collection. Results are ready within 48 hours. In some cases, a second analysis is recommended to confirm results, since sperm parameters can fluctuate.
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Hormone Panel (Blood Work): Occasionally, hormonal testing will be recommended. This is a simple blood draw measures testosterone, FSH, LH, estradiol, and prolactin — all of which directly influence sperm production and sexual function. Thyroid-stimulating hormone (TSH) is also often included, since thyroid function can affect fertility.
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Genetic Testing: When semen analysis reveals severe abnormalities, we may recommend genetic testing for chromosomal conditions (Klinefelter syndrome, Y chromosome microdeletions) or CFTR mutations. Sperm DNA fragmentation testing is an option and can be considered for unexplained infertility or recurrent pregnancy loss.
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Post-Ejaculation Urinalysis: When retrograde ejaculation is suspected, a urine sample collected after ejaculation confirms whether sperm are traveling into the bladder.
Male Infertility Treatment Options in St. Louis
A diagnosis of male infertility is not the end of your path to parenthood. At STL Fertility, we offer a full range of evidence-based treatments, each personalized to the cause and severity of your diagnosis and your family-building goals as a couple.
Sperm Banking & Fertility Preservation
At STL Fertility, we make sperm banking private, straightforward, and stress-free. You'll provide a sample in a fully private setting at our office, or at home. It's then analyzed, processed, and cryopreserved in our advanced on-site laboratory — where it can be stored safely for years until you're ready to use it. Our team walks you through every step with complete transparency and without judgment.
Sperm banking (sperm cryopreservation) is the process of collecting, freezing, and storing sperm for future use. It's a smart, proactive step for men who are:
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Considering starting TRT Injections (BANK Sperm before you start!)
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About to undergo cancer treatment (chemotherapy or radiation) that may affect sperm production
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Considering a vasectomy but may want biological children in the future
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Experiencing a declining sperm count and want to preserve current quality
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Planning to use assisted reproduction (IVF or IUI) at a future date
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About to undergo surgical sperm retrieval and want a backup sample preserved
Surgical Sperm Retrieval
For men with azoospermia or obstructive conditions, sperm can often be retrieved directly from the testes or epididymis through minimally invasive surgical procedures performed by our Urology partners.
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TESE (Testicular Sperm Extraction): A small tissue sample is taken from the testes and examined under a microscope for viable sperm.
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Micro-TESE (Microsurgical TESE): Performed under high-powered magnification, Micro-TESE identifies sperm-producing tissue with greater precision and minimal tissue removal — the preferred method for non-obstructive azoospermia.
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PESA (Percutaneous Epididymal Sperm Aspiration): A fine needle retrieves sperm directly from the epididymis — used when a blockage prevents sperm from entering the ejaculate.
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MESA (Microsurgical Epididymal Sperm Aspiration): A microsurgical technique that retrieves the highest yield of sperm from the epididymis, often used when vasectomy reversal is not a viable option.
Sperm retrieved through these procedures can potentially be used fresh or cryopreserved for future IVF cycles with ICSI.
Intracytoplasmic Sperm Injection (ICSI)
At STL Fertility, ICSI is performed by our highly trained embryology team using the most advanced laboratory technology available. Our fertilization and embryo development results consistently exceed national benchmarks — reflecting both the precision of our lab and the individualized nature of every treatment plan we build.
ICSI (Intracytoplasmic Sperm Injection) is one of the most transformative advances in male infertility treatment. Used alongside IVF, ICSI involves injecting a single healthy sperm directly into a mature egg — bypassing the barriers that low sperm count, poor motility, or abnormal morphology would otherwise create.
ICSI is recommended when:
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Sperm count is severely low (severe oligospermia)
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Sperm motility or morphology is significantly abnormal
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Sperm have been surgically retrieved from the testes or epididymis
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Previous IVF cycles resulted in poor or failed fertilization
Intrauterine Insemination (IUI) for Male Infertility
IUI is a quick, in-office procedure with minimal recovery time. Our physicians will guide you through whether IUI is the right first step or whether moving to IVF with ICSI gives your specific situation the best odds of success.
IUI (Intrauterine Insemination) is a less invasive option that works well as a first-line treatment for couples with mild male factor infertility. A prepared, concentrated sperm sample is placed directly into the uterus timed with your female partner’s ovulation — reducing the distance sperm must travel and increasing the chances of fertilization.
IUI may be a good starting point when:
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Sperm count or motility is mildly below normal
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Ejaculation difficulties or sexual dysfunction are present
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Unexplained infertility is the diagnosis after a complete couple's workup
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A mild combination of male and female factor infertility is identified
