The journey that a sperm takes to travel from the epididymis of the testicle to the vagina of the female during intercourse is an arduous one. The presence of ejaculate does not necessarily indicate the presence of sperms. The volume that the testicles contribute to the eventual ejaculated semen is only 5%. This explains why men who have had vasectomy done do not complain of decreased ejaculate volumes.

The aim of the treatment of male sub fertility is to first determine if the man is able to produce sperm. Once we can determine that he can produce sperm, we will want to find out if the sperms can be deposited successfully into the female genital tract. Ejaculated sperms are the most mature and will be the ones that have the highest chances of fertilising the egg in the woman.

If the quality of the sperm is poor and if there are correctable conditions which explain why the quality is poor, treatment would then be targeted at that.

The most treatable cause for male sub fertility is still the varicocele. Repair of varicoceles have been shown to improve the semen parameters.

Hormonal manipulation can also be used for suitable men to improve their sperm count.

Other procedures will be directed at sperm retrieval and this would range from percutaneous aspiration of sperm from the testes/epididymis to microsurgical techniques.