Restorative Andrology
Restorative andrology identifies the cause of male factor infertility and treats it. The goal is to correct the problem rather than work around it by collecting sperm for a lab procedure. Male factor is the sole cause of a couple's infertility in about 20% of couples. It contributes to the problem in another 30% to 40%.1
Many causes can be identified and treated. They include a varicocele, the most common treatable male cause. Others include damage to the DNA inside sperm (sperm DNA fragmentation), oxidative stress, low or unbalanced hormones, and a blocked duct that carries sperm.234 Surgery can restore the role of the man in natural conception when the cause is a blockage or a structural problem in the anatomy.45 Vasectomy reversal is one restorative option for couples whose barrier is a past vasectomy.
A semen analysis is the first test for the male partner.6 A full evaluation goes further. The AUA and ASRM male infertility guideline also recommends a health history and a physical exam. It adds hormone, genetic, or imaging tests when the findings warrant them.7 The WHO values are lower reference limits drawn from men who had recently fathered a child. They mark the low end of a range, not a line between fertile and infertile.8 A man's results can sit above those limits while a treatable cause is still present. Identifying that cause requires the full workup.9
Restorative andrology differs from the common practice of moving directly to ICSI. That step works around the problem in the man without treating it, and it carries risks of its own.10
Cited in this entry
- Schlegel PN, Sigman M, Collura B, et al. Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline Part I. J Urol. 2021;205(1):36-43. https://pubmed.ncbi.nlm.nih.gov/33295257/
- Sperm DNA Fragmentation: causes, evaluation and management in male infertility. https://pmc.ncbi.nlm.nih.gov/articles/PMC11152411/
- The Impact of Oxidative Stress in Male Infertility. https://pmc.ncbi.nlm.nih.gov/articles/PMC8766739/
- Clinical Outcomes of Varicocele Repair in Infertile Men: A Review. https://pmc.ncbi.nlm.nih.gov/articles/PMC4999483/
- Grande G et al. Comprehensive diagnostic and therapeutic approach to male factor infertility aimed at natural fertility: A multicentric retrospective cohort study. https://rrmacademy.org/library/comprehensive-diagnostic-and-therapeutic-approach-to-male-factor-infertility-8decfdf8/
- WHO laboratory manual for the examination and processing of human semen, sixth edition. https://www.who.int/publications/i/item/9789240030787
- Schlegel PN, Sigman M, Collura B, et al. Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I. The Journal of Urology. 2021;205(1):36-43. https://pubmed.ncbi.nlm.nih.gov/33295257/
- Campbell MJ, Lotti F, Baldi E, et al. Distribution of semen examination results 2020, a follow up of data collated for the WHO semen analysis manual 2010. Andrology. 2021;9(3):817-822. https://pubmed.ncbi.nlm.nih.gov/33528873/
- Grande G, Garolla A, Graziani A, et al. Comprehensive diagnostic and therapeutic approach to male factor infertility aimed at natural fertility. Andrology. 2025;13(8):2122-2130. https://pubmed.ncbi.nlm.nih.gov/39930939/
- Alukal JP, Lamb DJ. Intracytoplasmic sperm injection (ICSI): what are the risks? Urol Clin North Am. 2008. https://rrmacademy.org/library/intracytoplasmic-sperm-injection-icsi--what-are-the-risks-recsyzkxmivrzhdru/
This content is for educational purposes only and does not constitute medical advice. Consult an RRM clinician or healthcare provider for guidance specific to your situation.
