Understanding the Male Role in Fertility: What Every Couple Should Know

About the Speakers

• Angela Rastegar is CEO and co-founder of Sunfish. She spent her earlier career as a director at the largest surrogacy agency and egg bank in the world and has personally gone through four egg retrievals. Sunfish's mission is to make fertility treatment financially accessible and logistically manageable.
• Dr. Ilana Ressler is a double board-certified reproductive endocrinologist at Illume Fertility, with offices in Connecticut and New York. She trained at Duke University, completed her residency at the University of Chicago, and has been with Illume for nearly a decade.

Male factor infertility is one of the most underdiagnosed contributors to a couple's fertility challenges and also one of the most under-discussed. Dr. Ilana Ressler, reproductive endocrinologist at Illume Fertility, joined Sunfish to walk through what male factor infertility actually means, how it's evaluated, when to pursue IUI versus IVF, and what lifestyle changes can genuinely move the needle.

Click here to watch the webinar recording on-demand.

Key Takeaways

1. Male factor is a contributing cause of infertility in up to 30% of couples According to Dr. Ilana Ressler, male factor alone is the primary cause of infertility in approximately 20–30% of couples. In another third of cases, both male and female factors are present at the same time. Despite how common it is, male factor frequently goes undetected because it produces no obvious symptoms. A man can have low sperm count, poor motility, or abnormal morphology with no outward signs whatsoever. The only way to know is to test.

2. A single abnormal semen analysis result is not a diagnosis; a repeat test is always recommended. Sperm take approximately three months to develop from production to ejaculation. One result represents a single point in time, not an average. Dr. Ressler recommends repeating the semen analysis before drawing any conclusions about treatment direction. Persistent abnormalities on a second test warrant further evaluation by a reproductive urologist, including bloodwork, physical exam, hormone testing, genetic screening, and potentially ultrasound.

3. IUI is appropriate for mild male factor; IVF with ICSI is the most effective treatment for more severe cases. When the total motile count falls below 5 million, IVF is the recommended path. IVF with ICSI (intracytoplasmic sperm injection) allows an embryologist to handpick a single normal-looking sperm and inject it directly into each egg, physically overcoming the barriers created by low count or poor motility. This precision allows for higher success rates.

4. Lifestyle changes can meaningfully affect sperm quality, but the degree of impact depends on the cause. Sperm quality is influenced by nutrition, exercise, sleep, stress, alcohol consumption, tobacco, and drug use. Testosterone supplementation and anabolic steroids are particularly harmful to sperm production and should be stopped before attempting conception. Dr. Ressler has seen patients with zero sperm on a semen analysis recover and conceive naturally after stopping anabolic steroids. More moderate lifestyle changes, like improving sleep, have a less predictable effect, but the overall picture matters. Illume’s practice includes dietitians and acupuncturists as part of a whole-person approach to fertility care.

Questions from the Audience:

Q: What does a workup with a reproductive urologist actually involve? A reproductive urologist, distinct from a general urologist, specializes in male fertility. There are very few in this subspecialty, so a referral from your REI is important. The evaluation typically includes a detailed medical and social history, physical exam, bloodwork, and genetic testing. For more severe male factor cases, a karyotype (chromosomal map) may be ordered. Sperm DNA fragmentation testing is not routine but may be recommended for couples with recurrent pregnancy loss or implantation failure. In cases where no sperm are present at all (called azoospermia) a urologist may be able to surgically extract sperm for use in IVF.

Q: With a sperm count of 2 million and 2% motility, would IVF be recommended? Yes, in most cases. A total motile count below 5 million generally disqualifies a patient from IUI, making IVF the appropriate starting point. That said, Dr. Ressler emphasizes that no single result should drive a treatment decision in isolation. The full picture, including the female partner's evaluation, age, uterine health, and tube status, is always considered together before recommending a path forward.

Q: How can a partner be more involved when going through IVF? Dr. Ressler's advice: be present and take your cues from your partner. In an IVF cycle, the female partner bears the majority of the physical burden — daily injections, monitoring appointments, the egg retrieval procedure. Male partners can attend consultations and monitoring visits, help mix and administer injections, and take over logistics wherever possible. There is no single right way to be involved — every couple finds their own rhythm. What matters most, according to Dr. Ressler, is showing up consistently and making it clear you are in it together.

Q: When should you come into see an REI or fertility urologist? Dr. Ressler's top piece of advice for couples starting this journey: don't wait. Infertility is defined as 12 months of trying without success, or 6 months if the female partner is 35 or older. Male age has a more subtle effect on fertility than female age, since men continuously produce new sperm throughout their lives. Women are born with a fixed egg supply that declines in both quantity and quality starting in the mid-30s. Waiting costs women more than it costs men, and many patients come in wishing they had started sooner.

If you have any question at all, whether you have a diagnosed issue or are simply thinking about the road ahead, an early consultation gives you information and options before time becomes a factor.

How Sunfish Can Help

IVF is expensive, and the financial stress of treatment is one of the most commonly cited barriers to starting. Sunfish packages IVF into a single flat fee with monthly payment plans starting at 0% APR, unlimited transfers, and a money-back guarantee if you don't go home with a baby. A dedicated Sunfish coordinator supports you from initial consult through a successful cycle — with discounts on medications, connections to mental health resources, and financial advocacy at every step.

Book a consultation with the Sunfish team to learn about IVF packages at Illume and partner clinics nationwide.

This blog post is based on a Sunfish educational webinar. It is intended for informational purposes only and does not constitute medical advice. Consult your fertility specialist for guidance specific to your situation.

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