10 Questions to Ask Your Fertility Clinic About Male-Factor Infertility and ICSI

Male-factor evaluation is often reduced to a single sperm count — but a proper work-up covers DFI, hormones, genetics, and (if needed) surgical retrieval. These ten questions steer the conversation from “low sperm” to a complete plan: is ICSI truly indicated, which selection method fits, and is genetic counseling needed? Bring your semen analyses and any hormone/genetic results. General education, not individual medical advice.

The 10 questions

1. “How many semen analyses were done, and what were count, motility, and morphology?”
   Why: severity (mild/moderate/severe OAT) drives the technique.

2. “Has DNA fragmentation (DFI) been tested? If not, why not?”
   Why: a modifiable factor missed by standard SA (read more).

3. “Is ICSI indicated by my numbers — or is it routine here?”
   Why: questions over-use in mild/unexplained cases (evidence divide).

4. “If ICSI, which sperm selection (PICSI / Zymot / MACS) fits my case?”
   Why: matters most when DFI is high.

5. “Were hormones (FSH, testosterone) and a scrotal ultrasound / varicocele check done?”
   Why: finds treatable contributors.

6. “Do I need genetic testing — karyotype, Y-microdeletion, CFTR?”
   Why: some causes are inheritable; counseling protects the next generation.

7. “If there’s no sperm in the ejaculate, what retrieval (PESA / TESA / Micro-TESE) is planned?”
   Why: defines the surgical route for azoospermia.

8. “Could lifestyle (smoking, BMI, heat, antioxidants) or varicocele repair improve things?”
   Why: low-risk modifiable factors.

9. “What exactly changes for our cycle, and why?”
   Why: leaves with a concrete plan (use the checklist).

10. “Is a second opinion or andrology review of my results worthwhile?”
    Why: a fresh read can reveal a missed option.

How to use these questions

• Print them and tick answers during the visit.
• Lead with Q1 and Q2 — they frame the whole plan.
• Keep the tone collaborative; you’re building a review, not a confrontation.

What good answers will and won’t give you

• Will give: a clear technique decision and any genetic counseling need.
• Won’t give: a guarantee of fertilization or pregnancy; sperm is one variable.

Related reading

• The framework: Male-Factor Infertility and ICSI: A Clinical Decision Framework
• Read your work-up: How to Read a Male-Factor Work-Up and ICSI Plan
• What the evidence shows: Male-Factor Infertility and ICSI: What the Evidence Can—and Cannot—Tell You
• DFI decision: Could Sperm DNA Fragmentation Mean You Should Use ICSI, PICSI, or Zymot?

Your next step

Walk in prepared: the IVF Case Clarity Assessment builds a one-page summary and these questions around your numbers.

Medical disclaimer

General education only; not individual medical advice. Your specialist or andrologist remains the decision-maker for testing and treatment.

References

1. ESHRE Guideline Group on Male Infertility. ESHRE guideline: male infertility. Hum Reprod Open. 2024.
2. Practice Committee of ASRM. Intracytoplasmic sperm injection (ICSI): a committee opinion. Fertil Steril. (updated).
3. Agarwal A, et al. Sperm DNA fragmentation: a review. Transl Androl Urol. 2023.