Epidemiological characteristics and temporal trends of male infertility in Egypt (2012–2022): Analysis of 3,037 consecutive cases

Background: Male factors contribute to about half of global infertility cases, yet regional data are limited, particularly in Egypt. Objective: To characterize the sociodemographic, clinical, seminal, and hormonal profiles of infertile Egyptian men and investigate their correlations. Methods: We retrospectively analyzed the medical records of infertile men presented to a single busy andrology/infertility center in Egypt between June 2012 and May 2022. Demographic, clinical, seminal, and hormonal data were reviewed, and trends and correlations were assessed. Results: Of 3,037 men, primary infertility accounted for 76.13%, with a median infertility duration of 4 years. Varicocele was observed in 66.47% of cases, predominantly second-degree. Asthenozoospermia (31.74%), oligoasthenozoospermia (20.78%), and azoospermia (9.12%) were the most frequent semen abnormalities. Median sperm concentration was 24 million/ml, progressive motility 25%, and normal morphology 10%. From 2012 to 2022, median sperm concentration declined from 24 million/ml to 18 million/ml (p = 0.2), progressive motility declined from 25% to 17% (p < 0.001), and normal sperm morphology declined from 10% to 5% (p < 0.001). The COVID-19 pandemic period (2020–2022) exhibited the most prominent reduction in sperm progressive motility (from 21% to 17%; p < 0.001). Smoking negatively correlated with all sperm parameters. Follicle-stimulating hormone and luteinizing hormone levels correlated negatively with semen quality and testicular volume but positively with infertility duration. Neither varicocele grade nor total testosterone levels correlated significantly with sperm parameters. Conclusion: This study identified primary infertility, varicocele diagnosis and asthenozoospermia as predominant findings among infertile Egyptian men. Over a decade, temporal declines in sperm concentration, motility, and morphology were observed, exacerbated by the COVID-19 pandemic. Smoking and elevated gonadotropins negatively influenced semen quality and testicular volume, whereas testosterone levels and varicocele grade showed no significant correlation. These findings highlight the importance of developing integrated, region-specific strategies to address male infertility.