Male Infertility: Causes, Symptoms, Diagnosis, Tests and Treatment

Male infertility is common and can affect a man's ability to help achieve a pregnancy. It may be related to the number, movement, or quality of sperm, problems with sperm production, hormonal changes, reproductive organs, sexual function, or other medical and lifestyle factors.

The good news is that male infertility can often be evaluated and, in many cases, treated. Even when treatment cannot completely correct the underlying problem, fertility specialists may have several options to help couples achieve pregnancy.

What Is Male Infertility?

Male infertility is difficulty achieving a pregnancy because of factors affecting the male partner's reproductive health.

A couple is generally evaluated for infertility when pregnancy has not occurred after 12 months of regular, unprotected sexual intercourse.

However, you do not always have to wait 12 months to seek medical advice. Earlier evaluation may be appropriate if there is a known or suspected fertility problem, a history of testicular disease or surgery, sexual difficulties, or other concerns.

Male infertility may result from:

• Problems producing sperm
• Low sperm count
• Poor sperm movement
• Abnormal sperm shape
• Problems with sperm delivery
• Hormonal disorders
• Testicular conditions
• Genetic factors
• Certain infections
• Lifestyle and environmental factors

It is also important to remember that infertility is not necessarily caused by one partner. Male factors may contribute to infertility in many couples, and both partners may need evaluation.

How Common Is Male Infertility?

Male fertility problems are more common than many people realize.

When a couple has difficulty conceiving, the cause may be related to the woman, the man, both partners, or may remain unexplained even after testing.

This is why it is important not to assume that infertility is automatically a woman's problem.

A male fertility evaluation is usually straightforward, and a semen analysis is often an important first step.

What Causes Male Infertility?

There are many possible causes of male infertility. Some affect the production of sperm, while others affect sperm movement, sperm quality, hormones, or the ability to deliver sperm during intercourse.

Common causes include:

• Low sperm count
• Poor sperm motility
• Abnormal sperm morphology
• Varicocele
• Hormonal problems
• Testicular disorders
• Certain infections
• Genetic conditions
• Previous surgery or injury
• Problems with ejaculation
• Erectile difficulties
• Certain medications
• Smoking and tobacco use
• Excessive alcohol consumption
• Obesity and being significantly overweight
• Exposure to excessive heat or certain environmental factors

Sometimes, more than one factor contributes to male infertility.

Low Sperm Count

Low sperm count, medically called oligospermia, means that the concentration of sperm in the semen is lower than the reference range used by the laboratory.

A low sperm count may reduce the likelihood of sperm reaching and fertilizing an egg, although it does not necessarily mean that pregnancy is impossible.

The severity of the reduction matters, and sperm count is only one part of male fertility.

Poor Sperm Motility

Sperm motility refers to how well sperm move.

Sperm generally need to move effectively to travel through the female reproductive tract and reach the egg.

Reduced sperm movement is sometimes called asthenozoospermia.

Poor sperm motility may occur alongside a low sperm count or abnormal sperm morphology.

Abnormal Sperm Morphology

Sperm morphology refers to the size and shape of sperm.

A semen analysis may report the percentage of sperm with a typical shape according to established laboratory criteria.

Abnormal morphology does not automatically mean that a man cannot father a child. The overall semen analysis and the couple's fertility situation need to be considered together.

Varicocele and Male Infertility

A varicocele is an enlargement of veins in the scrotum, similar in some ways to varicose veins.

Varicoceles are relatively common and may sometimes be associated with abnormal sperm production or reduced sperm quality.

Not every varicocele causes infertility, and not every man with a varicocele requires treatment.

If a varicocele is suspected, a doctor can determine whether further assessment or treatment is appropriate.

Hormonal Problems and Male Infertility

Hormones play an important role in sperm production.

Problems affecting hormones involved in reproductive function may interfere with sperm production.

Depending on the circumstances, hormonal problems may be associated with:

• Low testosterone
• Disorders involving the pituitary gland
• Thyroid disorders
• Other endocrine conditions

A doctor may recommend blood tests if a hormonal problem is suspected.

It is important to remember that testosterone treatment is not a fertility treatment for men trying to conceive. In fact, taking testosterone from outside the body can reduce or stop sperm production in some men.

If you are trying to have a baby and have symptoms of low testosterone, discuss them with a doctor before starting any hormone treatment.

Can Infections Cause Male Infertility?

Some infections can affect the male reproductive system and may interfere with fertility.

Certain sexually transmitted infections can cause inflammation or scarring in the reproductive tract.

If you are concerned about a previous infection, it is important to discuss it openly with your doctor. Appropriate diagnosis and treatment may help protect reproductive health.

Can Lifestyle Affect Male Fertility?

Yes. Several lifestyle factors may influence sperm production and sperm quality.

Factors that may affect male fertility include:

• Smoking
• Tobacco use
• Excessive alcohol consumption
• Obesity
• Poor diet
• Lack of physical activity
• Certain recreational drugs
• Poor sleep
• Significant stress
• Excessive heat exposure
• Some medications
• Certain workplace or environmental exposures

This does not mean that lifestyle is always the cause of infertility. However, healthy lifestyle habits can support overall reproductive and general health.

What Are the Symptoms of Male Infertility?

Male infertility often has no obvious symptoms.

A man may feel completely healthy and still have an abnormal semen analysis.

The main sign is usually difficulty achieving a pregnancy with a partner despite regular, unprotected sex.

However, some symptoms may suggest an underlying problem.

These can include:

• Difficulty maintaining an erection
• Problems with ejaculation
• Low sexual desire
• Pain or swelling in the testicles
• A lump or enlarged veins in the scrotum
• Reduced facial or body hair
• Changes in testicular size
• Previous testicular injury
• A history of reproductive surgery
• Recurrent genital infections

These symptoms do not automatically mean that a man is infertile, but they should be discussed with a healthcare professional.

How Is Male Infertility Diagnosed?

A male infertility evaluation begins with a detailed medical and reproductive history.

Your doctor may ask about:

• How long you have been trying to conceive
• Previous pregnancies with the same or another partner
• Medical conditions
• Previous surgeries
• Testicular injuries
• Infections
• Medications and supplements
• Sexual function
• Lifestyle habits
• Smoking and alcohol use
• Occupational or environmental exposures
• Previous fertility problems

A physical examination may also be performed when appropriate.

What Is a Semen Analysis?

A semen analysis is one of the most important tests used to evaluate male fertility.

It examines semen and sperm characteristics such as:

• Sperm concentration
• Total sperm number
• Sperm motility
• Sperm morphology
• Semen volume
• Other characteristics of the semen sample

One abnormal semen analysis does not necessarily mean permanent infertility.

Sperm production can vary over time, and your doctor may recommend repeating the test if the initial result is abnormal.

It is important to have semen analysis results interpreted by a qualified healthcare professional rather than relying on a single number in isolation.

What Other Tests Are Used for Male Infertility?

Depending on the results of the initial evaluation, additional tests may be recommended.

These can include:

Hormone Tests

Blood tests may be used to assess hormones involved in sperm production and sexual function.

Scrotal Ultrasound

An ultrasound may be recommended if the doctor suspects a varicocele, testicular problem, or another structural abnormality.

Genetic Testing

Genetic tests may be considered in selected men with very low sperm counts or absent sperm, particularly when a genetic cause is suspected.

Other Specialized Tests

In certain situations, a fertility specialist may recommend additional tests to investigate sperm function, sperm DNA, or other reproductive factors.

Not every man needs all of these investigations. Testing should be tailored to the individual.

How Is Male Infertility Treated?

Male infertility treatment depends on the underlying cause.

Treatment may include lifestyle changes, medicines, surgery, treatment of infections or hormonal problems, or assisted reproductive techniques.

Lifestyle Changes

If lifestyle factors are contributing to poor sperm health, your doctor may recommend:

• Stopping smoking
• Avoiding tobacco products
• Limiting excessive alcohol
• Maintaining a healthy weight
• Eating a balanced diet
• Exercising regularly
• Getting enough sleep
• Managing stress
• Avoiding unnecessary heat exposure to the testicles
• Reviewing medications with your doctor

Remember that sperm production takes time. Improvements in lifestyle may therefore take several months before they are reflected in a semen analysis.

Medicines for Male Infertility

Medicines may be useful when a specific medical or hormonal problem is identified.

For example, certain hormonal conditions can interfere with sperm production and may be treated under the supervision of a specialist.

However, fertility medicines are not appropriate for every man.

Be Careful With Testosterone Treatment

If you are trying to have a baby, do not start testosterone therapy without discussing fertility with your doctor.

Although testosterone may improve symptoms of testosterone deficiency, testosterone taken from outside the body can suppress sperm production.

If fertility is a goal, the doctor may consider other approaches depending on the underlying condition.

Surgery for Male Infertility

Surgery may be appropriate in selected cases.

For example, treatment may sometimes be considered for:

• Varicocele
• Certain blockages in the reproductive tract
• Some problems affecting sperm delivery
• Certain testicular or reproductive conditions

Not every man with a varicocele or another abnormality requires surgery. The potential benefits and risks should be discussed with a specialist.

IUI for Male Infertility

Intrauterine insemination (IUI) involves placing prepared sperm directly into the uterus around the time of ovulation.

IUI may be considered in some couples where the male partner has mild sperm abnormalities or other selected fertility problems.

Whether IUI is appropriate depends on sperm quality, the female partner's fertility, age, and other factors.

IVF and ICSI for Male Infertility

In vitro fertilization (IVF) involves fertilizing an egg with sperm in a laboratory and transferring an embryo into the uterus.

In some cases of male infertility, a technique called intracytoplasmic sperm injection (ICSI) may be used.

During ICSI, a single sperm is injected directly into an egg to assist fertilization.

IVF with ICSI may be considered for certain couples with significant male-factor infertility, including some cases of very low sperm count or poor sperm quality.

The appropriate treatment depends on the results of the male and female fertility evaluations.

Can Male Infertility Be Treated?

In many cases, yes.

Treatment depends on why fertility is reduced.

For example:

• Hormonal problems may sometimes be treated medically.
• Some infections can be treated.
• Certain varicoceles may be treated surgically.
• Lifestyle factors can sometimes be modified.
• Some couples may benefit from IUI.
• IVF with ICSI may be an option for certain severe sperm problems.

Even when the underlying cause cannot be completely corrected, fertility treatment may still provide a pathway toward pregnancy.

When Should a Man See a Doctor About Infertility?

You should consider a fertility evaluation if:

• You and your partner have been trying to conceive for 12 months without pregnancy.
• Your partner is 35 or older and you are concerned about fertility.
• You have a known or suspected fertility problem.
• You have had testicular surgery or injury.
• You have a history of testicular infection.
• You have problems with erections or ejaculation.
• You have very low sexual desire.
• You notice testicular pain, swelling, or a lump.
• You have previously been told that your sperm count is low.
• You are taking testosterone and want to have children.

You do not necessarily need to wait a full year if there is a known risk factor for male infertility.

Can Male Infertility Be Prevented?

Not all causes of male infertility can be prevented. Genetic conditions and some medical problems, for example, may not be avoidable.

However, you can support your reproductive health by:

• Avoiding smoking and tobacco
• Limiting excessive alcohol consumption
• Avoiding recreational drugs
• Maintaining a healthy weight
• Eating a nutritious diet
• Exercising regularly
• Managing chronic health conditions
• Avoiding unnecessary exposure to excessive heat
• Practicing safer sex
• Seeking medical advice for testicular pain, swelling, or infection

If you are planning to have children, it is also useful to discuss long-term medications and medical conditions with your doctor.

Does Low Sperm Count Mean Infertility?

Not necessarily.

A low sperm count can reduce the likelihood of natural conception, but it does not automatically mean that pregnancy is impossible.

Fertility depends on several factors, including sperm count, motility, morphology, the woman's fertility, the frequency and timing of intercourse, and other reproductive factors.

If a semen analysis shows a low sperm count, your doctor may recommend repeating the test and looking for an underlying cause.

Frequently Asked Questions About Male Infertility

What is the most common cause of male infertility?

Male infertility can have many causes, including problems with sperm production, low sperm count, poor sperm movement, abnormal sperm morphology, varicocele, hormonal problems, infections, genetic conditions, and lifestyle factors. Sometimes no clear cause is identified.

What are the signs of male infertility?

Male infertility often has no symptoms. Difficulty achieving pregnancy is usually the main sign. Some men may have erectile or ejaculation problems, low libido, testicular pain or swelling, or other symptoms related to an underlying condition.

Does low sperm count mean a man is infertile?

No. A low sperm count can make conception more difficult, but it does not necessarily mean that a man cannot father a child. The severity of the problem and the overall fertility of both partners are important.

What is the best test for male infertility?

Semen analysis is one of the most important initial tests for male infertility. It evaluates sperm count, motility, morphology, and other semen characteristics.

Can male infertility be cured?

Some causes of male infertility can be treated or improved. Treatment may involve lifestyle changes, medication, surgery, treatment of an underlying condition, IUI, IVF, or ICSI.

Can a man with low sperm count have a baby?

Yes. Some men with low sperm counts can achieve pregnancy naturally, while others may benefit from fertility treatment. The appropriate approach depends on the sperm count, sperm quality, the female partner's fertility, and other factors.

Can testosterone cause infertility?

Yes. Testosterone taken from outside the body can suppress the hormones needed for sperm production and may significantly reduce or even stop sperm production in some men. Men who want to have children should discuss fertility before starting testosterone therapy.

Can male infertility be treated with IVF?

Yes. IVF can be used for some forms of male-factor infertility. In cases of significant sperm abnormalities, ICSI may be used to assist fertilization by injecting a single sperm directly into an egg.

When should a man get a fertility test?

If pregnancy has not occurred after 12 months of regular, unprotected intercourse, both partners should generally consider a fertility evaluation. Earlier testing may be appropriate when there is a known risk factor or concern about male reproductive health.

Takeaway

Male infertility is common, and it is not something that a man should feel embarrassed or ashamed about.

The first step is usually a proper evaluation, often beginning with a semen analysis. Once the possible cause is identified, your doctor can explain whether lifestyle changes, medicines, surgery, IUI, IVF, ICSI, or another approach may be appropriate.

If you and your partner are having difficulty conceiving, remember that fertility is a couple's issue, not simply a woman's or man's issue. Evaluating both partners can help identify the cause sooner and provide a clearer path toward treatment and pregnancy.