Male fertility

What is male infertility?

Up to 1 in 7 couples suffer from infertility – they're unable to conceive naturally even after trying for one year or longer. While infertility used to be thought of as a 'woman's problem,' male infertility causes up to one-half of all cases. But what is male infertility?

Male infertility occurs when the sperm fails to fertilise the egg, which can happen for a wide variety of reasons. For example, poor sperm production, blockages, and chronic health problems all contribute to male infertility.

However, in many cases, male infertility can be addressed and overcome. Read ahead to learn more about male infertility and understand how it works, and how you can improve your chances of conception.

How does conception work?

To understand more about the complex process of male fertility, it helps first to understand how conception works.

To be able to get your partner pregnant naturally, the following must happen

You need to produce healthy sperm – To produce healthy sperm, you must have at least one functioning testicle, and your male reproductive organs must have grown normally during puberty.
You must produce testosterone – You must produce a normal amount of testosterone to produce healthy sperm.
Your epididymis must function normally – Your epididymis carries your sperm from your testicles to your semen, allowing them to be ejaculated out of your urethra.
You must have a high enough sperm count – You need to have enough sperm in your semen to impregnate your partner: the lower your sperm count, the lower your chances of fertilisation. A low sperm count is considered fewer than 15 million sperm per millilitre of semen, or fewer than 39 million in total.
Your sperm must have good motility – Your sperm must have decent motility (movement) to move correctly and fertilise your partner’s egg.
Your sperm must have good morphology – At least some of your sperm must be the correct shape, with an oval head and long tail, with no visible abnormalities.

Lifestyle Factors That Can Cause Male Infertility

These lifestyle factors can cause or worsen male infertility.

Drinking alcohol – Alcohol lowers testosterone levels, cause erectile issues, and decrease sperm production.
Drug use – Smoking marijuana, taking cocaine, or abusing steroids can all cause your sperm quality to decrease. Steroids can also cause your testicles to decrease in size.
Smoking – Smoking, including second-hand smoke, lowers sperm count.
Weight – Obesity can negatively impact male fertility by lowering sperm counts and affecting hormonal levels.
Stress – Elevated stress levels can trigger abnormal cortisol and other hormonal levels, impacting fertility.

Medical causes of infertility in men

Medical Causes of Male Infertility Here are some of the most common medical causes of male infertility

Infections – Past infections that caused swelling or scarring in the epididymis (epididymitis) or testicles (orchitis) can prevent normal sperm production or block their release. Some STIs, such as gonorrhoea or HIV, can do the same. These issues usually resolve when the infection is treated, but some can cause lasting problems.
Ejaculation issues – Some men have problems with retrograde ejaculation, which occurs when semen enters the bladder instead of leaving the head of the penis during orgasm. Diabetes, spinal injuries, and past surgeries can all cause retrograde ejaculation.
Varicocele – A varicocele, which can cause reduced sperm quantity and quality, occurs when the veins that drain the testicles become swollen. It can often be treated with medication or surgery.
- Sperm-attacking Antibodies – In some cases, your immune system cells can mistakenly identify your own sperm as harmful and target them for elimination. This can often be treated with medications.
- Tumours – Both non-malignant and cancerous tumours can negatively impact the male reproductive organs directly, preventing the normal release of sperm. In addition, some tumours, particularly those in or near the pituitary gland, can affect hormones and overall fertility.

Undescended Testicles – Undescended testicles are relatively common – in foetal development, one or both testicles fail to descend normally into the testicles. Men who had this condition in infancy or childhood are more likely to experience decreased fertility.
Hormone Imbalances – When it comes to fertility, hormones are crucial. Hormone imbalances can affect the hypothalamus, pituitary, thyroid, and adrenal glands, preventing the normal development of sperm.
Tube Blockages – Tube blockages can prevent sperm from getting where they need to go – they can be blocked by injury, scar tissue, past trauma, or prior infections, as well as genetically inherited conditions. You can experience blockages in the epididymis, the vas deferens, the ejaculatory ducts, the urethra.
Chromosome Defects – In some cases, inherited genetic disorders, such as Klinefelter’s syndrome, cystic fibrosis, and Kallman’s syndrome can lead to abnormal reproductive organ development.
Sexual Intercourse Problems – Some men struggle to get or maintain an erection, making intercourse and ejaculation impossible. This can be caused by psychological issues, physiological abnormalities, or painful intercourse. See your GP if any of these apply – they can help.
Celiac Disease – Men with celiac disease, a digestive disorder that causes sensitivity to gluten, often suffer from infertility. A gluten-free diet can often solve the problem.
Medications – Certain medications can negatively impact male fertility, such as testosterone replacement therapy, ulcer medications, anabolic steroid use, cancer medications (chemotherapy), and many arthritis drugs. Speak to your GP about any concerns you may have about prescription and over the counter medications.
Previous Surgeries – Past surgeries can prevent sperm from being present in your ejaculate. These surgeries include vasectomy, scrotal and testicular surgeries, large abdominal surgeries, and prostate surgeries.
Environmental Causes – Certain professions are overexposed to chemicals and heat that reduce sperm health and function. These environmental causes include:
- Heavy metals
- Radiation or X-rays
- Industrial chemicals, including solvents, pesticides, and paints
- Overheating, including saunas and hot tubs

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Medical causes of infertility in men

Medical Causes of Male Infertility Here are some of the most common medical causes of male infertility

What Are the Symptoms of Male Infertility?

In most cases, the only symptom of male infertility is the failure to impregnate one’s female partner. However, there are some underlying problems, such as hormonal imbalances, dilated testicular veins, and blockages in the penis that can all have their own symptoms. Here are some of the symptoms of male infertility you might notice.

Pain or swelling in your testicles
Abnormal chest/breast growth (also known as gynecomastia)
Recurrent respiratory infections with no other known cause
Sexual problems, such as difficulty maintaining an erection or low/no sexual desire
No ejaculation or small volumes of ejaculate
Decreased facial hair or body hair

A lower sperm count than normal (a sperm count lower than 39 million per ejaculate, or fewer than 15 million sperm per millilitre of semen)

When Should You See a Doctor for Male Infertility?

If you have been having regular unprotected sex for more than a year and still haven’t conceived, you and your female partner should both see a doctor.

However, if you experience any of the following and haven’t been able to conceive for six months or more, you should see your doctor.

You have a history of prostate or testicular problems
Your partner is older than 35
You experience any pain or discomfort in your testicles or have a lump or swelling
You have a problem with maintaining an erection or can’t ejaculate
Have or have had an injury in your scrotum or testicles

Diagnosing Male Infertility

Many couples dealing with infertility have more than one cause or issue going on, and so both parties need to see a doctor. You’ll both go through a number of tests to assess your overall health and fertility. Unfortunately, in many cases, no cause is ever identified – this is called “Unexplained Infertility.”

The tests to diagnose male infertility involve a general medical questionnaire and a comprehensive physical examination. Your doctor will examine your genitals and rear, as well as ask about your sexual history and habits. While these can be sensitive topics, your honesty will help them come to a diagnosis or treatment plan.

Your doctor will also arrange for you to provide a semen sample for analysis. In most cases, you will be shown to a private room at the doctor’s office where you will masturbate and collect your ejaculate in a sample cup. However, certain religions forbid masturbation. In this case, your doctor can arrange to collect semen in an alternative way, such as a special condom used during intercourse.

The lab technicians then assess your sperm for movement (motility) and shape (morphology), as well as overall numbers. They will also test your semen for signs of infections or other problems. Your sperm count can fluctuate dramatically from one sample to the next for a wide array of reasons, which is why your doctor may arrange for several tests over a span of time.

Your testing may also include the following procedures:

Transrectal ultrasound – In this ultrasound, conducted with a small, lubricated wand, the doctor can check for blockages in your tubes as well as check your prostate.
Hormone testing – Your hormones play a vital role in sperm production and overall sexual health. Your doctor can test your hormone levels via a blood test.
Post-ejaculation urinalysis – In rare cases, your sperm could be travelling backwards into your bladder rather than being ejaculated out of your urethra, resulting in sperm in your urine. This is called retrograde ejaculation.
Scrotal ultrasound – A scrotal ultrasound uses high-frequency sound waves to examine images from inside your testicles and other reproductive structures.
Genetic tests – If you have an extremely low sperm count, your doctor might order genetic testing. These tests can determine if you have slight changes to your Y chromosome, which could reveal a genetic abnormality.
Testicular biopsy – Your doctor might want to take a testicular biopsy from your testicle, which can help assess sperm production and determine if you have a blockage.

Treating Male Infertility

In many cases, doctors can’t find the exact cause of male infertility. That said, they can still help you with recommended treatments or procedures that can help you conceive. Your female partner (if applicable) should also be thoroughly examined.

Some of the most common treatments for male infertility include:

Treating infections – You may have an infection of the reproductive tract and not even know it. Antibiotics can treat most infections, but they may not restore your fertility.
Surgery – If you have a varicocele or an obstructed vas deferens, it can often be corrected with surgery. In some cases, you can also reverse a prior vasectomy. If you have no sperm in your ejaculate, doctors may be able to retrieve it directly from your testicles in a surgical procedure.
Dealing with Sexual Intercourse problems – Premature ejaculation and erectile dysfunction can often be treated with counselling, medication, or a combination of both.
Hormone treatments – If you have a hormonal imbalance, your doctor might prescribe hormone replacement or medications.
Fertility treatments – Fertility treatments such as IUI (intrauterine insemination), IVF (in vitro insemination), or ICSI (intracytoplasmic sperm injection) can help you have a child using your sperm (collected via surgical extraction or masturbation).

In the rare cases where these treatments do not work, you and your partner could also consider using donor sperm to have a child.

How to Increase Your Chances of Pregnancy

Here are some of the most effective ways you can increase your chances of conceiving naturally.

Have sex more often – Have intercourse at least every other day (every day if possible) during the five days before your partner ovulates.
Track your partner’s ovulation – A woman ovulates in the middle of her menstrual cycle, approximately 14 days before her next period. She can track her ovulation using a wearable device, urine testing strips, or by checking her vaginal discharge, which has an ‘egg white’ texture during ovulation.
Say goodbye to lube – Most lubricants, including commercial options and even saliva, can impair sperm motility. If you wish to use lube, ensure you purchase a sperm-safe option.
Try to relax – Stress can cause certain hormones to spike, reducing your fertility. It’s also hard to ‘get in the mood’ when you feel stressed out. Try yoga, meditation, and exercise to reduce your stress levels.
Quit smoking – Nicotine in any form, including smoking, vaping, and chewing tobacco, can all impair your fertility. Now’s the time to quit for good.
Reduce your drinking – Some studies show that even a few drinks a month can lower male fertility and sperm health. So, it’s smart to reduce your alcohol intake to just a few units a week at most.
Say no to drugs – Illegal drugs, such as cannabis and cocaine, reduce male fertility.
Take supplements – Some supplements have been shown to improve sperm quality and count. These include:
- L-carnitine
- Selenium
- Coenzyme Q10
- Folic acid and zinc combination
- Vitamin C
- Vitamin E

How to Cope with Infertility

Trying and failing to conceive is stressful and frustrating and can have long-term mental health repercussions, including depression, anxiety, and PTSD. Keep the lines of communication open with your partner and consider seeking counselling together. It really helps to talk about your feelings during this emotionally fraught process.

Stress-relieving techniques, such as yoga, meditation, acupuncture, and massage therapy, can all help you relax and manage your emotions. Working out, going for a walk, and even getting a dog or cat can all help relieve stress and put you in a better headspace.

It’s worth exploring other routes to parenthood. While this can be a touchy subject, some couples choose to seek parenthood with donor sperm, donor embryos, or through fostering or adoption. There is no ‘one way’ to parenthood.

Finally, some people choose to let go of their dreams of parenthood after years of trying and the stress of failed fertility treatments. This is a painful and difficult choice, but many people describe complex feelings of relief, acceptance, and grief when they decide to stop trying to conceive.