Male infertility can be a difficult subject to talk about.
It can affect a person’s health, relationships, confidence and plans for the future. Old-fashioned ideas about masculinity can make the experience even harder, particularly when fertility problems are wrongly associated with being less of a man.
Infertility is a medical issue, not a measure of masculinity.
Male factors contribute to infertility in a substantial proportion of couples, which is why evaluating the male partner is an important part of a fertility assessment. The American Urological Association (AUA) and American Society for Reproductive Medicine (ASRM) state that male factors are involved in approximately half of infertile couples and that appropriate evaluation of the male partner is important before decisions about treatment are made.
The encouraging part is that some causes of male infertility can be treated, and even when the underlying problem cannot be completely corrected, fertility treatment may still provide a route to pregnancy.
This guide explains the common causes of male infertility, how it is investigated, what treatments may be available and what can help when the emotional side of infertility becomes overwhelming.
What Is Male Infertility?
Male infertility generally means that a man has a problem affecting his ability to contribute to conception.
The problem may involve:
- producing too few sperm
- producing no sperm
- sperm that do not move normally
- sperm with abnormal shape or function
- difficulty delivering sperm during ejaculation
- hormonal or testicular problems
- blockage of the reproductive tract
Sometimes more than one factor is involved.
And in some cases, no clear cause is identified even after investigation.
The NHS notes that abnormal semen may involve a low or absent sperm count, sperm that do not move properly, or sperm with abnormal shape. Many cases of abnormal semen remain unexplained.
Does Male Infertility Mean You Cannot Have Children?
No.
Infertility does not automatically mean that natural conception is impossible.
For example, a low sperm count can make conception more difficult but does not necessarily prevent it. The NHS notes that people with low sperm counts may still conceive naturally and that fertility treatments may help when needed.
The important question is not simply whether a man is fertile or infertile.
It is what is causing the fertility problem and what options are available.
That is why an assessment is so useful.
What Causes Male Infertility?
There are many possible causes.
Problems With Sperm
Sperm quality is one of the most important areas assessed in male infertility.
A semen analysis can identify problems with:
- sperm concentration
- sperm movement, known as motility
- sperm shape, known as morphology
- the overall characteristics of the semen
A low sperm count is one possible finding, but sperm quality is about more than the number of sperm present.
Problems With the Testicles
The testicles produce sperm.
Damage or disorders affecting the testicles can therefore interfere with fertility.
Possible causes include previous infections, injury, surgery, testicular cancer, congenital abnormalities and undescended testicles.
The NHS lists several of these as recognised causes of male infertility.
Hormonal Problems
Hormones help control sperm production.
Low testosterone or other disorders affecting the hormones involved in reproduction can interfere with sperm production.
This is sometimes called hypogonadism.
Importantly, testosterone treatment is not a general fertility treatment. External testosterone can actually suppress sperm production in some men.
The AUA/ASRM guideline advises clinicians not to prescribe testosterone monotherapy to men who wish to preserve current or future fertility.
Anyone considering testosterone treatment while trying to conceive should discuss the issue with an appropriate specialist.
Blockages
Sperm are produced in the testicles and then travel through a series of ducts before being ejaculated.
A blockage can prevent sperm from reaching the semen even when sperm production itself is functioning.
Blockages may occur because of previous surgery, infection, congenital conditions or other causes.
In selected cases, surgery or sperm retrieval can provide treatment options.
Ejaculation Problems
Some men have difficulty ejaculating normally.
This can happen for many medical or neurological reasons, and some medicines or previous procedures can contribute.
Treatment depends on the cause.
Varicocele
A varicocele is an enlargement of veins around the testicle.
It is a relatively common finding and can be associated with abnormal semen parameters in some men.
Not every varicocele needs treatment.
Whether treatment is appropriate depends on the clinical situation and fertility findings.
Can Medicines Affect Fertility?
Yes.
Some medicines can affect sperm production or sexual function.
The NHS lists medicines such as sulfasalazine among possible contributors to fertility problems and notes that its effect on sperm can be temporary. Chemotherapy can also severely reduce sperm production.
Some medicines may be essential for treating another condition, so do not stop prescribed medication simply because you are concerned about fertility.
Talk to the prescriber or fertility specialist first.
What About Anabolic Steroids?
Anabolic steroids are particularly important to mention.
They may be used to increase muscle mass and athletic performance, but prolonged misuse can reduce sperm production and sperm motility.
The NHS specifically identifies anabolic steroid misuse as a cause of fertility problems.
If you are using anabolic steroids and want to have children, discuss this honestly with your doctor.
Hiding steroid use can make it harder for a clinician to identify what is affecting fertility.
Can Smoking Affect Male Fertility?
Smoking can reduce semen quality.
The NHS advises stopping smoking as part of efforts to improve fertility.
Stopping smoking is worthwhile for many reasons, so fertility is simply another strong reason to quit.
Does Alcohol Affect Male Fertility?
Heavy alcohol consumption can affect sperm quality.
The NHS lists alcohol among factors that can affect fertility and notes that excessive drinking can affect sperm quality.
That does not mean that one drink automatically causes infertility.
As with many lifestyle factors, the bigger picture matters.
Can Weight Affect Male Fertility?
Yes.
Being overweight or obese can be associated with poorer fertility.
Weight is only one factor, however, and it should never be used to blame someone for infertility.
A realistic approach to nutrition, physical activity, and weight management may help as part of broader fertility care.
The NHS includes weight among lifestyle factors that can affect fertility.
Does Heat Damage Sperm?
Sperm production works best under conditions that are slightly cooler than core body temperature.
The NHS notes a link between increased scrotal temperature and reduced semen quality, although it also says that evidence is uncertain about whether loose-fitting underwear itself improves fertility.
This is another area where the internet often turns a reasonable biological observation into a long list of exaggerated warnings.
You do not need to panic about every warm seat or hot day.
If there is a genuine fertility problem, proper assessment is much more useful than trying to diagnose it from lifestyle myths.
Can Stress Cause Male Infertility?
Stress can affect relationships, sex drive and general wellbeing.
Severe stress may also affect sperm production in some circumstances.
But infertility is not simply caused by “thinking too much” or being unable to relax.
The NHS lists stress among factors that can affect fertility.
Reducing stress is worthwhile for overall wellbeing, but it should not be used to dismiss a genuine medical fertility problem.
How Is Male Infertility Diagnosed?
A fertility assessment normally begins with a medical and reproductive history.
A clinician may ask about:
- previous pregnancies
- how long you have been trying to conceive
- previous infections
- testicular injury or surgery
- medications
- anabolic steroid or recreational drug use
- alcohol and smoking
- sexual and ejaculation difficulties
- childhood problems such as undescended testicles
- previous cancer treatment
A doctor may also perform a physical examination.
The NHS says a male examination can include checking the testicles for lumps or abnormalities and looking for problems involving the penis.
What Is a Semen Analysis?
A semen analysis is one of the main tests used to investigate male fertility.
It examines the semen and sperm within it.
The test can provide information about sperm concentration, movement and shape.
The NHS identifies semen analysis as the main test for low sperm count.
An abnormal result does not necessarily mean that conception is impossible.
Semen measurements can vary, and results need to be interpreted in the context of the whole clinical picture.
What If the First Semen Test Is Abnormal?
One abnormal result does not automatically establish a permanent fertility problem.
A clinician may recommend repeating the test and carrying out further investigations depending on the findings.
The AUA/ASRM guideline recommends semen analysis as part of the initial male reproductive evaluation and emphasises that reproductive assessment should be guided by the history, examination and test results.
Are Blood Tests Used?
They can be.
Blood tests may be used to investigate hormone problems, particularly when the semen analysis or clinical history suggests an endocrine cause.
The exact tests depend on the person and the suspected problem.
Not everybody with a fertility concern needs the same collection of blood tests.
Are Ultrasounds or Scans Needed?
Sometimes.
Imaging may be considered when a physical examination or history suggests an anatomical problem.
Scrotal ultrasound can help investigate certain abnormalities, although it is not automatically required for every man undergoing a fertility evaluation.
The purpose of additional testing is to answer a specific clinical question rather than simply to order every test available.
Can Genetics Play a Role?
Yes.
Some forms of severe male infertility are associated with genetic abnormalities.
The AUA/ASRM guideline recommends genetic evaluation in selected men with very low sperm counts or no sperm in the ejaculate when appropriate, because genetic information can affect diagnosis, treatment and counselling.
Genetic testing is therefore something to discuss with a fertility specialist when the clinical findings make it relevant.
Can Male Infertility Be Treated?
Sometimes, yes.
Treatment depends entirely on the cause.
Possible approaches include:
- treating an underlying medical or hormonal problem
- stopping a fertility-impairing medicine when a safe alternative exists
- surgery for selected anatomical problems
- surgical sperm retrieval
- intrauterine insemination
- in vitro fertilisation
- intracytoplasmic sperm injection
- donor sperm in appropriate circumstances
The AUA/ASRM guideline emphasises that some male-factor conditions are treatable medically or surgically, while others require assisted reproductive technologies or other options.
What Is IUI?
Intrauterine insemination (IUI) involves placing prepared sperm directly into the uterus around the time of ovulation.
IUI may be considered in selected fertility situations, depending on sperm quality and the circumstances of both partners.
It is not appropriate for every couple.
What Is IVF?
In vitro fertilisation (IVF) involves fertilising an egg with sperm in a laboratory and then transferring an embryo to the uterus.
The NHS lists IVF as one of the main forms of assisted conception.
What Is ICSI?
Intracytoplasmic sperm injection (ICSI) is a form of assisted reproduction in which an individual sperm is injected directly into an egg.
It can be particularly useful when male-factor infertility makes conventional fertilisation difficult.
The AUA/ASRM guideline includes IVF with or without ICSI among assisted reproductive technologies used in the management of male infertility.
Can Sperm Be Retrieved Surgically?
In some situations, yes.
If sperm are being produced but cannot reach the semen because of an obstruction or another problem, sperm may sometimes be retrieved directly from the reproductive tract or testicle.
The NHS describes surgical sperm retrieval as an option for selected men with obstruction, absence of the vas deferens, or previous vasectomy when other approaches are not suitable.
Do Supplements or “Male Fertility Boosters” Work?
Be cautious.
The fertility supplement market is full of products promising to increase sperm count, boost testosterone or dramatically improve fertility.
Some nutrients are important for normal health, but that does not mean a particular supplement will solve infertility.
The NHS says there is no evidence that complementary therapies for fertility problems are effective.
Do not assume that a supplement is harmless simply because it is labelled natural.
Tell your clinician about supplements, herbal products and over-the-counter medicines you are taking.
What About Antioxidants?
Antioxidant supplements are often marketed for male fertility.
Research into individual supplements has produced mixed findings, and a supplement should not replace a proper fertility assessment.
The important question is not whether an ingredient appears in a fertility product.
It is whether strong evidence shows the specific intervention improves meaningful outcomes for the people using it.
Should You Change Everything About Your Lifestyle?
Probably not.
A better approach is to identify sensible improvements without turning fertility into an exhausting self-improvement project.
Stop smoking if you smoke.
Avoid anabolic steroids.
Keep alcohol within sensible limits.
Aim for a healthy weight where appropriate.
Eat a varied diet.
Stay physically active.
Manage other medical conditions.
And get a proper assessment rather than spending months trying random fertility hacks from the internet.
How Long Should You Try Before Seeking Help?
The right timing depends on age, medical history, and each partner’s circumstances.
The NHS advises seeking medical advice when a couple has been having regular unprotected sex without conceiving for a year, or sooner in some circumstances such as when the female partner is 36 or older.
You should also seek advice earlier when there is a known or suspected fertility problem, previous testicular disease or treatment that could affect fertility, or other relevant medical concerns.
What About the Emotional Side of Male Infertility?
This part is often overlooked.
Infertility can produce grief, anger, embarrassment, guilt, frustration and anxiety.
Some men feel that fertility problems make them less masculine.
They do not.
Sperm production is a biological function.
It is not a measure of courage, worth, sexual ability or whether someone is a good partner.
It is also important to remember that infertility affects couples, not just individuals.
The American Society for Reproductive Medicine recognises that infertility can be emotionally and financially taxing and supports access to psychological counselling and other forms of support.
Should You Talk to Your Partner?
Yes.
Keeping infertility hidden can make an already stressful situation harder.
Different people react in different ways.
One partner may want to talk about every appointment.
Another may need time alone.
Neither response automatically means that somebody cares less.
Try to keep the problem on the same side of the table rather than turning it into a competition over who is responsible.
Does Male Infertility Mean the Relationship Is Doomed?
No.
Infertility can put enormous pressure on a relationship, particularly when treatment becomes expensive, time-consuming or emotionally draining.
But the diagnosis itself does not determine what happens next.
Couples may benefit from counselling, support groups or simply making time for parts of their relationship that are unrelated to fertility treatment.
Your life together is bigger than a semen analysis.
How Can Men Cope Better With Infertility?
Start by accepting that difficult emotions are normal.
You do not have to pretend that infertility does not bother you.
It can help to:
- talk honestly with your partner
- ask your healthcare team questions
- keep medical information organised
- avoid blaming yourself or your partner
- take breaks from fertility discussions when you need them
- seek counselling if the stress becomes overwhelming
- be cautious of online claims promising miracle cures
You do not have to solve everything at once.
The next useful step is enough.
What If No Cause Is Found?
Sometimes investigations do not identify a clear explanation.
That can be especially frustrating because there is no obvious problem to fix.
The AUA/ASRM guideline recognises that male infertility can remain unexplained after evaluation.
An unexplained diagnosis does not mean that nothing can be done.
A fertility specialist can discuss whether further investigation, assisted conception or other options are appropriate.
What Should You Avoid?
Avoid spending large amounts of money on products that promise to “cure” male infertility.
Avoid taking testosterone without discussing future fertility.
Avoid anabolic steroids if you are trying to conceive.
Avoid stopping prescribed medication without professional advice.
Avoid blaming yourself or your partner.
And avoid assuming that one abnormal sperm test tells you the whole story.
Fertility is too important to be reduced to a single number.
The Bigger Picture
Male infertility is a medical problem, not a verdict on masculinity.
There are many possible causes, from sperm-production problems and hormonal disorders to blockages, testicular conditions, medication effects and genetic factors.
Some causes can be treated directly.
Others may be managed with assisted reproductive techniques such as IUI, IVF or ICSI.
And sometimes no single cause can be found.
The most useful thing you can do is move from guesswork to assessment.
A proper history, examination and semen analysis can provide much more useful information than a cupboard full of supplements.
And while the medical side matters, do not ignore the emotional side.
You are not less of a man because you have a fertility problem.
You are dealing with a health issue.
Asking for help is not weak.
Recommended Further Reading:
- Vitamin D: Why It Matters, Food Sources and When Supplements Help
- Balanced Diet: The Evidence-Based Guide to Healthy Eating
- Nutrition Terms Explained: RDA, DRI, EAR, AI and UL
Medical Disclaimer
This information is provided for general educational purposes only. It is not intended to diagnose, treat or prevent any medical condition and should not be considered a substitute for advice from a qualified healthcare professional.
Infertility has many possible causes and requires individual assessment. Anyone concerned about fertility should speak with a GP, urologist, reproductive specialist or appropriately qualified fertility professional.
Do not stop prescribed medicines or begin hormone treatment, supplements or other fertility treatments without appropriate professional advice.
Infertility can be emotionally difficult. Seek professional support if the psychological impact becomes difficult to manage.
Do not use this article as a substitute for individual medical assessment or professional guidance.
Sources:
- https://www.ncbi.nlm.nih.gov/books/NBK562258/
- https://www.auanet.org/meetings-and-education/for-medical-students/medical-students-curriculum/male-infertility
- https://www.medlineplus.gov/maleinfertility.html
- https://www.hopkinsmedicine.org/health/conditions-and-diseases/male-infertility
Male Infertility Coming To Terms → /male-infertility/
Male Infertility and Its Causes → /male-infertility/