Male infertility is a health condition that can make it harder for a couple to achieve pregnancy. Responsible for about 50% of infertility cases, it is more common than previously estimated. Male infertility may involve sperm production, sperm movement or shape, a blockage that prevents sperm from entering semen, or difficulty with erections or ejaculation. It often has no obvious symptoms, and should be assessed as part of the couple’s fertility care.
What does male infertility mean?
Male infertility is a condition in which a man has difficulty contributing to a pregnancy due to problems with sperm production, sperm quality, sperm movement, or the delivery of sperm during ejaculation. It may result from hormonal imbalances, genetic conditions, infections, lifestyle factors, or blockages in the reproductive tract. A medical evaluation, including semen analysis, can help identify potential causes and guide appropriate treatment.
Common causes
Possible causes include a low sperm count or no sperm in the ejaculate, reduced sperm movement, or a high proportion of sperm with atypical shapes. These findings can be related to hormone problems, genetic conditions, prior infections, testicular injury or surgery, an obstruction, or a varicocele, which is an enlarged vein around the testicle. In some cases, the cause is not identified.
Some medicines and health conditions can affect sperm. Testosterone treatment and anabolic steroids can suppress sperm production. Smoking, heavy alcohol use, some recreational drugs, obesity, and repeated exposure to excessive heat may also be relevant, though lifestyle changes cannot correct every medical cause.
How is male infertility diagnosed?
The evaluation usually starts with a reproductive and medical history, including previous pregnancies, sexual function, medications, illnesses, surgeries and family history. A clinician may perform a physical examination. Semen analysis checks the volume of the sample and measures sperm concentration, movement and shape. Because semen results can vary, repeat testing may be recommended.
Depending on the result and history, additional tests can include hormone blood tests, genetic testing like Sperm DNA fragmentation index, ultrasound or other imaging, and assessment for obstruction or infection. The specialist should explain what each test can answer and how its result may change treatment.
Treatment options
Treatment is based on the cause and the couple’s overall fertility picture. Options may include treating an infection or hormone imbalance, reviewing medicines, or surgery for selected obstructions or varicoceles. Some men with hormonal causes may benefit from specialist-prescribed medicines. Lifestyle measures such as stopping smoking, avoiding anabolic steroids, moderating alcohol and managing chronic health conditions can support general and reproductive health.
When sperm count or function is significantly affected, assisted reproductive techniques may be considered. In vitro fertilisation (IVF) with intracytoplasmic sperm injection (ICSI) allows a selected sperm to be injected into an egg. If sperm are absent from the ejaculate, surgical sperm retrieval may sometimes be possible. The most suitable approach depends on test results, egg factors, age, treatment history and patient preferences.
When should you seek help?
Consider an assessment if you have been trying to conceive without success, have a history of testicular or reproductive surgery, chemotherapy, sexual difficulties, a known hormonal or genetic condition, or a previous semen result outside the expected range. Male infertility is not a measure of masculinity, and many causes can be managed. Early evaluation can clarify the options for both partners.
Learn more from Nordica’s male factor infertility service page, Dr Abayomi Ajayi’s article on azoospermia, ASRM’s patient guide to male fertility evaluation, and the NHS guide to infertility.
