Male Infertility

Male infertility means that a problem affecting a man's reproductive system reduces the chance of his partner conceiving. A couple is usually assessed for infertility after trying to conceive for about a year without success (or sooner if the woman is older or there are known problems).

It is common: male-factor problems contribute to around half of cases where couples struggle to conceive, either on their own or alongside a female-factor problem. This is why both partners are assessed together.

Fertility depends on the testicles making enough healthy sperm, hormones that support sperm production, and an open pathway for sperm to be ejaculated and reach the egg. A problem at any of these stages can lower fertility.

Most male infertility comes down to sperm: too few (a low count), sperm that do not move well, sperm with an abnormal shape, or no sperm in the semen at all (azoospermia).

In most cases the only sign is difficulty conceiving — there are usually no other symptoms. Occasionally there may be clues to an underlying cause, such as swelling or a lump in the testicle, problems with sexual function, or signs of a hormonal imbalance.

Because there are often no outward signs, testing is the only reliable way to find out whether there is a male-factor problem and what is causing it.

Common causes include a varicocele (enlarged veins in the scrotum), hormonal problems that reduce sperm production, blockages that stop sperm reaching the semen, infections, and genetic conditions. A history of an undescended testicle, previous surgery, or cancer treatment such as chemotherapy can also affect fertility.

Lifestyle and environmental factors can play a part too, including smoking, heavy alcohol use, being significantly overweight, heat exposure, and certain medications. For some men, no clear cause is found despite testing.

The key test is a semen analysis, which measures the number of sperm, how well they move, and their shape. Because results can vary, the test is often repeated. A physical examination and a review of your medical history help look for causes such as a varicocele.

Depending on the findings, further tests may include blood tests for hormones, a scrotal ultrasound, and genetic tests. These help identify a treatable cause and guide the best approach for you as a couple.

Treatment depends on the cause. Where there is a specific, treatable problem, options include surgery to repair a varicocele, medication for a hormonal imbalance, or treating an infection. General health measures — stopping smoking, reducing alcohol, reaching a healthy weight, and avoiding excess heat — can also help sperm quality.

When conceiving naturally is difficult, assisted reproduction is often very effective. This ranges from intrauterine insemination (IUI) to IVF, and in particular IVF with ICSI, where a single sperm is injected directly into an egg. For men with no sperm in the semen, sperm can often be collected directly from the testicle (surgical sperm retrieval, including micro-TESE) and used with ICSI.

Looking after your general health supports fertility: not smoking, keeping alcohol within safe limits, staying physically active, maintaining a healthy weight, and avoiding prolonged heat to the testicles (such as very hot baths). Tell your doctor about any medicines or supplements you take, as some can affect fertility.

Because fertility involves both partners, being assessed and supported together gives the clearest picture and the best plan.

The outlook is often good. Many causes of male infertility can be treated, and even when sperm are very few or absent, assisted reproduction — especially IVF with ICSI and surgical sperm retrieval — helps many couples have a baby.

Not every cause can be prevented, but protecting your general and reproductive health helps. Where fertility may be affected by upcoming treatment such as chemotherapy, storing sperm beforehand keeps future options open. A fertility specialist can explain what is realistic in your situation.