Infertility In Men

Overview

Male infertility means a man has a problem with his fertility that makes it harder for him and his partner to conceive (get pregnant). It is not about being 'less of a man', and it is not anyone's fault. In many cases, the sperm are not being made in the usual numbers, are not moving well, or cannot reach the egg. Sometimes the cause is a blockage, a hormone problem, or an issue that has been there since birth. Often no clear cause is found, but doctors can still offer help.

Yes. Around 1 in 7 couples struggle to get pregnant within a year, and male factors play a part in roughly half of those cases. So if you are in this situation, you are far from alone.

Any man can be affected, whatever his age, background or health history. Fertility tends to decline slowly with age, and some medical conditions, medicines, injuries or treatments (such as cancer treatment) can raise the risk. But many men with infertility have no obvious risk factors at all.

Symptoms

Common symptoms

• Being unable to get a partner pregnant after a year of regular, unprotected sex — this is the most common sign
• No symptoms at all — many men feel perfectly well
• Low sex drive (low libido) in some cases
• Problems getting or keeping an erection, or difficulty ejaculating
• Small or shrinking testicles, or a soft feeling to the testicles
• Aches, swelling or a heavy feeling in the scrotum (the pouch that holds the testicles)
• Less body or facial hair, or some breast enlargement — these can point to a hormone problem
• Small amounts of semen when ejaculating, or semen that looks different

Symptoms in children

• Infertility itself is not diagnosed in children, but some conditions that affect future fertility show up early
• One or both testicles that have not come down into the scrotum by around 6 months of age (undescended testicles)
• Puberty that starts very late or does not seem to start
• A small penis or unusual genital appearance noticed by a parent or doctor
• Repeated hernia or groin surgery in childhood — worth mentioning to a doctor later in life

Symptoms in older adults

• Fertility in men gradually lowers with age, so conceiving can take longer
• Other health conditions (such as diabetes or heart disease) and their treatments can affect fertility
• Some long-term medicines can reduce sperm production or sex drive — a pharmacist or doctor can review them
• Erection or ejaculation problems become more common with age and can be treated

Causes

Main causes

• Problems with sperm production — sperm may be made in low numbers, move poorly, or be shaped abnormally; the cause is often not found
• A varicocele — swollen veins inside the scrotum that can warm the testicles and affect sperm
• Blockages in the tubes that carry sperm, sometimes from past infection, injury or surgery
• Hormone problems — the brain and the testicles do not communicate as they should
• Past infections such as mumps in adulthood, or sexually transmitted infections that cause scarring
• Genetic conditions that affect how sperm are made
• Medicines or treatments such as chemotherapy or radiotherapy
• Undescended testicles in childhood, or injury to the testicles
• Ejaculation problems, such as semen going into the bladder instead of out (retrograde ejaculation)
• Lifestyle factors working together — smoking, heavy drinking, obesity, heat and stress

Risk factors

• Smoking or vaping, and using recreational drugs
• Drinking a lot of alcohol regularly
• Being overweight or very inactive
• Long-term heat exposure — hot tubs, saunas, laptops on the lap, tight underwear, or working in very hot places
• Long-term stress, poor sleep or severe tiredness
• Some prescription medicines — always ask before stopping anything
• Past cancer treatment, pelvic surgery, or injury to the groin
• Health conditions such as diabetes, thyroid problems or obesity
• Age — fertility slowly lowers over the years

When to see a doctor

See a doctor urgently if:

• Sudden severe testicular pain, or a swollen, hot, red and painful scrotum — seek emergency care
• A new lump or hard area in a testicle — get this checked the same day if possible
• Blood in the semen that continues, or comes with pain or fever
• Painful ejaculation that keeps happening

Book a routine appointment if:

• You and your partner have been trying for a baby for a year without success (after 6 months if your partner is over 35)
• You have a known risk factor — past testicular injury, undescended testicles, cancer treatment, or groin surgery
• You have a low sex drive, erection or ejaculation problems, or small testicles
• You have had mumps, a sexually transmitted infection, or repeated urinary infections
• You are about to start a medicine or treatment that might affect fertility — ask about preserving sperm first
• You feel anxious or low about fertility — talking about it early really helps

Diagnosis

A doctor will talk with you about how long you have been trying, your past health, operations, infections, medicines, and lifestyle. They will examine you, including your testicles, and usually arrange a sperm test called a semen analysis. Because fertility is a couple's issue, your partner will usually be offered tests too — that is normal and helps build the full picture.

Tests that may be done

• Semen analysis — a sperm sample checked in a lab for number, movement and shape; often repeated after a few weeks because results vary
• Physical examination of the penis, testicles and scrotum
• Blood tests to check hormone levels, such as testosterone and the hormones that control sperm production
• Blood tests to rule out infection or other health conditions
• An ultrasound scan of the scrotum, or of the prostate area if a blockage is suspected
• Genetic tests in some cases, especially if sperm numbers are very low
• A urine test after ejaculation, to check for retrograde ejaculation
• Tests for your partner at the same time, so you get the whole picture

What to expect at your appointment

Most of the tests are quick and simple. For a semen sample, you usually produce it privately at the clinic or at home and bring it in within a short time — the clinic will explain exactly what to do. You may need to avoid ejaculating for 2 to 5 days beforehand. Results often take a week or two. You may need two or three appointments before the full picture is clear. Bring your questions, and ask for a copy of your results so you can keep track.

Treatment

Treatment depends on what is found. If there is no clear cause, which is common, doctors still have good options. The plan is usually built step by step: first, treating any underlying problem and improving lifestyle; then, if needed, specialist fertility treatments. Many couples conceive naturally after simple changes, and others are helped with assisted reproduction. Your doctor will talk you through the choices, their chances of success, and what they involve, so you can decide together.

Self-care at home

• Stop smoking and avoid recreational drugs — this is the single biggest change many men can make
• Cut down on alcohol, ideally to very little or none while trying to conceive
• Keep the testicles cooler: avoid hot tubs and saunas, tight underwear, long laptop-on-lap sessions, and long bike rides in tight shorts
• Move more and aim for a healthy weight — even modest weight loss can improve sperm quality
• Eat a balanced diet rich in fruit, vegetables, whole grains, nuts and fish, and low in processed food
• Get regular sleep and find ways to manage stress
• Review your medicines with a doctor or pharmacist — never stop a prescribed medicine on your own
• Avoid anabolic steroids and bodybuilding supplements, which can shut down sperm production
• Have sex every 2 to 3 days around your partner's fertile window rather than saving up — regular ejaculation helps sperm quality

Medical treatments

Treatment is matched to the cause. If a hormone problem is found, a specialist may prescribe treatment to correct it — the type and dose are decided only by your specialist. Infections are treated with appropriate antibiotics prescribed by a doctor. If a blockage or a varicocele is found, surgery may be offered. When no cause is found, or when simpler steps do not work, fertility treatments are available. These include putting sperm directly into the womb (intrauterine insemination), or IVF (in vitro fertilisation — where eggs and sperm are brought together in the lab), sometimes with a technique that injects a single sperm into an egg (ICSI). If sperm are not present in the semen at all, specialists can sometimes collect sperm directly from the testicles. Your fertility team will explain which options suit you, the realistic chance of success, and the costs, which vary between services.

When is surgery considered?

Surgery can help in a few situations: repairing a varicocele (swollen veins in the scrotum), clearing a blockage in the tubes that carry sperm, or reversing a vasectomy. Surgery is also used to collect sperm directly from the testicle when none are present in the semen. Surgery is not right for everyone, and your specialist will explain the benefits of the procedure and also what could go wrong before you decide.

Living with this condition

Fertility problems can affect every part of life — your mood, your relationship, your sleep and your sense of self. It is normal to feel sad, frustrated or angry at times. Try to see it as a health issue you are tackling together rather than a personal failing. Keep talking with your partner, keep doing normal things you both enjoy, and set limits on how much you talk about fertility with family and friends if it starts to feel heavy.

Lifestyle tips

• Keep sex regular and relaxed — timing it only to ovulation can add pressure and strain the relationship
• Stay active with something you enjoy; moderate exercise supports fertility
• Limit caffeine and avoid energy drinks; keep alcohol low or zero
• Protect your sleep — aim for 7 to 8 hours where you can
• Avoid heat and chemicals at work; ask your employer about safety measures
• Keep a simple record of appointments and results so you feel in control
• Plan breaks from fertility talk — set aside 'no fertility chat' times
• Ask about counselling; fertility clinics usually offer it and it can be very helpful

Diet and exercise

A balanced Mediterranean-style way of eating — plenty of vegetables, fruit, beans, nuts, whole grains, olive oil and fish, with less processed meat and sugary food — is linked with better sperm health. Drink water through the day. Regular moderate exercise such as brisk walking, swimming, cycling (avoid tight shorts for long periods) or strength work helps weight, mood and hormone balance. Very intense endurance training and anabolic steroids can work against fertility, so aim for balance rather than extremes.

Mental health and emotional wellbeing

Fertility struggles can cause real grief, anxiety and low mood in men, and many men find it hard to speak up. You are not weak for finding this hard. Depression and anxiety are common and treatable, and talking about it helps. If you feel persistently low, hopeless, or are having thoughts of harming yourself, please reach out straight away — contact your doctor, a local crisis line, or your local emergency number if you are in danger. Support is available and things can get better.

Prevention

Not all infertility can be prevented — some causes are genetic or present from birth. But many lifestyle factors are within your control, and improving them often helps sperm quality. Stopping smoking, keeping alcohol low, staying a healthy weight, avoiding heat and anabolic steroids, and reviewing medicines with a doctor all make a real difference. It is never too late to make a start.

Vaccines

Make sure you are up to date with routine vaccinations, including the one that protects against mumps. Mumps in adulthood can cause swelling of the testicles, which can affect fertility. Your doctor can check your vaccination history.

Screening programmes

There is no routine screening test for male infertility. The main check is a semen analysis, which is arranged if you have been trying to conceive without success or have risk factors. Be aware of your testicles — a monthly self-check in a warm shower, feeling for lumps or changes, helps you notice anything new and get it checked quickly.

Complications

If left untreated

• Continued difficulty conceiving, which can be disappointing and frustrating
• Relationship strain and loss of closeness if worries are not shared
• Anxiety, low mood or depression in some men
• An underlying health problem, such as a hormone or genetic condition, staying undiagnosed
• In some cases, missed early warning signs of a testicular problem — which is why lumps should always be checked

Long-term outlook

The outlook is genuinely encouraging. Many couples conceive naturally after simple changes, and fertility treatments help many more. Sperm quality can improve within about 2 to 3 months of healthy changes, because that is how long a new sperm takes to mature. Even when sperm numbers are low, modern treatments can often help. Whatever happens, you deserve clear information, good support and time to decide what is right for you.

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