male infertility risks and benefits for patients

Overview

Male infertility means a man has difficulty getting his partner pregnant, even after having regular, unprotected sex for a year or more. It is often related to problems with sperm production, sperm quality, or blockages that stop sperm from reaching the egg. It is a medical condition, not a measure of masculinity, and it can affect anyone.

Yes. Around 1 in 7 couples have difficulty getting pregnant, and a male factor contributes in almost half of these cases. It affects millions of men worldwide.

It can affect men of any age, though fertility gradually declines after age 40. It can affect men who already have children, men with no children, and men with a wide range of health histories. Because fertility involves a couple, it also affects partners and relationships.

Symptoms

Common symptoms

• No obvious signs — many men feel completely healthy
• Difficulty getting your partner pregnant after one year of regular unprotected sex
• Lower sperm count or poor sperm movement, found only through a fertility test
• Problems with sexual function, such as erectile difficulties or trouble ejaculating
• Pain, swelling, or a lump in the testicle area

Symptoms in children

• Male infertility is usually only diagnosed after puberty. In children, warning signs are rare, but one or both testicles not descending in infancy, genital injury, or very late puberty may need evaluation by a doctor.

Symptoms in older adults

• Fertility naturally declines with age, so it may take longer to conceive as a man gets older.
• Older men are more likely to have health conditions such as diabetes or hormonal changes that can affect fertility.

Causes

Main causes

• Problems with sperm production — the testicles make too few sperm, or the sperm do not move or form normally
• Blockages in the tubes that carry sperm, which can stop sperm from reaching the penis
• Hormone imbalances, including low levels of male hormones
• Infections that affect the testicles or the tubes that carry sperm
• Genetic conditions, such as a missing or extra chromosome
• Undescended testicles at birth
• Damage to the testicles from injury, surgery, or previous illness

Risk factors

• Smoking and vaping
• Drinking too much alcohol
• Using recreational drugs, including marijuana and anabolic steroids
• Being overweight or severely underweight
• Older age, especially over 40
• Frequent exposure of the testicles to heat, such as saunas, hot baths, or very tight underwear
• Certain medicines and treatments, including some blood pressure medications, testosterone therapy, and chemotherapy
• Medical conditions such as diabetes, chronic kidney disease, or thyroid problems

When to see a doctor

See a doctor urgently if:

• You feel a new lump or hardening in a testicle
• You have sudden or severe pain in a testicle
• You notice blood in your semen

Book a routine appointment if:

• You and your partner have been trying to conceive for one year or more without success
• You have a low sex drive, trouble getting or keeping an erection, or problems with ejaculation
• You have had testicular surgery, infections, or injuries in the past
• You have a condition or take medication that can affect fertility and you plan to have children

Diagnosis

A doctor can evaluate male infertility through a detailed conversation about your health, lifestyle, and family history, followed by a physical exam and simple tests. Fertility testing usually involves both partners, because the cause may be on either side or on both sides.

Tests that may be done

• Semen analysis — a test that checks sperm count, movement, and shape
• Physical examination — checking the testicles, penis, and the tubes for any abnormalities
• Hormone blood tests — to check whether hormone levels are balanced
• Urinalysis after ejaculation — to check for problems with ejaculation
• Genetic testing — in some cases, to look for inherited conditions

What to expect at your appointment

Fertility testing is usually painless. You will be asked to produce a semen sample after avoiding ejaculation for a few days. Your doctor will explain each step, and you may be referred to a fertility specialist or a urologist. Results may take several weeks, but they will help guide the next steps clearly.

Treatment

Treatment for male infertility depends on the cause. Options range from simple lifestyle changes to medical treatments, surgery, and assisted conception. Many men can become fathers, even with a low sperm count or other fertility problems.

Self-care at home

• Stop smoking and avoid recreational drugs
• Limit alcohol to within recommended guidelines
• Keep a healthy weight through balanced meals and regular exercise
• Avoid heat exposure to the testicles, such as hot baths or saunas
• Ask your doctor whether any medicines you take can affect fertility
• Try to reduce stress with physical activity, talking to someone, or mindfulness

Medical treatments

Medical treatment depends on the cause. Some men benefit from hormone treatments to correct imbalances, while others may need treatment for an underlying health condition. Doctors may also use assisted reproduction techniques, such as intrauterine insemination (IUI) or in vitro fertilisation (IVF), sometimes with a procedure that collects sperm directly from the testicles. In the UK, some treatments are available through the NHS, but availability varies depending on where you live.

When is surgery considered?

Surgery may be recommended for certain causes, such as a varicocele (enlarged veins in the scrotum), a blocked tube, or to retrieve sperm directly from the testicles. Surgery to repair a previous vasectomy can also be an option for some men.

Living with this condition

Male infertility is managed over time, not overnight. The emotional side can be as important as the physical side. It helps to communicate openly with your partner, take part in appointments together, and set realistic expectations. Fertility treatment can take months, and support from friends, family, or counsellors can make the journey easier.

Lifestyle tips

• Wear loose-fitting underwear and avoid sitting for long periods without breaks
• Sleep enough and manage stress — both support hormonal health
• Avoid hot tubs, saunas, and placing electronic devices on your lap for long periods
• Stay up to date with general health checks, such as blood pressure and blood sugar

Diet and exercise

A healthy diet with plenty of vegetables, fruits, whole grains, lean proteins, and healthy fats supports general health. Some studies suggest that antioxidants in fruits and vegetables are good for sperm health. Regular physical activity helps maintain a healthy weight, but excessive endurance training may lower sperm production, so moderate exercise is best.

Mental health and emotional wellbeing

Infertility can be very stressful. It can cause anxiety, low mood, guilt, and strain in relationships. These feelings are normal and important to address. Talking to a counsellor or a therapist who understands fertility issues can help. If you often feel down, anxious, or hopeless, please speak to your GP or a mental health professional.

Prevention

Some causes of male infertility cannot be prevented, but many risk factors are within your control. Avoiding smoking, limiting alcohol, keeping a healthy weight, protecting against sexually transmitted infections, and reducing heat exposure to the testicles all help protect fertility.

Vaccines

There is no vaccine specifically for male infertility. However, staying up to date with general vaccinations can prevent infections such as mumps, which can sometimes affect fertility if it causes testicular inflammation.

Screening programmes

There is no routine fertility screening for the general public. If you have risk factors or concerns, ask your doctor for a check-up. Regular self-examination of the testicles helps you notice any lumps or changes early.

Complications

If left untreated

• Difficulty or inability to conceive a child naturally
• An underlying health issue, such as a hormonal problem or testicular disease, could go undetected
• Stress and emotional strain in a relationship
• In rare cases, a testicular tumour could be missed if the cause of swelling or pain is not investigated

Long-term outlook

The outlook for male infertility is often very good. Many causes can be treated, and modern assisted reproduction helps many couples build a family. In some cases, the path may be long, but with the right medical advice and support, most men have real options. Medical treatment has never been more advanced.

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