male infertility that comes and goes

Overview

Male infertility is when a man has difficulty getting his partner pregnant. When we say it 'comes and goes,' we mean that a man's fertility can change over time. Sperm count, shape, and movement may vary from month to month, and sometimes a period of poor fertility may improve on its own or with simple changes. It is not a constant, unchanging condition for every man.

Yes, it is fairly common. Up to 1 in 7 couples have difficulty conceiving, and male factors play a role in about half of those cases. Many men have temporary or fluctuating fertility issues at some point.

It can affect men of any age after puberty, but it becomes more likely as men get older. It can affect men who have had no previous fertility problems, as well as those with conditions like varicocele, hormone imbalances, or a history of infections.

Symptoms

Common symptoms

• No obvious symptoms — the only sign may be trouble conceiving after a year of regular unprotected sex.
• Changes in sex drive or erectile function (though these are not always related).
• Discomfort, swelling, or a dull ache in the testicles (may be intermittent).
• Problems with ejaculation, such as low volume or painful ejaculation.

Symptoms in children

• Male infertility is not typically diagnosed in childhood. However, certain conditions present from birth, like undescended testicles or hormonal disorders, may affect future fertility and should be monitored by a pediatrician.

Symptoms in older adults

• In older men, the same symptoms may appear, but there may also be changes related to prostate health or other age-related conditions. These should be discussed with a healthcare provider.

Causes

Main causes

• Heat exposure — spending a lot of time in hot baths, saunas, or wearing tight clothing can temporarily lower sperm count.
• Illness or fever — a significant illness can disrupt sperm production for several weeks or months.
• Stress — high stress levels may affect hormones that control sperm production.
• Poor sleep or excessive fatigue — sleep disturbances can affect fertility hormones and sperm quality.
• Too much or too little exercise — extreme training can reduce sperm quality, while a sedentary lifestyle can also be harmful.
• Alcohol, smoking, or recreational drug use — these can temporarily lower sperm quality and count.
• Certain medical conditions — infections, sexually transmitted infections, thyroid problems, or hormonal imbalances can cause intermittent fertility issues.
• Varicocele — a varicose vein (enlarged vein) in the scrotum that may cause sperm quality to fluctuate.
• Medications — some prescription and over-the-counter medicines can temporarily affect fertility (always ask your doctor about this).

Risk factors

• Being overweight or obese.
• Age over 40 (fertility slowly declines with age).
• Smoking or using tobacco products.
• Drinking alcohol heavily or regularly.
• Using recreational drugs like marijuana, cocaine, or anabolic steroids.
• Working in hot environments (e.g., bakery, welding, or spending long hours sitting).
• Exposure to pesticides, heavy metals, or radiation.
• History of testicular infections, injury, or prior surgeries in the groin area.

When to see a doctor

See a doctor urgently if:

• If you experience sudden severe testicular pain or swelling, seek emergency care immediately.
• If you have a high fever with testicular pain or swelling, call a doctor or visit urgent care the same day.

Book a routine appointment if:

• If you and your partner have been trying to conceive for 12 months or more with no success, schedule an appointment.
• If the female partner is over 35, it is recommended to see a doctor after 6 months of trying.
• If you have concerns about your fertility, desire children soon, or notice persistent testicular discomfort or changes in sexual function, it is reasonable to talk to your doctor earlier.

Diagnosis

Your doctor will begin by taking a detailed history of your health, lifestyle, and any medications you use. They will also ask about your sexual history and any past infections or surgeries. The doctor will examine you, often including a physical exam of the testicles and scrotum.

Tests that may be done

• Semen analysis — the most important test. It looks at sperm count, shape, and movement. Because fertility can fluctuate, more than one sample may be needed weeks apart.
• Blood tests — to check hormone levels such as testosterone, follicle-stimulating hormone (FSH), and others.
• Ultrasound of the scrotum — can check for varicocele, blockages, or other structural issues.
• Urine tests — sometimes used to check for infections or signs of retrograde ejaculation.
• Genetic testing — only in certain cases, if a cause is suspected or before some fertility treatments.

What to expect at your appointment

A diagnosis is not a final label. Your doctor will explain what the tests show, discuss whether the pattern suggests a temporary or treatable cause, and work with you to make a plan. It is okay to ask questions and to bring your partner with you for support.

Treatment

Treatment depends on what is causing the fertility issues. Because the problem may be temporary, lifestyle changes alone can be effective in many cases. Your doctor may also recommend treating any underlying medical condition or using assisted reproductive techniques. The goal is always to improve your chances of achieving a pregnancy, not to assign blame.

Self-care at home

• Reduce heat exposure: avoid hot baths, saunas, and tight underwear; try loose-fitting boxer shorts.
• Quit smoking and limit alcohol (in moderation, if at all).
• Get regular, moderate exercise (like brisk walking, cycling, or swimming) but avoid extreme endurance training.
• Aim for 7–8 hours of good-quality sleep each night.
• Manage stress — consider deep breathing, meditation, or talking to a counselor.
• Eat a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats.

Medical treatments

Your doctor may suggest treatments for specific causes. For example, if a hormone imbalance is found, hormonal therapy may be discussed. If an infection is present, antibiotics may be prescribed. In some cases, assisted reproduction methods like intrauterine insemination (IUI) or in vitro fertilization (IVF) can be an option. Medications, when used, are chosen based on your individual situation and are always discussed with you first.

When is surgery considered?

In some cases, surgery may be recommended. For example, a varicocele can sometimes be repaired surgically to improve sperm quality. Other procedures might be used to correct blockages in the tubes that carry sperm. Surgery is not needed for everyone, and your doctor will explain the potential benefits and risks before any procedure.

Living with this condition

Living with fertility concerns can be emotionally challenging. On a day-to-day basis, focus on taking care of your body and your relationship. Keep up with healthy routines, communicate openly with your partner, and try not to turn sex into a 'scheduled task' — try to keep intimacy enjoyable and connected.

Lifestyle tips

• Keep your testicles cool — avoid laptop heat, hot tubs, and tight underwear.
• Quit smoking and avoid recreational drugs.
• Limit alcohol to one drink per day or less.
• Exercise moderately — too little or too much can both be a problem.
• Get enough sleep and find healthy ways to manage stress.

Diet and exercise

A balanced diet supports sperm health. Include foods rich in antioxidants (like fruits and vegetables), zinc (oysters, nuts, beans), selenium (brazil nuts, fish), and healthy fats (avocado, olive oil, oily fish). Regular, moderate exercise helps maintain a healthy weight and improves hormone balance. Aim for about 150 minutes of moderate activity per week.

Mental health and emotional wellbeing

Fertility problems can cause stress, anxiety, and feelings of guilt or low self-worth. It is normal to feel this way. Talking to your partner, friends, or a professional counselor can really help. In some countries, the emotional support of a psychologist is part of fertility care — you can ask your healthcare team about this.

Prevention

Not all male infertility can be prevented, especially if it relates to genetics, injuries, or certain medical conditions. However, many causes that come and go are linked to lifestyle, and adopting healthy habits can reduce your risk and improve your fertility over time. Avoiding heat, smoking, excessive alcohol, and extreme exercise are all useful steps.

Vaccines

There is no vaccine for male infertility. Some infections that can harm fertility are preventable through vaccines (for example, mumps, HPV, and hepatitis B). Ask your doctor or pharmacist if you are up to date with your routine vaccinations.

Screening programmes

There is no routine screening test for male infertility. If you are planning a family, you can talk to your doctor about your fertility concerns, and they may suggest a semen analysis or other tests as needed.

Complications

If left untreated

• If an underlying infection or hormone imbalance goes untreated, it may lead to permanent damage to sperm production.
• A varicocele, if severe and untreated, may gradually affect sperm quality over many years.
• The emotional stress of unexplained infertility can strain relationships and affect mental well-being.

Long-term outlook

The outlook is generally good. Many men with sporadic or temporary infertility find that their fertility improves with lifestyle changes or simple medical treatment. By talking to a doctor, you can understand your personal situation, explore the options that are right for you, and make a plan. Even when it takes more time or help, there are many ways to build a family.

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