Male Infertility: Causes, Testing and Treatment Options

• What is male infertility?
• How common is male infertility?
• Signs and symptoms of male infertility
• What causes male infertility?
• How is male infertility tested?
• Can male infertility be treated?
• When donor sperm may be an option
• Emotional support for men and couples

Male infertility is when male fertility factors prevent a couple from conceiving despite having regular, unprotected sexual intercourse for at least a year. Male fertility factors include sperm disorders, hormonal imbalances, blockages in delivery tubes and certain medical conditions. 

Fertility can be a sensitive topic. If you and your partner are experiencing fertility challenges, it's important to remember that fertility is influenced by many different factors. Taking a shared approach can help you and your partner feel supported, informed and better prepared for the next steps.

An estimated 7% of all men are affected by male infertility, and male infertility issues are the sole factor in around a third of infertility cases (British Fertility Society). A combination of both male and female fertility issues contributes to another third of all infertility cases, and in the final third of cases, female fertility issues are the sole factor.

Male infertility often has no noticeable symptoms. Many men only become aware of a potential fertility issue when they start trying to have a child.

In some cases, underlying health conditions can affect fertility and cause symptoms. However, these symptoms are not specific to infertility and may not be present at all. Possible male infertility signs include:

• Problems with ejaculation
• Difficulty getting or maintaining an erection
• Reduced sexdrive (low libido)
• Pain, swelling, or discomfort in the testicles
• Signs of low testosterone

Emotional consequences of male infertility

Fertility challenges can affect more than your ability to conceive. For many men, difficulties achieving a pregnancy with their partner can bring up a range of emotions, including frustration, disappointment, stress, or uncertainty.

If you and your partner are navigating fertility challenges, it's important to remember that you don't have to go through it alone. Talking openly with each other and seeking support from healthcare professionals, counsellors or trusted people around you can make an important difference.

Male infertility can have many different causes. Some affect sperm production, while others impact sperm quality or the transport of sperm. Common causes of male infertility include:

• Low sperm quality 
• Sperm production problems
• Sperm transport or blockage issues
• Hormone imbalances
• Genetic causes
• Infections
• Varicocele
• Medical treatments 
• Medication or testosterone use
• Lifestyle and environmental factors.

Sperm count, motility and morphology

Sperm quality issues include low sperm count (oligozoospermia), poor sperm motility (asthenozoospermia) and abnormal sperm morphology (teratozoospermia). These issues are usually picked up via a sperm analysis, which provides a comprehensive account of overall sperm health.

Azoospermia and sperm blockages

Azoospermia (zero sperm count) refers to a condition where there are no viable sperm in a man’s ejaculate. This may be caused by either issues with sperm production or blockages in a man’s reproductive tubes. Depending on the cause, some cases of azoospermia are treatable. Consequently, it is possible to have azoospermia and still have children using your own sperm in the future.

Male fertility is assessed through a semen analysis, physical examination, hormone blood tests, genetic testing and ultrasound scans. Semen analysis is typically the first step and may be repeated to confirm results. Depending on the results, your doctor or fertility specialist may recommend additional tests.  

Semen analysis

Semen analysis assesses semen volume and sperm count, motility and morphology. The results can provide valuable insight into your overall sperm health and may help identify potential causes of infertility related to sperm quality. 

Further male fertility tests

A semen analysis is often the first step in understanding male fertility. However, it cannot always explain why the results look the way they do. If a semen analysis indicates potential fertility challenges, additional tests may help provide a more complete picture of your reproductive health. These tests include:

• Physical examinations
• Testicular imaging
• Serum hormone profile
• Genetic testing
• Seminal oxidative stress testing
• Sperm DNA fragmentation

If you have questions about your results, speaking with a fertility specialist can help you understand your options and determine whether additional testing may be relevant for you.

Some cases of male infertility can be treated, depending on the cause. Common treatments include:

• Lifestyle changes
• Medication/hormone treatment
• Surgery 
• Assisted reproduction

Lifestyle changes

Lifestyle changes can improve some sperm quality indicators, especially when fertility issues are caused by health or environmental factors. Potentially effective lifestyle changes include:

• Quitting smoking
• Reducing alcohol consumption
• Maintaining a healthy weight through a balanced diet and regular exercise
• Avoiding recreational drugs and anabolic steroids
• Reducing stress and getting enough sleep
• Avoiding excessive heat exposure (such as hot tubs or saunas)
• Limiting exposure to harmful chemicals or toxins

Medication/hormone treatment

Medicines or hormone therapy can help if infertility is caused by hormonal imbalances or certain medical conditions. Hormone treatment can be used to stimulate sperm production when hormone levels are imbalanced, while antibiotics are often used to treat infections related to infertility. Medications may also be used to help with erectile dysfunction and similar issues that contribute to infertility.

Surgery

Surgery is a viable treatment option if infertility is the result of a physical problem that is preventing sperm from being produced or transported. Surgery may be used in the following instances:

• Repairing a varicocele
• Removing blockages in the tubes that carry sperm
• Reversing a previous vasectomy
• Retrieving sperm directly from the testes when it cannot be ejaculated naturally

Assisted reproduction

Assisted Reproductive Technologies (ART) like IUI, IVF and ICSI help couples achieve pregnancy when natural conception is difficult. They are regularly used to overcome infertility and help those who would otherwise struggle to have children.

For some people, donor sperm can be a pathway to parenthood. It may be considered when pregnancy is unlikely to be achieved using the male partner's sperm, when fertility treatment has not been successful, or when there are concerns about passing on a hereditary condition.

Choosing whether to use donor sperm is a deeply personal decision, and there is no right or wrong way to approach it. Many people find it helpful to talk through their thoughts, questions, and options with someone who understands the process.

Our team is here to support you with clear information and guidance at every stage of your journey. You can book a free, no-commitment consultation with one of our advisors or reach out through our WhatsApp support service whenever questions arise.

Reading about other couples’ experiences can be incredibly valuable, too.

Male infertility can have an emotional impact as well as a physical one. Many men experience feelings of disappointment, frustration, sadness, or uncertainty, which can also affect relationships, confidence, and overall wellbeing.

If you and your partner are navigating fertility challenges together, open and honest communication can help you feel supported and connected throughout the process. Many people also find it helpful to attend appointments together, ask questions, and make decisions as a team.

You do not have to go through this alone. Healthcare professionals, counsellors, and support organisations can provide guidance and a safe space to talk about your experiences. Reaching out for support can be an important step in taking care of your emotional wellbeing during your fertility journey.

How can you tell if a male is infertile?

The only reliable way of identifying male infertility is through testing. This usually involves an initial semen analysis to assess key sperm quality indicators. A repeat test may be necessary to confirm results and your fertility specialist may recommend additional testing to identify root causes. 

Healthcare professionals typically recommend a semen analysis when couples have been trying to conceive for 12 months without success, unless the female partner is over 35, in which case help should be sought after six months of trying.

Can male infertility be cured?

Some causes of male infertility can be treated, but not all. Treatment options and potential paths to parenthood will depend on the results of your semen analysis and other relevant testing.

In some cases, lifestyle changes may be sufficient to improve semen quality. In others, assisted reproductive technologies can help couples have children. Donor sperm is also an option for those who cannot conceive using their own sperm.

What are the most common causes of male infertility?

The most common causes of male infertility are:

• Low sperm quality
• Sperm production problems
• Sperm transport problems
• Hormone imbalances
• Genetic conditions
• Varicocele
• Infections
• Lifestyle and environmental factors

What tests are done for male infertility?

Semen analysis is usually the first test conducted to determine male infertility. A repeat semen analysis may follow to confirm results. Depending on your specialist’s clinical judgement, further tests may be required. These can include:

• Physical examinations
• Testicular imaging
• Serum hormone profile
• Genetic testing
• Seminal oxidative stress testing
• Sperm DNA fragmentation

Does low sperm count mean you cannot have a baby?

Low sperm count can reduce the likelihood of conceiving via sexual intercourse, but it does not mean pregnancy is impossible. 

If diagnosed with a low sperm count, it is important that you discuss the results and next steps with your fertility specialist. They may recommend considering treatment for the underlying cause, or using donor sperm depending on your particular circumstances.

Can donor sperm help after male infertility?

Donor sperm helps many couples experiencing male fertility challenges build a family. Couples typically consider donor sperm as an option when the male partner’s sperm cannot be used, when treatment has not been successful, or when they feel it is the right route. 

Today, comprehensive donor screening, detailed donor profiles and extensive support ensure the process is safe and transparent, and aspiring parents can make an informed decision about whether donor sperm is right for them.