SEXUAL HEALTH CONCERN

Male Fertility

Also called: male infertility, low sperm count, varicocele

Male fertility problems occur when factors affecting sperm production, quality or delivery reduce the chance of achieving a pregnancy. They can be linked to hormonal, genetic, testicular, medical or lifestyle factors, although sometimes no clear cause is identified.

TYPICALLY OCCURS

Sperm problems, hormones, genetics and testicular conditions

TREATED BY

Fertility surgery, IVF/ICSI, medication and lifestyle management

ALSO LINKED TO

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Why it happens?

Male fertility depends on the production of sufficient healthy sperm and their ability to reach and fertilise an egg. Sperm are produced in the testes through a process regulated by hormones from the brain and pituitary gland, including signals that influence testosterone production. Fertility can be reduced when sperm concentration is low, sperm do not move effectively, or a higher proportion have abnormalities affecting their structure or function. Some individuals produce very few sperm or no sperm detectable in the semen. However, semen quality naturally varies, and an abnormal result does not necessarily mean that conception is impossible.

A wide range of medical and anatomical factors can affect male fertility. Varicoceles — enlarged veins around the testicle — are associated with impaired fertility in some men. Previous testicular injury, undescended testes, infections, genetic conditions and blockages within the reproductive tract can also interfere with sperm production or delivery. Hormonal disorders involving the testes, pituitary gland or hypothalamus may reduce sperm production. Cancer treatments such as chemotherapy or radiotherapy can have significant effects, while certain medications and the use of anabolic steroids or external testosterone can suppress the hormonal signals required for normal sperm production.

Lifestyle and general health can also influence reproductive function. Smoking, excessive alcohol consumption, recreational drugs, obesity and exposure to excessive heat or certain environmental and occupational substances may negatively affect sperm health in some individuals. Age can influence sperm quality as well, although the relationship differs from the age-related decline in female fertility. Erectile or ejaculation difficulties may also make conception more difficult without directly affecting sperm production. Importantly, male fertility problems frequently have no obvious outward symptoms, so semen analysis and appropriate medical investigation are often necessary to identify whether a male factor is contributing to difficulty conceiving.

How far along is it?

Early

Pregnancy has not occurred as quickly as expected, but there may be no obvious symptoms or known reproductive problem. At this point, reduced male fertility cannot be assumed without appropriate assessment.

Moderate

Testing may identify a reduced sperm count, impaired sperm movement or other semen abnormalities. Hormonal, anatomical or medical factors may also be discovered during investigation.

Advanced

More substantial problems with sperm production or delivery are identified, such as very low sperm numbers, absence of sperm in semen, significant reproductive-tract obstruction or an underlying genetic or hormonal condition.

What addresses it?

Treatments that address this

Male infertility treatment→Varicocele surgery→

In the UK, fertility advice is generally worth seeking when a couple has been having regular unprotected sex for one year without achieving a pregnancy. Earlier assessment may be appropriate when the female partner is aged 36 or over or when either partner has a known condition that could affect fertility.

Male fertility assessment may be particularly worthwhile sooner if there is a history of undescended testes, testicular injury or surgery, cancer treatment, genital infection, erectile or ejaculation problems, anabolic steroid or testosterone use, or a known hormonal or genetic condition. Changes such as a testicular lump, swelling or persistent pain should also be medically assessed rather than being treated solely as a fertility issue.

Because fertility involves both partners, difficulty conceiving should not automatically be attributed to either person. Where appropriate, investigating both partners can provide a clearer understanding of the factors involved.

Quick Questions:

What are the most common causes of male infertility?

Common causes include problems with sperm production or quality, varicoceles, hormonal disorders, genetic conditions, reproductive-tract blockages and previous testicular damage. Lifestyle, medications and certain medical treatments can also contribute.

How do you know if you have a male fertility problem?

Male infertility often causes no obvious symptoms. Semen analysis is one of the main initial tests and assesses factors such as sperm concentration, movement and appearance. Additional investigations may be recommended depending on the results and medical history.

Can low testosterone cause male infertility?

Certain hormonal disorders can reduce both testosterone and sperm production. However, low testosterone and infertility are not the same condition. Importantly, taking external testosterone can suppress sperm production and may reduce fertility.

Can male fertility problems be treated?

Sometimes. The options depend on the underlying cause and may include treating a medical or hormonal condition, surgery for selected anatomical problems, lifestyle changes or assisted reproductive techniques such as IVF with intracytoplasmic sperm injection (ICSI).