Male Infertility: Causes, Symptoms, Treatment & More 

Introduction

Planning for a baby is often filled with hope, but when things don’t go as expected, it can be confusing and stressful for both parents. What many people don’t realise is that fertility challenges are not limited to women; male factors can also contribute to them. 

Male infertility refers to a man’s inability to achieve a pregnancy with his partner. It is a common but often overlooked factor in infertility. The good news is that in many cases, this is manageable with proper medical guidance and care¹. 

In this blog, we will cover male infertility causes, symptoms, diagnosis, and management options for male infertility, along with when to seek medical advice. 

What Is Male Infertility?

Infertility is not only a female issue. Male factors play a role in many cases. In fact, around one-third of infertility cases are due to male-related problems. 

Male infertility refers to difficulty in achieving pregnancy with their partner even after having regular, unprotected intercourse for one year².

Types of Male Infertility

The types of male infertility can be broadly classified as follows³:

• Primary Male Infertility: This means a man has never been able to achieve a pregnancy even after trying for a long time. 
• Secondary Male Infertility: This means a man has achieved a pregnancy with their partner before but is now facing difficulty¹. 

Causes of Male Infertility

Male infertility can occur due to problems in different parts of the male reproductive system (including the testes, sperm-carrying tubes, glands, and hormones involved in sperm production). Common male infertility causes include³:

1. Pre-Testicular Causes (Hormonal Problems)

 These involve problems with the hormones that control sperm production. Hormones from the testicles and the pituitary and hypothalamus areas of the brain control sperm production. So, any imbalance in these hormones can affect fertility. 

2. Testicular Causes (Problems in the Testes)

These can affect the production and quality of sperm: 

• Problems with Sperm Production: In some cases, the testicles may not produce enough sperm or may not produce sperm at all. This can be due to conditions such as varicocele (swollen veins in the testicles) or treatments such as chemotherapy. 
• Poor Sperm Quality or Function: Even if sperm are produced, they may not work properly. Issues like poor movement (motility) or abnormal shape (morphology) can reduce the chances of fertilisation. 

3. Post-Testicular Causes (Transport Problems)

These involve problems with movement of sperm through the reproductive system and their delivery during ejaculation. These may be caused by a blockage in the reproductive tract due to infections, injuries, or damage to the genital tract. 

Note: In some men, semen analysis may be abnormal, but no clear cause of infertility is identified despite detailed evaluation. This is known as idiopathic male infertility and accounts for around 30% of male infertility cases⁴. 

Symptoms of Male Infertility

In most cases, men may not have any obvious symptoms of infertility, and the most common sign is difficulty in achieving pregnancy despite regular, unprotected intercourse. However, some male infertility symptoms may point to underlying issues, for example: 

• Reduced facial or body hair (may suggest hormonal problems)¹ 
• Low sex drive (libido) (may be linked to hormonal imbalance) 
• Problems with sexual function (such as difficulty with erection or ejaculation/erectile dysfunction)⁵ 
• Unusual semen changes (such as very low semen volume)¹ 
• Pain, swelling, or lumps in the testicular area (could indicate conditions like varicocele or infection)⁶ 

Risk Factors for Male Infertility

Certain factors can increase the risk of male infertility by affecting sperm production, quality, or delivery. Common risk factors include: 

• Age:Fertility in men can naturally decline with age, affecting sperm quality and function.
• Smoking and alcohol use:These can reduce sperm count and quality. 
• Obesity or unhealthy lifestyle: Excess weight and a diet low in nutrition can affect hormone levels and sperm health⁷. 
• Use of anabolic steroids: Synthetic versions of male hormones (testosterone) can lower natural testosterone and reduce sperm production⁸. 
• Nutritional deficiencies: Deficiencies in nutrients like vitamin C, vitamin D, and zinc may be associated with male infertility as these nutrients are essential for healthy sperm formation¹. 
• Heat exposure: When the scrotum (the pouch containing the testicles) is frequently exposed to heat, such as taking hot baths and saunas or placing a laptop on the lap, it might affect sperm production⁹.
• Infections: Sexually transmitted infections (STIs) or other infections can damage the male reproductive tract⁷. 
• Medical treatments: Treatments like chemotherapy or radiation can affect sperm-producing cells¹. 
• Environmental exposures: Exposure to toxins or chemicals can harm sperm quality^3,7. 

Diagnosis and Tests for Male Infertility

Infertility in men is diagnosed through a combination of medical history, physical examination, and laboratory tests. These include^1,10: 

1. Medical History and Physical Exam

The doctor will ask about health history, lifestyle, past illnesses, medications, and sexual history. A physical exam may be done to check the testicles and reproductive organs for any visible problems. 

2. Semen Analysis 

This is a key test for evaluating male infertility. 

• Usually, two semen samples are tested at least a few weeks apart, as results may vary, for sperm count, motility, morphology, and overall quality. 
• Three days of abstinence (meaning no ejaculation or sexual activity) is recommended before sample collection for accurate results. 
• According to WHO, normal values on semen analysis should be: 
  • Sperm count: ≥39 million/ejaculate 
  • Total motility: >40% 
  • Normal morphology: ≥4% 

3. Hormone Blood Tests

These tests check hormones like testosterone, luteinising hormone (LH), prolactin, and follicle-stimulating hormone (FSH) to see if there is a hormonal issue affecting sperm production. Blood tests for male infertility may also help identify infections, genetic conditions, vitamin deficiencies, and underlying health issues that can affect male reproductive health and fertility. Your doctor may also suggest blood tests that include many important parameters that can check a male’s reproductive health. 

4. Imaging Tests

Tests like scrotal ultrasound help detect problems such as varicocele or blockages in the reproductive tract. 

5. Other Tests (If Needed)

 These may include: 

• Genetic testing: Recommended in men with azoospermia (no sperm in the semen) or severe oligospermia (very low sperm count) to identify genetic or chromosomal causes. 
• Sperm DNA tests: To assess sperm quality and DNA. 
• Testicular biopsy: In selected cases, a testicular biopsy is done where a small piece of tissue is taken from one or both testicles. 

Treatment for Male Infertility

The management of male infertility depends on its cause. In some cases, pregnancy may still occur naturally, but medical care can improve the chances. Your doctor may suggest and prescribe one of the following options for male infertility treatment¹:

1. Hormone Therapy

In cases of hormonal imbalance, therapies using hormones like human chorionic gonadotropin (hCG), FSH, or other medications may help improve sperm production, especially in specific conditions. 

2. Assisted Reproductive Techniques (ART)

If male infertility treatment options like medications do not work, ARTs such as the following may be used to help achieve pregnancy: 

• Intrauterine insemination (IUI): Motile sperm are placed directly into the uterus to increase the chances of fertilisation. 
• In vitro fertilisation (IVF): Eggs and sperm are combined in a laboratory, and the fertilised embryo is then placed in the uterus. 
• Intracytoplasmic sperm injection (ICSI): A single sperm is directly injected into an egg to help fertilisation (often considered the gold standard in individuals with serious male fertility issues). In conditions like azoospermia, sperm can be retrieved directly from the testicles or reproductive tract and used for ICSI. This applies to both obstructive azoospermia (normal sperm production, but no sperm in ejaculate due to blockage) and non-obstructive azoospermia (reduced sperm production, where limited sperm may still be retrieved). 

3. Surgical Option

Surgery may be needed to fix physical problems such as a varicocele or blockages in the reproductive tract. These procedures may help improve sperm flow and fertility in some men. 

Prevention of Male Infertility

Male fertility is closely linked to lifestyle and overall health. So, making the right changes can help improve sperm quality and support reproductive health. Some options include^1,11: 

1. Follow a Healthy and Balanced Diet

Eating foods rich in nutrients like omega-3 fatty acids, vitamins (C, E), zinc, and folate supports sperm production and protects sperm from damage. Therefore, following a diet rich in fruits, vegetables, whole grains, and healthy fats could be beneficial. 

2. Maintain a Healthy Weight

Both obesity and being underweight can affect hormones and reduce sperm production. So, trying to maintain an ideal weight may help improve fertility. 

3. Exercise Regularly (but not Excessively)

Moderate physical activity improves hormone levels and sperm quality, while too little or too much exercise may have negative effects. 

4. Avoid Smoking, Alcohol, and Drugs

Smoking, excessive alcohol, and other recreational drugs (like marijuana) may affect sperm health. Thus, quitting or reducing their use may improve fertility over time. 

5. Manage Stress and Mental Health

Chronic stress can affect hormones and lower testosterone, impacting sperm production. So, if you feel stressed, management techniques like meditation or therapy might help. 

6. Get enough Sleep

Poor sleep or irregular sleep patterns can reduce sperm quality and affect fertility. Thus, getting proper sleep is important for hormone balance.  

7. Avoid Heat and Harmful Exposures

 Excess heat (like hot tubs or tight clothing) and exposure to toxins, chemicals, or radiation might harm sperm production. So, you should try to avoid them as much as possible. 

8. Be Mindful of Sexual Habits

Regular intercourse, especially around ovulation, can improve chances of conception. Also, some lubricants (such as the artificial ones) may affect sperm movement and should be chosen carefully. 

When to See a Doctor?

Knowing when to seek medical help can improve the chances of early diagnosis and management. You should consider seeing a doctor if you have^1,5,6,7,11: 

• Been trying to conceive for 1 year without success. If you have any of the risk factors for male infertility mentioned earlier, you should see a doctor sooner. 
• Problems with erection (erectile dysfunction) or ejaculation (these can affect the ability to conceive) 
• A low libido (may indicate hormonal issues) 
• Pain, swelling, or lumps in the testicles (which could suggest conditions affecting sperm production) 
• A history of infections or surgery (such as STIs, testicular injury, or surgeries in the genital area) 
• Known medical or hormonal conditions (like low testosterone or other endocrine disorders) 
• Been exposed to toxins or treatments (such as chemotherapy, radiation, or harmful chemicals) 
• Red flag signs, such as no sperm in semen (azoospermia), small or underdeveloped testes, gynecomastia (breast enlargement), or undescended testicles (the testicles do not move down into the scrotum after birth). 

Note: Couples trying to conceive are generally advised to have regular intercourse every 2 to 3 days, undergo evaluation of both partners, and understand that improvements in sperm health may take around 3 months¹². 

Also Read: Varicocele – Symptoms, Causes, Home Remedies

Conclusion

Male infertility is a common yet often overlooked condition that can significantly affect a couple’s ability to conceive. Reasons for male infertility include sperm-related issues, hormonal imbalances, lifestyle influences, and underlying medical conditions. 

The reassuring part is that many cases are manageable with the right diagnosis and care. From lifestyle changes and medications to advanced male infertility treatments like IVF and ICSI, there are multiple options available to improve the chances of conception.  

Apart from this, seeking timely medical advice, making informed lifestyle choices, and addressing both physical and emotional aspects can make a meaningful difference. With the right support and approach, many couples can successfully achieve their goal of parenthood. 

Frequently Asked Questions (FAQs)

References

1. Leslie SW, Soon-Sutton TL, Khan MA. Male Infertility. In: StatPearls. StatPearls Publishing; 2026. Accessed April 30, 2026. http://www.ncbi.nlm.nih.gov/books/NBK562258/ 

2. Male Infertility. Accessed April 30, 2026. https://medlineplus.gov/maleinfertility.html 

3. Infertility. Accessed April 30, 2026. https://www.who.int/news-room/fact-sheets/detail/infertility 

4. Corsini C, Boeri L, Candela L, et al. Is There a Relevant Clinical Impact in Differentiating Idiopathic versus Unexplained Male Infertility? World J Mens Health. 2023;41(2):354-362. doi:10.5534/wjmh.220069 https://pmc.ncbi.nlm.nih.gov/articles/PMC10042653/

5. Sexual Problems in Men. Accessed April 30, 2026. https://medlineplus.gov/sexualproblemsinmen.html 

6. Paick S, Choi WS. Varicocele and Testicular Pain: A Review. World J Mens Health. 2019;37(1):4-11. doi:10.5534/wjmh.170010 https://pubmed.ncbi.nlm.nih.gov/29774668/

7. Infertility: MedlinePlus Medical Encyclopedia. Accessed April 30, 2026. https://medlineplus.gov/ency/article/001191.htm 

8. El Osta R, Almont T, Diligent C, Hubert N, Eschwège P, Hubert J. Anabolic steroids abuse and male infertility. Basic Clin Androl. 2016;26:2. doi:10.1186/s12610-016-0029-4 https://pmc.ncbi.nlm.nih.gov/articles/PMC4744441/

9. Mortazavi SAR, Taeb S, Mortazavi SMJ, et al. The Fundamental Reasons Why Laptop Computers should not be Used on Your Lap. J Biomed Phys Eng. 2016;6(4):279-284. https://pmc.ncbi.nlm.nih.gov/articles/PMC5219578/

10. Sunder M, Leslie SW. Semen Analysis. In: StatPearls. StatPearls Publishing; 2026. Accessed May 4, 2026. http://www.ncbi.nlm.nih.gov/books/NBK564369/ 

11. Bocu K, Boeri L, Mahmutoglu AM, Vogiatzi P. Can lifestyle changes significantly improve male fertility: A narrative review? Arab J Urol Int J. 23(3):190-200. doi:10.1080/20905998.2024.2421626 https://pmc.ncbi.nlm.nih.gov/articles/PMC12308861/

12. Infertility-Prevention-and-Management-Guideline-.pdf. Accessed May 4, 2026. https://moh.gov.bt/wp-content/uploads/2025/02/Infertility-Prevention-and-Management-Guideline-.pdf? 

13. The Effects of Cigarette Smoking on Male Fertility – PMC. Accessed April 30, 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC4639396/ 

14. Alcohol’s Effects on Male Reproduction – PMC. Accessed April 30, 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC6761906/ 

15. An Overview of E-Cigarette Impact on Reproductive Health – PMC. Accessed April 30, 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC10053939/ 

16. Ricci E, Viganò P, Cipriani S, et al. Coffee and caffeine intake and male infertility: a systematic review. Nutr J. 2017;16:37. doi:10.1186/s12937-017-0257-2 https://pubmed.ncbi.nlm.nih.gov/28646871/

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