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When a couple struggles to conceive, the woman is often the first to be tested. In reality, male factors contribute to roughly half of infertility cases. The good news: a simple, private test can give valuable answers, and many causes are treatable. Our earlier post on male fertility problems gives the overview. This guide focuses on testing and everyday factors you can change.
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What is male infertility?
It means reduced chance of causing a pregnancy because of problems with sperm production, quality or delivery. It is usually considered after 12 months of regular unprotected intercourse, or sooner if there are known risk factors.
Signs to watch for
Many men have no symptoms and only find out after a semen test. Possible signs include difficulty conceiving after a year, low sexual desire or erectile difficulties, problems with ejaculation, pain, swelling or a lump in the testicle area, a history of undescended testicles, injury, surgery or infection, and signs of hormonal imbalance.
Common causes
- Varicocele: enlarged veins in the scrotum, one of the most common correctable causes
- Hormonal imbalance: pituitary, thyroid or testosterone problems
- Low sperm count, poor movement or abnormal shape, sometimes with no clear cause
- Blockages in the tubes that carry sperm
- Infections of the testicles, prostate or urinary tract
- Genetic conditions
- Ejaculation problems, including retrograde ejaculation
- Medicines and treatments, such as testosterone supplements, anabolic steroids and chemotherapy
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The semen analysis: what it measures
This is the key first test. A sample is checked for:
- Volume of semen
- Sperm concentration (count per millilitre)
- Motility: how many sperm swim, and how well
- Morphology: the shape of the sperm
- Other factors, such as the presence of white cells or clumping
Results can vary from day to day, so the test is often repeated. Abstain for two to five days beforehand, as advised, and follow the collection instructions carefully for an accurate result.
Other tests
Your urologist may also recommend a physical exam, hormone blood tests, a scrotal ultrasound and, in selected cases, genetic tests or sperm DNA tests.
Lifestyle factors that affect sperm health
- Smoking, shisha and vaping reduce sperm quality
- Heavy alcohol use and recreational drugs can lower counts
- Obesity is linked to hormonal changes and poorer semen quality
- Heat: frequent hot tubs, saunas, long hours with a laptop on the lap and tight clothing can affect production
- Anabolic steroids and unprescribed testosterone can switch off natural sperm production, a risk in the gym community
- Stress and poor sleep can affect hormones and sexual function
Because sperm take about three months to develop, lifestyle changes need roughly that long to show results.
Treatment options
- Lifestyle changes: stopping smoking, reducing alcohol, losing weight, regular exercise
- Medication: hormone therapy or treating infections
- Surgery: repairing a varicocele or correcting blockages in selected men
- Assisted reproduction: options such as insemination or IVF/ICSI, planned together with the fertility team, if needed
Take the first step
Many men delay testing out of embarrassment. A semen analysis is simple, private and quick, and the earlier you test, the sooner you and your partner get clear answers.
