Male infertility

Male infertility means a problem with the male partner's reproductive system is making it difficult for a couple to conceive, usually diagnosed after a year of regular, unprotected sex without pregnancy. It's common and often treatable, contributing to around half of all cases where a couple can't conceive.

Symptoms of male infertility

In most cases, male infertility causes no physical symptoms at all. The main sign is simply not being able to get your partner pregnant after trying for a year.

Depending on the underlying cause, you might also notice:

• problems with sexual function, such as erectile dysfunction, trouble ejaculating, or a low sex drive
• pain, swelling or a lump in a testicle
• less facial or body hair than usual, or breast growth
• regular respiratory infections, headaches, or a reduced sense of smell
• runny or watery semen, which can be linked to a low sperm count.

Infertility can also take an emotional toll, and feelings of depression, grief, loss or inadequacy are common. It's worth talking to a therapist, or asking your doctor about support, if you're struggling with these feelings.

Causes and risk factors

Male infertility usually comes down to a problem with sperm production, sperm delivery, or both, though a hormone imbalance can also be responsible. Common causes include:

• a problem with the sperm itself, such as a low count, poor movement (motility), or an abnormal shape
• varicocele, swollen veins in the scrotum, which is the most common treatable cause and is thought to be a factor in around 40% of cases
• a blockage in the tubes that carry sperm, for example after an infection, surgery or a vasectomy
• hormonal disorders affecting your hypothalamus or pituitary gland, which control sperm and testosterone production
• genetic conditions, such as Klinefelter syndrome, Y chromosome deletions or cystic fibrosis
• undescended testicles as a child, or previous testicular trauma, surgery or cancer treatment
• infections, including some sexually transmitted infections, mumps, or inflammation of the testicle or epididymis
• antisperm antibodies, where your immune system mistakenly attacks your own sperm, which can happen after a vasectomy or testicular injury.

Lifestyle and environmental factors can also affect your fertility, including being overweight, smoking or vaping, drinking heavily, using recreational drugs or anabolic steroids, and regularly exposing your testicles to heat, for example in saunas or hot tubs.

Long-term exposure to certain industrial chemicals and air pollutants may also play a role, though on their own they rarely explain infertility.

In around 1 in 4 UK cases, no clear cause is found in either partner, which doctors call unexplained infertility.

Types of male infertility

Doctors sometimes describe male infertility as:

• primary infertility, where you've never fathered a child
• secondary infertility, where you've fathered a child before, but are now having difficulty conceiving again.

It can also be classified by where the problem lies:

• a hormonal (pre-testicular) cause, affecting the signals that control sperm production
• a testicular cause, affecting the testicles themselves
• a post-testicular cause, such as a blockage or an issue with ejaculation, affecting how sperm is delivered.

Diagnosing male infertility

Your doctor will ask about your medical and sexual history, including how long you've been trying to conceive, any past infections or surgery, and your lifestyle. Then, with your consent, they’ll carry out a physical examination, including checking your testicles and penis.

The main test is a semen analysis, which checks the number, movement and shape of your sperm – you'll usually need at least 2 samples, ideally around a month apart, since results can vary. Depending on what this shows, further tests may include:

• blood tests, to check your hormone levels and look for genetic conditions
• a urine test, to check for infections, diabetes, or sperm that has travelled backwards into your bladder
• an ultrasound scan of your testicles, to look for a varicocele, blockage or lump
• a testicular biopsy, to see how well your testicles are producing sperm, if no sperm is found in your semen.

Treatment for male infertility

Treatment depends entirely on the cause, and often combines more than one approach.

• Lifestyle changes: Such as stopping smoking, cutting down on alcohol, reaching a healthy weight and avoiding recreational drugs or anabolic steroids
• Medicines: For example to treat an infection, correct a hormone imbalance, or manage erectile dysfunction
• Surgery: Such as a varicocelectomy to repair a varicocele, or a vasectomy reversal, both of which can improve sperm counts. Success of vasectomy reversal depends heavily on how much time has passed since the original vasectomy and success rates drop significantly the longer you wait.
• Surgical sperm retrieval directly from the testicle or epididymis: If there's a blockage or no sperm in your ejaculate.

If natural conception still isn't possible, assisted reproductive techniques can help. These range from intrauterine insemination (IUI), where prepared sperm is placed directly into the womb, to in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI), where a single sperm is injected directly into an egg in a laboratory. ICSI in particular means that even men with very few or poor-quality sperm can often still father a biological child.

Some couples conceive without any treatment at all. Studies suggest around 1 in 4 untreated couples go on to conceive within 2 years.

When to see a doctor

See a GP if you and your partner haven't been able to conceive after a year of regular, unprotected sex, or after 6 months if your partner is 36 or older. Your GP can arrange initial tests for both of you and refer you to a specialist if needed.

Get checked sooner if you have a history of undescended testicles, testicular surgery, trauma or cancer treatment, or if you notice pain, swelling or a lump in a testicle, problems with erections or ejaculation, or a reduced sex drive.