According to the World Health Organization, around one in six people worldwide experience infertility at some point in their lives. In many communities, the woman is blamed when a couple cannot conceive. Yet male factors contribute to roughly half of infertility cases, alone or together with female factors.
This guide explains the causes of male infertility, how it is diagnosed, what a semen analysis shows, treatment options, and lifestyle changes that can improve sperm health.
Imagine a couple married for four years without a pregnancy. Relatives whisper about the wife; she has had test after test, all normal. Her husband refuses to be tested, saying, “There is nothing wrong with me.” Finally a nurse at the fertility clinic explains, privately and gently, that a simple semen test is the quickest way to help them both. The result shows a low sperm count with a treatable cause. Within a year, they are expecting. Years of blame could have been avoided with one test.
How male fertility works
Sperm are produced in the testicles, mature over about two to three months, and travel through the epididymis and vas deferens to mix with fluids from the prostate and seminal vesicles. Fertility depends on the number of sperm, their movement (motility), their shape (morphology), and a clear pathway for ejaculation. Hormones from the brain and testicles control production.
Common causes
| Category | Examples |
|---|---|
| Testicular problems | Varicocele (enlarged veins), undescended testicles, injury, mumps orchitis, genetic conditions |
| Infections | Sexually transmitted infections, prostatitis, epididymitis |
| Blockages | Scarring after infection, previous surgery, vasectomy, congenital absence of the vas deferens |
| Hormonal problems | Low testosterone, pituitary disorders, thyroid disease |
| Ejaculation and sexual problems | Erectile dysfunction, retrograde ejaculation |
| Medicines and drugs | Anabolic steroids, testosterone supplements, some chemotherapy, cannabis |
| Lifestyle and environment | Smoking, heavy alcohol, obesity, heat exposure, certain chemicals |
| Unexplained | No cause found in a proportion of men |
Important: taking testosterone or anabolic steroids, for example for bodybuilding, can stop sperm production.
When to seek help
Couples are usually advised to seek assessment after 12 months of regular unprotected sex without pregnancy, or after 6 months if the woman is 35 or older. Men should seek help earlier if they have a history of testicular problems, surgery, cancer treatment or sexual problems. Both partners should be assessed together.
Tests
- Medical and sexual history and physical examination.
- Semen analysis: the key test, assessing volume, sperm concentration, motility and morphology, using reference values published by the WHO. Usually repeated if abnormal, because results vary.
- Hormone blood tests (testosterone, FSH, LH, prolactin).
- Scrotal ultrasound to look for varicocele or other problems.
- Genetic tests in some cases of very low or absent sperm.
- Infection screening.
Preparing for a semen test
- Follow the lab’s instructions on abstinence (often 2 to 7 days).
- Collect the whole sample in the container provided, usually by masturbation.
- Deliver it to the lab within the time advised, kept at body temperature.
- Avoid lubricants unless approved.
Treatment options
- Treating infections with antibiotics.
- Varicocele repair in selected men.
- Hormone treatment for specific hormonal causes.
- Stopping harmful medicines or substances, including steroids.
- Surgery for blockages or sperm retrieval from the testicle.
- Assisted reproduction: intrauterine insemination (IUI), IVF or ICSI (injecting a single sperm into an egg).
- Donor sperm, where acceptable to the couple.
Lifestyle changes that can help
- Stop smoking.
- Limit alcohol.
- Reach a healthy weight.
- Avoid anabolic steroids and unprescribed testosterone.
- Keep the testicles cool: avoid long hot baths, laptops on the lap and very tight underwear.
- Eat a balanced diet rich in fruit, vegetables and whole grains.
- Exercise regularly.
- Manage stress and sleep.
- Reduce exposure to pesticides, heavy metals and solvents at work.
Because sperm take around three months to develop, improvements usually take that long to show.
The emotional side
Infertility can affect a man’s sense of masculinity and cause shame, anxiety and relationship strain. Counselling and honest conversations help. See our guide to supporting each other through infertility and to men’s mental health.
Frequently asked questions
How common is male infertility?
Male factors contribute to around half of infertility cases in couples.
What is a normal sperm count?
Labs use WHO reference values; your healthcare provider will interpret results in context, often after two tests.
Can lifestyle changes improve sperm?
Yes. Stopping smoking, limiting alcohol, healthy weight and avoiding steroids can help over about three months.
Does testosterone help male infertility?
No. Taking testosterone usually reduces sperm production.
But is infertility a woman’s problem?
No. Infertility is a couple’s problem, and both partners should be tested from the start. Testing men is usually simpler, cheaper and less invasive, and can save years of unnecessary blame and treatment.
Your next step: If you and your partner have been trying for a year or more, ask your healthcare provider for a semen analysis at the same time as your partner’s tests.
Related: Supporting each other through infertility · Low testosterone · Men’s mental health
Sources: World Health Organization infertility prevalence estimates (2023) and WHO laboratory manual for the examination and processing of human semen (6th ed., 2021); NICE guideline CG156 Fertility problems.
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