When a couple has difficulty conceiving, the focus is often – unfortunately and incorrectly – placed on the woman. In reality, a male factor causes or contributes to infertility in 40–50% of cases among couples. Despite this, male infertility remains a subject that is rarely discussed openly, partly because of embarrassment and partly because of a lack of information.
In this article, we explain what male infertility is, its most common causes, which symptoms should not be ignored, and when it is time to consult a specialist.
What is male infertility?
Male infertility is defined as a man’s inability to achieve pregnancy with a fertile female partner after 12 months of regular, unprotected intercourse. It may be caused by a low sperm count, poor sperm motility, abnormal sperm shape, the complete absence of sperm in the ejaculate (azoospermia), or a combination of these factors.
The good news is that many causes can be diagnosed and, depending on the cause, successfully treated or overcome with assisted reproduction (IUI, IVF, or ICSI).
The most common causes of male infertility
1. Varicocele
Enlarged veins in the scrotum (similar to varicose veins in the legs) are the most common treatable cause of male infertility. A varicocele increases the temperature in the testicles, which can negatively affect sperm production and quality.
2. Hormonal disorders
An imbalance in the hormones involved in sperm production – testosterone, FSH, and LH – can significantly reduce fertility. The cause may lie in the pituitary gland, the hypothalamus, or the testicles themselves.
3. Infections
Sexually transmitted infections, such as chlamydia or gonorrhoea, as well as inflammatory conditions such as prostatitis or epididymitis, can damage the reproductive organs or block the passage of sperm.
4. Genetic factors
Conditions such as Klinefelter syndrome or Y-chromosome microdeletions can cause reduced or completely absent sperm production.
5. Ejaculation problems
Retrograde ejaculation (when semen enters the bladder instead of leaving through the penis), as well as erectile dysfunction, can make natural conception difficult or impossible.
6. Lifestyle factors
- Smoking and excessive alcohol consumption
- Obesity and a sedentary lifestyle
- Chronic stress
- Exposure to toxins, pesticides, and heavy metals
- Prolonged exposure to high temperatures (saunas, hot baths, or keeping a laptop on the lap)
- Anabolic steroids and certain medications
7. Age
Although male fertility declines more slowly than female fertility, sperm quality and the genetic integrity of sperm DNA still decrease with age, particularly after the age of 40.
Symptoms to look out for
Male infertility often has no visible symptoms – many men only discover a problem after a couple has been trying unsuccessfully to conceive for some time. However, certain signs may indicate a problem:
- Swelling, pain, or a feeling of heaviness in the testicular area
- Problems with erections or ejaculation
- Reduced libido
- Reduced or sparse facial and body hair growth (a possible sign of hormonal imbalance)
- Recurring infections of the reproductive tract
- An unusual smell, colour, or consistency of the ejaculate
If you notice any of these symptoms, there is no need to wait for a full year of unsuccessful attempts – it is worth consulting a specialist sooner.
When should you seek help?
The general recommendation is for a couple to consult a specialist after 12 months of regular attempts without success, or after 6 months if the female partner is over 35.
Men should seek help sooner, regardless of this timeframe, if they:
- Have a history of testicular surgery, hernia surgery, or prostate problems
- Have undergone cancer treatment (chemotherapy or radiation therapy)
- Have a family history of fertility problems
- Notice any of the symptoms listed above
What does the diagnostic process involve?
The first and most fundamental step in assessing male fertility is a semen analysis – a test that provides information about sperm count, motility, and morphology. Depending on the results, the specialist may recommend additional investigations, including hormone testing, genetic testing, a scrotal ultrasound, or a sperm DNA fragmentation test.
What comes next? – Treatment options
Depending on the cause, treatment may include:
- Lifestyle changes – in milder cases, these alone may significantly improve sperm quality
- Medication or hormonal therapy
- Surgical correction (for example, in cases of varicocele)
- Assisted reproduction – IUI, IVF, or ICSI, which can enable conception even in cases of severe male infertility.
Conclusion
Male infertility is more common than many people realise, but in a large number of cases it can be diagnosed and treated. The key is to consult a specialist early and to communicate openly as a couple, without embarrassment or delay.
If you and your partner have been trying to conceive for some time, our team can help you find the right specialist and clinic, starting with a free initial consultation.
Book a call with the VivaFert team HERE.
