For years, society has treated infertility as a woman’s problem or responsibility, but the reality looks different. Male factors contribute to around half of fertility challenges, yet many men still find it hard to talk about infertility.
In this guide, we cover the main causes of male infertility, the symptoms to look out for, and the tests used to assess male fertility. We also explain treatment options, including IUI, IVF, ICSI, and surgical sperm retrieval.
Male infertility plays a much bigger role in fertility challenges than many people expect. In roughly 20% of cases, male factors are the sole cause. In another 30-40% of cases, both male and female factors play a role.
This means that in roughly half of couples experiencing fertility challenges, there’s a male component involved. Despite this, many men struggle in silence, weighed down by stigma and outdated ideas about masculinity.
However, perspectives are starting to change. Dr. Nuno Louro, a urologist and andrology specialist at Procriar, says:
“We’re seeing a slow but important shift. More couples are starting to understand that infertility is a shared issue that requires both partners to be involved in testing and treatment.”
But this shift doesn’t happen without resistance. Dr. Louro points to a fundamental challenge:
“Sexuality and fatherhood are two of the strongest pillars that many men build their sense of masculinity on. When those are shaken, it can feel like everything is collapsing.”
The message he wants men to hear is clear:
“Being infertile doesn’t define who you are as a person or as a man. It’s a medical condition, and it’s something you can work through together.”
It’s not only women who struggle with the emotional challenges of infertility. It also takes a real psychological toll on men; especially when they’re the one facing the diagnosis.
Leonor Neves, a clinical psychologist at Procriar, sees this firsthand. She explains that getting an infertility diagnosis affects men’s mental health whether the issue is with them, their partner, or both.
The research is clear: men dealing with infertility have higher rates of depression and anxiety than fertile men. They also report lower quality of life overall.
Our culture links fertility with being a man. Neves explains:
“Social expectations around masculinity often require men to be fertile, strong, and emotionally controlled. Male infertility gets perceived as a form of ‘inferior masculinity.'”
This creates an impossible situation: a man struggling with infertility may find it hard to acknowledge his pain or show vulnerability, precisely because doing so feels like it contradicts what he’s “supposed” to be.
“It forces men to rebuild their sense of masculine identity”, Neves adds.
The result? Shame. Many men avoid seeking help because they worry it’ll make them appear “less masculine.” The silence just makes everything worse.
Open communication between partners makes a real difference.
Neves says:
“Studies show that couples who perceive their partner as available and attentive experience lower levels of anxiety related to infertility.”
This means creating space for honest conversations about fears, disappointments, hopes, and frustrations.
Neves emphasises:
“Since male infertility carries so much stigma and makes emotional expression difficult for many men, it’s especially important to build open, empathetic, and honest communication within the relationship.”
One helpful shift: see infertility as something you’re facing together, not as anyone’s failure. Since male factors play a role in about half of all cases, it’s rarely just one person’s issue anyway.
Male infertility has many possible causes, from lifestyle factors and medical conditions to genetics. Understanding the causes can help you take practical steps to support your reproductive health.
Diet, exercise, and day to day habits can have a bigger impact on male fertility than many people expect.
Weight can matter. Dr Louro notes that “diet and a sedentary lifestyle, often linked with obesity, play a significant role.” Research suggests obesity can affect sperm quality in a few ways. It can upset hormone balance, raise the temperature around the testicles, and increase cell damage that can harm sperm. Men with obesity often have a lower sperm count and sperm that do not swim as well as they should.
Smoking is extremely harmful. Smoking impacts male fertility in various ways. It:
In fact, smokers tend to have about 23% fewer sperm than non-smokers, and the chemicals in cigarettes build up in reproductive tissues over time.
Heavy drinking (more than 14 drinks per week):
Moderate drinking has less of an impact on fertility, but chronic heavy use damages the cells in the testes that produce sperm.
Dr. Louro puts it simply:
“Avoid toxic substances like tobacco, excessive alcohol, and recreational drugs.”
This is one of the most misunderstood aspects of male fertility. Many men assume that taking testosterone will boost their fertility; after all, testosterone is the male hormone. But the opposite is true.
Dr. Louro warns:
“The use of testosterone or anabolic steroids, whether for sports performance or aesthetic reasons, can have a very negative impact on men’s reproductive health.”
Here’s what really happens when you introduce external testosterone: your body responds by shutting down its own production. More critically, it stops producing the hormones that signal the testes to make sperm.
Anabolic steroid use can lead to severe oligospermia (very low sperm count) or even azoospermia (no sperm in the ejaculate). The good news is that this is often reversible if caught early, though recovery can take many months or even years after stopping the drugs.
The testes hang outside the body for a reason: sperm production needs cooler temperatures than the rest of your body. Anything that increases heat down there can hurt fertility.
Frequent hot baths, saunas, or hot tubs can temporarily reduce sperm production. Jobs that involve a lot of sitting (like long-haul driving) or exposure to heat can affect sperm quality. Even resting a laptop on your lap for long periods raises the temperature enough to have an impact.
Tight underwear might play a small role, though the research is mixed. The bigger issue is anything that traps heat for extended periods.
What helps: limit time in hot baths and saunas, use a laptop desk instead of your lap, and if your job involves long hours sitting, take regular breaks to move around and cool down.
Varicocele (enlarged veins in the scrotum) is the most common reversible cause of male infertility. It affects about 15% of all men, but 40% of men struggling with infertility. These enlarged veins raise testicular temperature and cause cellular damage that reduces sperm quality.
Infections of the reproductive tract can temporarily or permanently affect fertility. STIs like chlamydia and gonorrhea can cause scarring that blocks sperm passage. Mumps infection after puberty can lead to testicular inflammation and lasting damage.
Hormonal imbalances affect sperm production and fertility:
Retrograde ejaculation (where semen enters the bladder instead of exiting the penis) can result from diabetes, spinal injuries, or certain medications.
Undescended testicles that weren’t corrected in childhood often lead to reduced fertility later in life, even if surgically corrected.
Genetic causes are behind many cases of severe male infertility.
Klinefelter syndrome (where men have an extra X chromosome) affects about 1 in 500 men and often results in very low sperm production.
Y chromosome microdeletions (missing pieces of the Y chromosome that contain genes needed for sperm production) cause severe reductions in sperm count or no sperm at all.
Cystic fibrosis gene mutations don’t just affect the lungs. They can also cause a condition where the tubes that carry sperm are missing from birth. Men with this condition produce sperm, but it can’t leave the testicles naturally.
Exposure to pesticides, heavy metals (like lead, mercury, and cadmium), industrial chemicals, and radiation can all damage sperm production. Men working in agriculture, manufacturing, or certain medical fields may face higher risks.
Chemicals found in everyday plastics can interfere with hormones and sperm development. While each exposure might seem small, the effects can add up over time.
Some medications can hurt fertility. Chemotherapy drugs can damage or destroy the cells that produce sperm, sometimes permanently. Certain blood pressure medications, antidepressants, and antifungal drugs can also affect sperm production.
If you’re planning to conceive, talk to your doctor about how any new medications might affect your fertility.
While men can remain fertile much longer than women, age still plays a role. Sperm quality declines over time. Men over 40 generally have lower sperm volume, reduced movement, and more abnormal shapes compared to younger men. Older fathers also have higher rates of damaged sperm DNA and slightly increased risks of certain genetic conditions in their children.
Thankfully, modern medicine offers plenty of ways to address male infertility. But first, you need to know what you’re dealing with.
Doctors have several goals when assessing male fertility. They want to identify conditions that can be reversed to improve fertility and make natural conception possible. These include conditions like varicoceles, hormonal imbalances, or infections that can be treated.
They also look for irreversible conditions (like genetic issues, missing sperm-carrying tubes, or damage from past chemotherapy) where the man’s own sperm can still be used through assisted reproduction techniques like IVF or ICSI.
Finally, doctors look for cases where donor sperm might be necessary. They screen for serious underlying health issues like testicular or pituitary tumors.
Dr. Louro says:
“Testing also checks for genetic conditions that could affect the health of future children.”
Doctors need a detailed medical history, physical examination, and tests tailored to your specific situation to assess your fertility.
Semen analysis is the most basic fertility test for men. It measures sperm count, motility (how well sperm move), morphology (sperm shape), and other parameters. Often, multiple samples are needed since results can vary.
Depending on initial findings, you might also be given the following tests:
Male infertility does not always cause obvious symptoms. Many men feel completely well, so the first sign is often difficulty conceiving. If you have been having regular, unprotected sex for 12 months without pregnancy, or for 6 months if your partner is over 35, it is worth having a more detailed fertility assessment.
Possible male infertility symptoms include:
If you notice any of these signs of male infertility, tests like a semen analysis and hormone blood tests can help identify the cause and guide treatment.
Assisted reproduction techniques can help you conceive when male infertility affects sperm count, sperm movement, sperm shape, or sperm delivery. Your clinic will recommend the best option based on your semen analysis results, your partner’s fertility tests, and how long you have been trying.
IUI (intrauterine insemination)
ICSI (intracytoplasmic sperm injection)
» surgical sperm retrieval (TESE or TESA, or epididymal sperm retrieval)
If you are unsure which fertility treatment fits your situation, start with a semen analysis and a review with a fertility specialist. This helps you understand your options and choose the approach with the best chance of success.
A common issue is how long it can take to get to the first male fertility test. Dr Louro explains:
“Men often pay less attention to their health, take fewer preventive steps, and see healthcare professionals less often.”
This can show up in fertility care too. Some men only do a semen analysis after their partner has already done lots of tests. That can slow everything down, and time matters as fertility can change with age for both partners.
There are a few reasons this happens. Some men worry about what the results might mean. Some feel awkward talking about sex and fertility. Others still assume fertility testing starts with the woman.
Dr. Louro says:
But getting checked early is a positive step. It helps you get clear answers, understand your options, and move forward as a team. It also shows you are taking responsibility for your health and the future you want to build together.
Male infertility can feel personal, but it is a medical issue, and you do not have to figure it out on your own.
The right testing can bring clarity quickly, and in many cases there are practical steps and effective treatments that can help.
If you have been trying to conceive without success, or you have concerns about symptoms or risk factors, contact Procriar to book a male fertility assessment.
A specialist can review your history, arrange the right tests, and guide you towards the next best step for you and your partner.
