Male Infertility: Common Causes and When to Seek Help
When couples have trouble getting pregnant, the focus often turns to the woman first. That’s understandable—but it’s only part of the picture. In reality, male fertility plays a role in about half of all infertility cases.
And yet, many men don’t realize this until months—or even years—into the process.
The truth is, fertility is a shared journey. Understanding what affects male fertility, and knowing when to get checked, can save a lot of stress, confusion, and unnecessary self-blame.
What Sperm Health Really Comes Down To
Most people think fertility is just about sperm count. But it’s more than that. Healthy sperm depends on three things:
- How many sperm there are
- How well they move
- How they’re shaped
If one of these is off, getting pregnant can be harder—even if everything else seems fine.
Another thing many men don’t know: sperm production takes time. About two and a half months, start to finish. That means the choices you make today—your sleep, diet, stress level, and habits—can affect your fertility a few months from now. There’s no instant fix, but positive changes really do add up.
Common Medical Reasons Men Struggle With Fertility
Some fertility issues are related to medical conditions, many of which are treatable.
One of the most common is a varicocele, which is a group of enlarged veins in the scrotum. These veins can raise the temperature around the testicles, and sperm don’t do well in heat. Fixing a varicocele often improves sperm quality.
Hormone imbalances can also interfere with sperm production. Testosterone, along with a few other hormones, needs to be in the right range for the testes to work properly.
Infections may damage sperm or block the tubes that carry them—sometimes without obvious symptoms. Past surgeries involving the groin, testicles, or prostate can also leave scar tissue that gets in the way.
Some men experience retrograde ejaculation, where semen goes backward into the bladder instead of out of the penis. It’s not dangerous, but it can make conception difficult.
There are also genetic causes, which are less common but important to identify early so couples know what options make the most sense.
One big surprise for many patients: testosterone therapy. Even though it can improve energy and libido, outside testosterone actually shuts down natural sperm production. I see this often in men who had no idea it could affect fertility.
Lifestyle Habits That Matter More Than You Think
Daily habits play a bigger role in fertility than most men expect.
- Smoking damages sperm DNA and lowers sperm count and movement.
- Heavy drinking can reduce testosterone and slow sperm production.
- Recreational drugs, including marijuana and steroids, can interfere with fertility.
- Weight issues, whether too high or too low, can disrupt hormone balance.
Heat is another overlooked factor. The testicles sit outside the body for a reason—they need cooler temperatures. Frequent hot tubs, saunas, or even resting a laptop directly on your lap can raise temperatures enough to affect sperm development.
Work and environmental exposures matter too. If your job involves chemicals, heavy metals, or pesticides, that’s important information for your doctor to know.
When Is It Time to Get Checked?
If the female partner is under 35 and pregnancy hasn’t happened after a year of trying, it’s reasonable to get evaluated. If she’s 35 or older, that window shortens to six months.
That said, you don’t have to wait if something already feels off.
It’s a good idea to seek help sooner if you’ve had:
- Testicular pain, swelling, or injury
- Changes in sex drive
- Problems with erections or ejaculation
- Previous cancer treatment
- Surgery involving the reproductive organs
Getting answers earlier usually means more options and less frustration.
What a Fertility Check-Up Is Actually Like
Most men expect the process to be awkward or complicated. In reality, it’s usually pretty straightforward.
It starts with a conversation—your medical history, lifestyle, medications, and any previous pregnancies you may have fathered. These details help guide the next steps.
The main test is a semen analysis, which looks at sperm count, movement, and shape. Because sperm levels can vary, an abnormal result is often repeated to be sure.
Blood tests may be done to check hormone levels, and sometimes imaging or genetic tests are helpful, depending on the situation.
What Can Be Done If There’s a Problem?
Treatment depends on the cause—and many men are relieved to learn there are solutions.
- Varicoceles can often be repaired.
- Infections can be treated.
- Hormonal issues may improve with medication.
- Some blockages can be corrected with surgery.
Lifestyle changes are almost always part of the plan. Quitting smoking, cutting back on alcohol, improving diet, exercising regularly, and avoiding excess heat all support healthier sperm. These changes take time, but they matter.
For some couples, assisted reproductive options make the most sense.
IUI places sperm directly into the uterus.
IVF with ICSI allows fertilization even when sperm numbers are very low by injecting a single sperm into an egg.
A Final Thought
Fertility struggles can be emotionally heavy—especially for men who aren’t used to talking about reproductive health. It’s important to know that infertility is a medical issue, not a personal failure.
Asking for help doesn’t mean something is “wrong” with you. It means you’re taking an active role in your health and your future.
At our practice, we approach fertility concerns with respect, honesty, and compassion. Whether you’re just starting to ask questions or have been trying for a while, we’re here to help you understand what’s going on and explore the options that make sense for you.
If you have concerns about fertility, don’t hesitate to reach out. Getting clarity can be the first step toward moving forward.
