Male Infertility: Causes, Symptoms, Tests and Treatment

If you and your partner have been trying to conceive without success, it is easy to assume the problem sits with her. That assumption is common, and it is often wrong. Male infertility is far more widespread than most men realize, and the good news is that many of its causes can be identified and treated.

This guide walks you through what male infertility is, what causes it, how it is diagnosed, and what you can do about it. Read it as a starting point for a conversation with your doctor, not a verdict.

What Is Male Infertility?

Male infertility means a man has a reduced chance of getting his partner pregnant because of a problem with his sperm or reproductive system. Doctors usually diagnose infertility after 12 months of regular, unprotected intercourse without a pregnancy. If your partner is 35 or older, the timeline shortens to 6 months.

Here is a fact that surprises many couples: in about one third of infertility cases the cause is on the male side, in another third it is on the female side, and in the rest it involves both partners or remains unexplained. Male factors play a role in up to half of all couples who struggle to conceive. That is why a full evaluation should always include both of you.

Male infertility typically comes down to one of three issues: your body is not making enough healthy sperm, your sperm are not moving or shaped the way they should be, or sperm are made but cannot get out. You will see terms like low sperm count (oligospermia), poor sperm motility (asthenospermia), abnormal sperm shape (teratospermia), and no sperm in the semen (azoospermia). Each points to a different set of possible causes and solutions.

What Are the Top 3 Causes of Male Infertility?

Many conditions can affect male fertility, but three groups of causes account for most diagnoses.

1. Varicocele

A varicocele is an enlargement of the veins inside the scrotum, similar to varicose veins in the legs. It is the most common correctable cause of male infertility. Varicoceles are found in roughly 15 percent of all men and in about 35 to 40 percent of men with primary infertility. They are thought to raise the temperature around the testicles and reduce oxygen delivery, which can lower sperm count, motility, and quality. Many men have no pain at all, so you may not know you have one until a doctor examines you.

2. Hormonal imbalances and testicular problems

Sperm production depends on a chain of signals from your brain to your testicles. The pituitary gland releases follicle stimulating hormone (FSH) and luteinizing hormone (LH), which tell your testicles to make sperm and testosterone. If any part of that chain breaks down, sperm production can fall sharply. Causes include pituitary or thyroid disorders, high prolactin, undescended testicles in childhood, testicular injury or infection, cancer treatment, and genetic conditions such as Klinefelter syndrome or Y chromosome microdeletions.

3. Blockages and ejaculation problems

Sometimes your testicles make plenty of healthy sperm, but those sperm cannot reach the semen. Blockages in the tubes that carry sperm can result from infections, surgery, injury, or a congenital absence of the vas deferens (often linked to cystic fibrosis gene variants). Retrograde ejaculation, where semen flows backward into the bladder, can also occur, particularly in men with diabetes or after certain surgeries or medications.

Beyond these three, everyday factors matter too. Smoking, heavy alcohol use, obesity, anabolic steroid use, chronic stress, poor sleep, and exposure to heat or environmental toxins are all linked with lower sperm quality. The encouraging part is that you have real influence over many of them.

What Are the Symptoms of Male Infertility?

Here is the tricky part: most men have no symptoms at all. The first and often only sign is that a pregnancy has not happened. That is exactly why testing matters.

When symptoms do appear, they usually point to an underlying condition. Pay attention if you notice:

• Pain, swelling, or a lump in the testicle area
• Problems with ejaculation, such as very small semen volume or a dry orgasm
• Erectile dysfunction or reduced sexual desire
• Decreased facial or body hair, which can suggest a hormonal issue
• Breast tissue growth (gynecomastia)
• A history of testicular injury, undescended testicles, hernia repair, or repeated infections of the groin area
• A reduced sense of smell, which can be linked to a rare hormonal condition

None of these means you are infertile, and having none of them does not mean you are fine. If you are struggling to conceive, a semen test is the only way to know where you stand.

What Tests Are Done for Male Infertility?

The idea of fertility testing can feel uncomfortable, but the process is simple and mostly painless. Here is what you can expect.

Medical history and physical exam. Your doctor will ask about your health, medications, past surgeries, infections, lifestyle habits, and sexual function. A physical exam checks for a varicocele, testicular size, and any structural concerns.

Semen analysis. This is the cornerstone of male fertility testing. You provide a sample after a short period of abstinence, usually two to seven days depending on the lab, and the lab measures volume, sperm concentration, motility, and shape. The World Health Organization's 2021 lower reference limits are about 1.4 mL for volume, 16 million sperm per mL, 39 million sperm in total, 42 percent total motility, and 4 percent normal shape. Sperm counts vary from sample to sample, so doctors often repeat the test after a few weeks before drawing conclusions.

Hormone blood tests. These typically measure FSH, LH, and testosterone, and sometimes prolactin and thyroid hormones. They help show whether a hormonal problem is limiting sperm production.

Scrotal ultrasound. This imaging test can confirm a varicocele and reveal other structural problems in the testicles or surrounding tubes.

Post ejaculation urine test. This checks for sperm in your urine, which can indicate retrograde ejaculation.

Genetic testing. If your sperm count is very low or zero, your doctor may recommend a karyotype, Y chromosome microdeletion testing, or cystic fibrosis gene screening.

Sperm DNA fragmentation testing. This measures damage to the genetic material inside sperm. It is not needed for everyone, but it can be useful after repeated pregnancy loss or unexplained infertility.

Testicular biopsy. In select cases, usually when no sperm appear in the semen, a small sample of testicular tissue helps determine whether sperm are being produced.

A urologist, ideally one who specializes in male reproductive health, can guide which tests make sense for you.

How Is Male Infertility Treated?

Treatment depends entirely on the cause, and many men have more options than they expect.

Lifestyle changes. Quitting smoking, cutting back on alcohol, improving sleep, managing weight, and eating a nutrient rich diet can all support better sperm health. Our fertility nutrition guide explains which foods are worth prioritizing.

Treating underlying conditions. Infections can be treated with antibiotics. Hormonal problems may respond to medication that stimulates sperm production. Varicocele repair surgery may improve semen quality in selected men, particularly those with abnormal semen results and a palpable varicocele.

Surgery for blockages. Some obstructions can be corrected surgically, and in other cases sperm can be retrieved directly from the testicle or epididymis.

Assisted reproductive technology. If natural conception is unlikely, options include intrauterine insemination (IUI), in vitro fertilization (IVF), and IVF with intracytoplasmic sperm injection (ICSI), where a single sperm is injected directly into an egg. ICSI has made it possible for many men with very low counts, or those who need surgical sperm retrieval, to father biological children.

Supplements. Antioxidants such as vitamin C, vitamin E, zinc, selenium, folate, and coenzyme Q10 have been studied for sperm quality, with mixed results. Before buying anything, read our breakdown of the best fertility supplements and talk to your doctor, because more is not always better.

One important timing point: sperm take roughly 74 days to develop, so changes you make today usually show up in your semen about three months later. If you are wondering how long to give it, our guide on how long it takes to improve fertility naturally sets realistic expectations.

What Should I Avoid to Improve My Male Fertility?

Small daily habits add up. Here is what research suggests you should limit or avoid.

Excess heat. Your testicles sit outside your body because sperm production works best at a temperature slightly below core body temperature. Frequent hot tubs, saunas, heated car seats, long hours of sitting, and a laptop resting on your lap can raise scrotal temperature. Learn more about how temperature affects sperm health. If you are wondering about the opposite extreme, see our article on cold plunges and male fertility.

Smoking and recreational drugs. Tobacco is associated with lower sperm count and motility. Marijuana use has also been linked with reduced sperm concentration, and other recreational drugs can harm sperm production.

Heavy alcohol use. Regular heavy drinking can lower testosterone and reduce sperm quality.

Anabolic steroids and testosterone therapy. This one catches many men off guard. Outside testosterone signals your brain to shut down the hormones that drive sperm production, and sperm counts can drop to zero. If you use testosterone or supplements that contain steroid like compounds, speak with your doctor before trying to conceive.

Ultra processed food and excess weight. Obesity is associated with hormonal changes and lower sperm counts, and diets heavy in processed foods tend to be linked with poorer semen quality.

Environmental toxins. Pesticides, certain plastics (such as BPA and phthalates), lead, and some industrial solvents may affect sperm. Reduce exposure where you can, especially if you work around chemicals.

Some lubricants. Many commercial lubricants can reduce sperm movement. If you use one while trying to conceive, choose a product labeled as fertility friendly.

Chronic stress and poor sleep. Both can affect hormones and sperm quality over time.

For a broader checklist you can share with your partner, see our guide on what to avoid when trying to conceive.

How to Cope With Infertility as a Man?

Infertility is a health issue, but it is also an emotional one. Many men feel pressure to stay strong, stay quiet, and fix it. If that sounds like you, here is what can help.

Name what you are feeling. Frustration, shame, anger, sadness, and fear are all normal reactions. Research shows men facing infertility experience real emotional distress, even when they do not talk about it. Pretending you feel fine rarely helps.

Talk to your partner honestly. You and your partner are on the same team, and you may be grieving differently. She may want to talk through every detail while you may want space. Agree on how and when to discuss it so neither of you feels shut out.

Separate your worth from your sperm count. A semen result is a medical data point. It says nothing about your masculinity, your value as a partner, or your ability to be a great father.

Find support outside your relationship. A counselor who understands fertility struggles, a men's support group, or a trusted friend can give you a place to speak freely. Many fertility clinics offer counseling services.

Take action where you can. Waiting is hard. Booking the tests, improving sleep, moving more, and making dietary changes give you something productive to do with the worry.

Protect your relationship. Treatment schedules can take over your life. Plan time together that has nothing to do with fertility.

Know when to ask for professional help. If you notice persistent low mood, loss of interest in things you enjoy, trouble sleeping, or thoughts of hopelessness, speak with a doctor or mental health professional. If you ever have thoughts of harming yourself, contact a crisis line or emergency services right away.

When Should You See a Doctor?

Do not wait a full year if you have a known risk factor. See a doctor sooner if you have a history of testicular problems, previous genital surgery or injury, cancer treatment, or symptoms such as pain, swelling, or sexual dysfunction. The same applies if your partner is 35 or older, or if you have had recurrent pregnancy loss. Early answers save time and stress.

Frequently Asked Questions About Male Infertility

Can male infertility be cured?

It depends on the cause. Infections, hormonal imbalances, varicoceles, lifestyle related issues, and some blockages are often treatable. Some genetic causes cannot be reversed, but assisted reproduction such as IVF with ICSI can still make biological fatherhood possible for many men.

Can stress cause male infertility?

Stress alone rarely causes complete infertility, but chronic stress can affect hormone levels, sleep, sexual function, and sperm quality. Managing stress is a helpful part of a broader plan, not a standalone fix.

How long does it take to improve sperm quality?

Sperm take about 74 days to develop, so most men need roughly three months of consistent changes before a repeat semen analysis reflects them.

Can a man with a low sperm count still get his partner pregnant?

Yes. A low count lowers the odds per cycle, but it does not make pregnancy impossible. Many couples conceive naturally, and treatments such as IUI, IVF, and ICSI can help when natural conception is unlikely.

Does age affect male fertility?

Men do not lose fertility as abruptly as women, but sperm quality and semen volume decline gradually with age, and advancing paternal age is associated with longer time to conception and a higher chance of some genetic changes in sperm.

Do both partners need to be tested?

Yes. Because causes can sit with either partner or both, testing only one person can leave important answers behind. A joint evaluation is faster and more complete.

Take the Next Step

Male infertility is common, it is medical, and it is not a reflection of who you are. The sooner you get clear answers, the sooner you can act on them.

If you want guidance that looks at both partners, Katy Poole, a fertility consultant and nurse practitioner, offers personalized fertility consulting services that include assessments for both partners. You can also explore the Get Pregnant Faster program to learn how to support egg and sperm health, and browse more fertility health resources to keep learning.