Male infertility

Expert reviewer Dr Muhammad Akhtar, Consultant Gynaecologist
Next review due November 2022

Getting pregnant (conceiving) often takes a while, so try not to worry if it doesn’t happen straightaway. Some couples take two years or more. If your partner isn’t pregnant after a year of trying though, this may be a sign of fertility problems, so it’s worth seeing your GP.

This information looks at infertility in men. We also have information on female infertility and infertility treatments.

What is male infertility?

Most couples who have regular sex (every two to three days) without using contraception will conceive within one year. If you’ve been trying for that long without pregnancy happening, speak to your GP. They may use the term 'infertility' at this point, but remember that it doesn't necessarily mean you can't have children naturally; getting pregnant can take longer for some couples. About one to two in every 10 couples have difficulty conceiving after a year.

There are two types of infertility:

• primary infertility – you and your partner have never had children together
• secondary infertility – you and your partner have had children together, but are now having problems conceiving

Infertility can be caused by a problem that affects you, your partner or both of you. Men may have a problem with sperm or blood hormone levels, or may not be ejaculating (releasing semen) properly.

Symptoms of male infertility

Infertility doesn’t cause any specific symptoms in men. But if it is caused by a medical or surgical condition, or low hormone levels, you may have symptoms. These will depend on the cause.

A condition that affects your testicles may cause:

• pain and swelling in your testicles
• prominent veins in your testicles

A problem with your prostate gland or epididymis (the tube that carries sperm from the testicles), may cause:

• blood in your semen
• pain when ejaculating
• trouble ejaculating when you have sex

Low hormone levels may cause:

• problems getting or keeping an erection
• mood changes
• weight gain
• lower sex drive (libido) than usual
• less facial hair, so you need to shave less often

If you have problems with ejaculation, you may notice cloudy urine after having sex, or not being able to ejaculate.

Diagnosis of male infertility

Many couples don’t conceive straightaway when they start trying for children. But if you and your partner have been trying for a year and you’re worried about your fertility, see your GP, ideally together.

Common questions

Your GP will ask you how long you and your partner have been trying for a baby and whether you’ve had any problems having sex. They may ask about your lifestyle and medical history, including if you:

• have had children with a previous partner
• have ever had any sexually transmitted infections (STIs), serious long-term diseases or other conditions that can affect fertility
• are taking any medicines
• smoke
• drink a lot of alcohol regularly
• have been stressed
• have a job that may be a factor

If you find it difficult to talk about any of these issues with your partner present, you may prefer to make separate appointments with your doctor.

Initial tests

Your GP may ask to examine you and do some tests. A sample of semen can show whether you’re producing enough healthy sperm. You’ll be advised about how to give the sample, which may be done at home or in a clinic. The sample will need to be collected through masturbation after at least two days, but no more than seven days, since you last ejaculated. Your semen will be tested for a number of things, including how many sperm there are, how fast they move and their size and shape. If this shows up any problems, you’ll need to have the test repeated around six to 12 weeks later. If the second test confirms a problem with your sperm, your GP may refer you and your partner to a fertility specialist.

If you’re unable to get an erection or keep one for long enough to have sex, your GP may arrange blood tests to look for low hormone levels or evidence of diabetes. Erectile dysfunction can be a sign of diabetes.

Further tests

You may need to see a fertility specialist for further tests and investigations if your sperm count is low. You may have:

• a urine sample to check for retrograde ejaculation – semen is ejaculated backwards into your bladder instead of outside your body
• an ultrasound scan of your testes – your doctor may suggest this if you’re not producing any sperm
• tests for genetic conditions that may affect sperm production

If an underlying health condition is causing your fertility problems, treating this may improve your chance of getting your partner pregnant. Sometimes your doctor may not find a specific cause for your infertility, but there are still treatments you can try.

How can I boost my fertility?

If you have been trying for a baby for less than a year, your GP may suggest you keep trying to conceive naturally. Some couples take two or three years to conceive without any medical help.

Timing

Having sex every two to three days will maximise the chance of pregnancy by making sure you’re having sex during your partner’s most fertile time of the month. Avoid lubricants if you can – some can affect the quality of your sperm and make them less likely to fertilise your partner’s egg.

Lifestyle and diet

You may find it helpful to make some changes to your lifestyle. Stop smoking and don’t regularly drink more than 14 units of alcohol a week. Some illegal drugs can also affect fertility.

Your GP may also suggest you lose excess weight, because being overweight can affect fertility.

Avoiding heat

If your scrotum (which contains your testicles) is too warm, this may reduce sperm quality. Several things can cause this. Examples include working in hot conditions, driving for extended periods, using laptops and having hot baths or saunas. Loose-fitting underwear may help to lower scrotal temperature. It’s not yet clear whether this can improve fertility.

Medication

If you’re taking medicines for another health problem, speak to your GP or pharmacist. Some medicines can affect sperm production, such as sulfasalazine (taken for rheumatoid arthritis or other long-term inflammation). Antidepressants and some medicines for high blood pressure can affect ejaculation. It’s important not to stop any prescribed medicines you’re taking before talking to your GP. They may need to change which medicines you’re taking or adjust your dose.

Avoiding work hazards

Some jobs involve working with hazards that can affect your fertility. These include heat, metals, pesticides and X-rays. If your GP suspects that your work could be affecting your fertility, they may suggest that you speak to your employer or an occupational health advisor at your workplace.

Reducing stress

Having trouble conceiving can be stressful. This may affect your sex drive or your relationship, meaning you have sex less frequently. Your GP may suggest counselling (talking therapy) to discuss your thoughts and feelings. For more information, see the section Living with male infertility.

Treatment for male infertility

Most infertility treatments need to be prescribed by a specialist doctor. Our infertility treatments topic provides more detailed information about treatments for male and female infertility, and when you can be referred.

Medicines

If you have low testosterone levels (hypogonadism), your doctor may suggest gonadotrophin injections to improve your fertility. These trigger your body to make testosterone and produce sperm.

If you have retrograde ejaculation, sperm are ejaculated backwards into your bladder instead of through your urethra and out of your body. Your doctor may prescribe medicines such as pseudoephedrine to help close the opening to your bladder.

Medicines such as sildenafil (Viagra®), tadalafil (Cialis®) or alprostadil may be helpful if you have trouble getting an erection.

Medical devices

If your infertility problems are caused by problems getting an erection, and medicines like the ones mentioned above haven’t helped, your doctor may suggest a vacuum pump. This involves placing your penis into a tube and pumping out the air, so that blood flows into your penis. A constriction band placed at the base of your penis keeps your erection going. You remove this after 30 minutes.

Surgery

Having no sperm in your semen is often caused by a blockage in the tubes that take sperm from your testicles to your penis. This is called obstructive azoospermia. Surgery may be possible, to remove the blockage and improve your fertility.

If you’ve had a vasectomy (surgery to stop sperm going into your semen), it may be possible to have this reversed by paying for this treatment privately. Ask your doctor if this is possible for you.

If you have varicoceles (swollen veins in your scrotum) and there is no other reason for your infertility, your doctor may suggest surgery. Surgery for varicoceles may improve quality of your sperm, although there’s not enough evidence that it increases the chance of having a baby naturally. There is a small amount of evidence that it may increase fertility after assisted reproduction treatments. If this treatment is an option, your doctor will discuss this further with you.

Assisted reproduction

If other treatments haven’t worked, or aren’t right for you, your doctor may recommend assisted reproduction (assisted conception). There are several methods. Which is best for you will depend on what’s causing your infertility. Some involve using sperm donated from another person if you have a problem with sperm production.

Intra-uterine insemination (IUI) can help if you have trouble maintaining an erection and find it hard to have sex. It involves placing sperm (yours or a donor’s) into your partner’s womb when she ovulates. Your partner may need to take medicines that trigger her ovaries to produce eggs.

In vitro fertilisation (IVF) involves mixing your partner’s eggs with sperm (yours or a donor’s) in a laboratory. The aim is to fertilise some of the eggs so they develop into embryos. One or more of the embryos can be transferred into your partner’s uterus, hopefully leading to pregnancy.

Intracytoplasmic sperm injection (ICSI) involves injecting individual eggs with sperm in a laboratory to fertilise them. This may be recommended if you have a low sperm count or difficulty having sex, or you may have ICSI alongside IVF.

Causes of male infertility

Many things can cause infertility in men. In about a quarter of couples, doctors can’t find any specific cause (this is sometimes called unexplained infertility).

Sperm disorders

The most common reason for male infertility is a problem with your sperm. It may be that:

• you don't have enough sperm in your semen
• your sperm don't move as fast as they need to
• your sperm are the wrong shape

You may have all three of these problems at the same time.

Some men have no sperm at all in their semen. This is usually caused by a condition called obstructive azoospermia. The tubes that carry sperm from your testicles to your penis (seminal ducts) are blocked. You may be born with this or you may develop it after an infection, bladder neck surgery or scarring after an inguinal hernia repair.

Hypogonadism

If you have hypogonadism, you don’t produce enough, or any, of the hormone testosterone. This may affect your sperm count, or mean you can’t get an erection and have low sex drive (libido).

You can have hypogonadism from birth or develop it after an illness or accident. You may also develop it if you’re taking certain medicines, such as spironolactone (a water tablet or diuretic), and cimetidine (an antacid).

Ejaculation disorders

Several problems can affect how you ejaculate (release semen).

• Erectile dysfunction – you can’t keep an erection for long enough to have sex.
• Retrograde ejaculation – your semen is ejaculated backwards into your bladder rather than out of your body when you orgasm.
• Delayed ejaculation means you can’t ejaculate inside your partner’s vagina. This may be a psychological problem.
• Anorgasmia – you don’t reach an orgasm and ejaculate. This may be because you don’t have enough feeling in your penis (sometimes caused by nerve damage).

Other factors that affect fertility

A number of other factors can affect male fertility. These include:

• smoking – this reduces the quality of your sperm
• drinking too much alcohol– this may reduce the quality of your sperm
• taking illegal drugs, such as marijuana and cocaine
• using anabolic steroids
• having mumps after puberty – this causes testicular inflammation in some men, which can lower sperm count, although complete infertility afterwards is rare
• being overweight or obese
• having varicoceles – swollen veins in your scrotum
• your scrotum being too warm
• exposure to chemicals through your work – for example, pesticides
• some medicines – for example, sulfasalazine (used to treat rheumatoid arthritis and inflammatory bowel disease), chemotherapy, spironolactone (a water tablet or diuretic) or finasteride (a hair loss prevention tablet)
• stress
• getting older – this can be a factor, although less so than for women
• having small testicles, or an inherited condition that has affected how your testicles develop and function

Living with male infertility

If no reason for infertility is found, your doctor will reassure you that it can take time for you and your partner to conceive. You may find having trouble conceiving upsetting and stressful. Even if there’s a chance your partner may become pregnant naturally, it can be reassuring to know that help and support are available.

Stress may mean you don’t feel like having sex so often, which can lead to further difficulties conceiving. You may feel pressure from family and friends to have children. This can also affect your relationship. It’s important to find ways of managing stress before it affects your relationship. Relaxation exercises may help.

It may help you both to speak to other people who understand what you’re going through. Meeting other couples through a support group can reassure you that you’re not alone.

Sometimes it helps to talk to someone who doesn’t know you or your partner and isn’t involved in your treatment. If you’re struggling, your clinic can give you details of a specialist fertility counsellor, to help you explore your feelings and find ways to cope. You can also talk through the different treatments and the options available to you.