Male infertility
Your health expert: Mr Luciano Nardo , Consultant in Obstetrics and Gynaecology, RCOG accredited subspecialist in Reproductive Medicine
Content editor review by Rachael Mayfield-Blake, March 2022
Next review due March 2025
Male infertility is the term used to describe being unable to naturally get somebody pregnant. You’ll need investigations and treatment to increase your chance of having a baby.
This information looks at infertility in men. We also have information on female infertility and infertility treatments.
About male infertility
Getting pregnant (conceiving) happens quickly for some people, but for others it can sometimes take a while. Try not to worry if it doesn’t happen straightaway. But, if you haven’t managed to conceive a baby after a year or two of trying, it could be a sign of fertility problems for you or your partner, or sometimes for both of you, and it’s a good idea to see your GP.
Types of male infertility
There are two types of male infertility:
- primary infertility – you and your partner have never had children together, or in previous relationships
- secondary infertility – you and your partner have had children together (or in previous relationships), but are now having problems getting pregnant
Causes of male infertility
Many things can cause infertility in men (see below). ). But sometimes doctors can’t find any cause. This is sometimes called unexplained infertility.
Sperm disorders
The most common reason of 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 a different shape
You may have all three of these problems at the same time.
You might not have any sperm at all in your semen. This is usually caused by a condition called obstructive azoospermia, where the tubes that carry sperm from your testicles to your penis (seminal ducts) are blocked. Or they didn’t develop as they should when you were a baby, so you’re born with this condition. You may develop obstructive azoospermia after an infection, surgery on your bladder, or from scarring after an inguinal hernia repair operation, for example.
Hypogonadism
If you have hypogonadism, you don’t produce enough, or any, of the hormone testosterone. This may affect your sperm count and sex drive (libido), or mean you can’t get an erection and ejaculate.
You may be born with hypogonadism or develop it after an illness or treatment for an illness, such as chemotherapy. You may also develop it if you take 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 – you may have nerve damage, for example.
Other things that affect fertility
A number of other things can affect male fertility, by reducing the quality of sperm for example, and these include:
- smoking
- alcohol
- illegal drugs, such as marijuana and cocaine
- anabolic steroids
- mumps – if you have this after you've gone through puberty it can causes testicular inflammation , which can lower sperm count, although complete infertility afterwards is rare
- being overweight or obese
- 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 – your sperm may be less mobile if you’re older than 55, although age is less of a factor for fertility in men compared to women
- having small testicles, or an inherited condition that has affected how your testicles develop and function
- a genetic disease
- an injury to your testicles
Symptoms of male infertility
There aren’t any specific male infertility symptoms. But if it’s caused by a medical or surgical condition, or low hormone levels, you may have symptoms.
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 the tube that carries sperm from the testicles ( epididymis), 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
- changes to your mood
- tiredness
- problems concentrating
- 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 that your urine looks cloudy after you have sex, or you can’t ejaculate at all.
Diagnosis of male infertility
If you’ve been trying to conceive a baby for a year or more, you and your partner (if you have one), may wish to see your GP for advice.
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 alcohol or take drugs
- have been stressed
- have a job that may be a factor (see Causes of male infertility above)
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 may be able to take the sample at home or in a clinic. You’ll need to collect the sample (through masturbation) at least two days after, but no more than five days, since you last ejaculated. Your semen will be tested for a number of things, including:
- how many sperm there are
- how fast the sperm move
- the size and shape of your sperm
If this shows up any problems, you’ll need to repeat the test around a month later. If the second test confirms a problem with your sperm, your GP may refer you 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. These will look for low hormone levels or evidence of diabetes, as erectile dysfunction can be a sign of diabetes.
Further tests
If you’ve been trying for a baby for a year or more, you may decide to see a GP for advice. You may need to see a fertility specialist for further tests and investigations if your sperm count is low. You may need:
- to give a urine sample to check for retrograde ejaculation, where semen is ejaculated backwards into your bladder instead of outside your body
- an ultrasound scan of your testes if you’re not producing any sperm
- tests for genetic conditions that may affect sperm production
- hormone tests to check the levels of your hormones
Sometimes your doctor may not find a specific cause for your infertility, but there are still treatments you can try.
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Self-help for male infertility
There are lots of things you can do to help boost your fertility.
Timing
If you’re having unprotected vaginal sex to conceive, have sex regularly, every two or three days. This will maximise the chance of pregnancy by making sure you’re having sex during your partner’s most fertile time of the month. Some lubricants can affect the quality of your sperm and make them less likely to fertilise an egg – ask a pharmacist which types are suitable to use.
Lifestyle and diet
If you smoke, stop. Ask your GP to refer you to a stop smoking service for help. If you regularly drink alcohol, try to cut down, or don’t drink at all. And since drugs can affect your sperm, it’s best not to take them too.
If you’re overweight, try to lose some weight, as it may help.
Heat Control
If your scrotum, which contains your testicles, is too warm, it may reduce the production of sperm. Several things can cause this. Examples include working in hot conditions, driving for extended periods, using a laptop on your lap, and having saunas. Loose-fitting underwear may help to lower scrotal temperature but it’s not yet clear whether this can improve fertility.
Medicines
If you take medicines for another health problem, speak to your GP or pharmacist as some medicines can affect sperm production. Some antidepressants and medicines for high blood pressure can affect ejaculation. But don’t stop taking any prescribed medicines before you talk to your GP. They may need to change which medicines you take or adjust your dose.
Avoiding work hazards
Some jobs involve working with hazards that can affect your fertility, such as heat, metals, pesticides and X-rays. If your GP thinks 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.
Reduce stress
Having trouble getting pregnant can be stressful. This may affect your sex drive or your relationship, meaning you have sex less often. Your GP may refer you for counselling (talking therapy) to discuss your thoughts and feelings.
Treatment for male infertility
Most infertility treatments are prescribed by a specialist doctor. There are lots of treatment choices and you may find it helpful to read more information about infertility treatments. If you have a health condition that’s causing your fertility problems, treatment for this may improve things.
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 haven’t helped, your doctor may suggest a vacuum pump. You place your penis into a tube and pump out the air, so that blood flows into your penis. You put a constriction band at the base of your penis to keep your erection going, which you remove after 30 minutes.
Surgery
- You may need an operation to remove a blockage in the tubes that take sperm from your testicles to your penis (obstructive azoospermia).
- If you’ve had a vasectomy (surgery to stop sperm going into your semen), it may sometimes be possible to have a vasectomy reversal. You would need to have private treatment as the NHS doesn’t fund this operation.
- If you have varicoceles (swollen veins in your scrotum) and there’s no other reason for your infertility, your doctor may suggest surgery. The National Institute for Health and Care Excellence (NICE) doesn’t recommend this as a treatment. But some research suggests that surgery may possibly improve your chances of pregnancy, although there’s not enough evidence to show it increases the chance of having a baby naturally.
Assisted reproduction
If other treatments haven’t or aren’t right for you, your doctor may recommend assisted reproduction (assisted conception). Assisted conception means help to conceive a baby using ways other than having sex. What type of assisted conception is an option for you will depend on the reasons why you’re finding it hard to get pregnant.
Intracytoplasmic sperm injection (ICSI) involves injecting individual eggs with sperm in a laboratory before they are put into the womb. Your doctor may recommend ICSI if you have a low sperm count or difficulty having sex, or you may have ICSI alongside IVF (see below).
In vitro fertilisation (IVF) involves mixing eggs with sperm (yours or a donor’s) in a laboratory. IVF can help if there doesn’t seem to be a specific cause for your infertility, or other treatments haven’t worked. It can also help if you have retrograde ejaculation, or if you’re using surrogacy to have a baby.
Intra-uterine insemination (IUI) can help if you have trouble maintaining an erection and find it hard to have sex, or if you’re in a same-sex relationship. It involves placing sperm (yours or a donor’s) into a woman’s womb when she ovulates (releases an egg).
Gamete intrafallopian transfer (GIFT) involves an egg and sperm being transferred into a woman’s fallopian tubes before the egg fertilises.
You can find out more about all types of assisted conception, including their success rates and risks, from the Human Fertilisation and Embryology Authority (HFEA).
Living with male infertility
Trouble getting pregnant, for any length of time, can be upsetting and stressful. Feeling stressed, whatever the cause, can affect your relationships and your sex life, which in turn can make conceiving even harder. There’s also some evidence that stress can affect how successful certain treatments are. It’s important to find ways of managing stress before it affects your relationship.
You may find it helpful to get support from others going through the same thing. You can find local support groups and access online support through the charity, Fertility Network UK. Or it may help to talk to someone who doesn’t know you or your partner, and isn’t involved in your treatment. Counselling may help you talk about the impact it’s having – ask your fertility clinic to refer you, or find a counsellor yourself.
There aren’t any symptoms of male infertility. But if you have a medical condition that’s affecting your fertility, or your hormone levels are low, you may have symptoms of that. If you’re trying for a baby and haven’t managed to conceive (get pregnant) after a year or two of trying, it could be a sign of fertility problems for you or your partner, or sometimes for both of you, and it’s a good idea to see your GP.
See our section: Symptoms of male infertility above for more information.
It depends on the cause but there are many treatments to help improve fertility. These include medicines, medical devices and surgery. If you have a health condition that’s causing your fertility problems, treatment for this may improve things too.
See our section: Treatment of male infertility above for more information.
Age is less of a problem for men than women in terms of fertility. While women’s fertility naturally quickly declines after the age of 35, this doesn’t seem to be the case for men. But your sperm may become less mobile after you reach 55. And the quality of your sperm can get worse with age.
It depends on what’s causing male infertility, but there are lots of treatments that can help to improve your fertility. There are also assisted reproduction (assisted conception) treatments to help you have a baby. Your doctor will explain your options.
See our section: Treatment of male infertility above for more information.
If you give a sample of semen, it can be tested to show whether you’re producing enough healthy sperm. Your semen will be tested to see: how many sperm there are; how fast your sperm move, and the size and shape of your sperm. But even if the tests show things are normal, other things may be affecting your fertility. Ask your doctor for more information.
See our section: Diagnosis of male infertility above for more information
If you have a condition called obstructive azoospermia, the tubes that carry sperm from your testicles to your penis (seminal ducts) are blocked. This means you might not have any sperm at all in your semen. It may be possible to have an operation to remove the blockage, or to take sperm directly from the tubes or your testes, which may help to improve your fertility. Ask your doctor if this is an option for you.
See our section: Treatment of male infertility above for more information.
Treatments for infertility
Female infertility
Prostate cancer
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- Personal communication, Mr Luciano Nardo, Consultant in Obstetrics and Gynaecology, 3 March 2022
