Male infertility

Expert reviewer Raj Mathur, Consultant Gynaecologist
Next review due March 2020

Getting pregnant (conceiving) often takes a while. So if your partner doesn’t get pregnant straight away, it’s important not to worry. Some couples take two years or more to conceive. But if your partner hasn’t got pregnant after a year of regular sex and no contraception, this could be a sign of fertility problems.

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

What is male infertility?

One in seven couples have difficulty conceiving. A doctor may use the word ‘infertility’ if your partner isn’t pregnant after one year of having regular sex without using contraception. But this still doesn’t mean you can’t have children naturally.

• There are two types of infertility. Primary infertility. This means you and your partner have never had children together.
• Secondary infertility. This is when you and your partner have had children together, but are now having problems conceiving.

Infertility can be caused by a problem that affects you or your partner. In about four out of 10 couples who can’t conceive, both partners have a condition that affects their ability to have a baby. You may have a problem with your sperm or hormone levels, or may not be ejaculating (releasing semen) properly.

Over eight out of 10 couples will conceive within one year of having regular, unprotected sex. Most couples will get pregnant within two years of trying without having any medical help. If you and your partner have been trying to get pregnant for a year without any success, there may be an underlying reason. It’s worth speaking to your GP for advice.

Symptoms of male infertility

Infertility doesn’t cause any specific symptoms in men. But if your infertility is caused by a specific medical condition or low hormone levels, you may notice some symptoms of these. Your symptoms will depend on what’s causing your infertility.

If you have a condition that affects your testicles, you may notice:

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

If you have a problem with your prostate gland or epididymis, you may have:

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

If you have low hormone levels, you may have:

• 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

Diagnosis of male infertility

Many couples don’t get pregnant straight away 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. It's a good idea for you and your partner to see your GP together.

Common questions

Your GP will need to ask you lots of questions. These will probably include 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

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. They may ask you to provide a sample of semen. This is to check whether you’re producing enough healthy sperm. You’ll need to take the sample after you’ve gone three days without ejaculating. Your semen will be tested for a number of things, including how many sperm it contains and how fast the sperm are able to move. 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 there’s 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 check your blood glucose levels. This is because erectile dysfunction can be a sign of diabetes.

Further tests

You may be offered further tests and investigations if your sperm count is low. You may need to see a fertility specialist for some of these. Test you may have include the following.

• A check on your hormone levels. Low levels of the hormone testosterone are a sign of a condition called hypogonadism, which can reduce your production of sperm.
• A urine sample to check for sperm in your urine – a sign of retrograde ejaculation. This is when you don’t ejaculate (release semen) properly. Your semen is ejaculated backwards into your bladder instead of outside your body.
• An ultrasound scan of your testes – you may be advised to have this if you’re not producing any sperm.
• Tests for genetic conditions, such as cystic fibrosis.

If your fertility problems are caused by an underlying health condition, treating this may improve your chance of getting your partner pregnant. Sometimes though, your doctor may not find a specific cause for your infertility. If this is the case, there are still many options you can try.

How can I boost my fertility?

If you and your partner 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 help to make sure you’re having sex during your partner’s most fertile time of the month. This will maximise the chance of your partner getting pregnant. If you use lubricants, be aware that some of these 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 if you can make some changes to your lifestyle. Stop smoking or at least cut down, and don’t drink more than 14 units of alcohol a week on a regular basis. Your GP may also suggest you lose any excess weight, because being overweight can affect your fertility.

Heat

Some research has found that if your scrotum (which contains your testicles) is too warm, this may reduce the quality of your sperm. Several things can cause your scrotal temperature to rise. Examples include having hot baths, working in hot conditions, driving for extended periods and using laptops. It’s been suggested that wearing loose-fitting underwear may help to lower your scrotal temperature. But 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, such as sulfasalazine (taken for rheumatoid arthritis or other long-term inflammation) can affect your production of sperm. Antidepressants and some medicines for high blood pressure can affect ejaculation. Your GP may need to change which medicines you’re taking, or adjust the dose you’re taking.

Work hazards

Some jobs involve working with certain hazards that can affect your fertility. These include heat, metals, pesticides and X-rays. If you’re worried that your work could be affecting your fertility, speak to your employer or the occupational health advisor at your workplace.

Having trouble conceiving can be stressful, which may affect your sex drive. This can affect your relationship too, and may mean you have sex less frequently. So it’s important to relax. Your GP may suggest you have some counselling (talking therapy) to discuss your thoughts and feelings. For more information, see the section Living with male infertility.

Treatment for male infertility

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

Medicines

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

If you have retrograde ejaculation, your 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 – these close the opening to your bladder.

Medicines such as sildenafil (Viagra®) may be helpful if you have trouble getting an erection.

Medical devices

If your infertility problems are caused by problems getting an erection, your doctor may suggest you try a vacuum pump. This involves placing your penis into a tube and pumping out the air, so that blood flows into your penis. You place a constriction band at the base of your penis to keep your erection going, and remove this after 30 minutes.

Surgery

If you have obstructive azoospermia, you’ll have no sperm in your semen. This is often caused by a blockage in the tubes that take sperm from your testicles to your penis. If this is the case, you may be able to have surgery 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. Ask your doctor if this is a suitable option for you.

If you have varicoceles (swollen veins in your scrotum) and no other reason for your infertility has been found, your doctor may suggest surgery. Surgery for varicoceles is thought to improve quality of your sperm, but there’s no evidence that it will increase your chance of having a baby. If this treatment is an option for you, your doctor will discuss this further with you.

Assisted reproduction

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

Intra-uterine insemination (IUI) involves placing sperm (yours or from a donor) into your partner’s uterus around the time she ovulates. Your partner may be given some medicines that trigger her ovaries to produce eggs. This may be recommended if you have trouble maintaining an erection and find it hard to have sex.

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

Intracytoplasmic sperm injection (ICSI) involves injecting individual eggs with sperm (usually from a donor) in a laboratory to fertilise them. This may be recommended if you don’t make any sperm, make very few sperm or your sperm are the wrong shape. 

Causes of male infertility

There are many things that can cause infertility in men. But in about a quarter of couples, doctors can’t find any specific cause.

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 who have problems with fertility have no sperm at all in their semen. This is usually caused by a condition called obstructive azoospermia. This is when the tubes (called seminal ducts) that carry sperm from your testicles to your penis are blocked. You may be born with this blockage or you may develop it after an infection or surgery, such as a vasectomy.

Hypogonadism

Your infertility may be caused by a condition called hypogonadism. This means you don’t produce enough, or any, of the hormone testosterone. Low testosterone levels may affect your sperm count, can mean you can’t get an erection, and that you have little sex drive (libido).

You can have hypogonadism from birth or develop it later on, 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 cyproterone (used to treat prostate cancer).

Ejaculation disorders

There are several problems that can affect how you ejaculate (release semen).

• Erectile dysfunction is when you can’t keep an erection for long enough to have sex.
• Retrograde ejaculation is when your semen is ejaculated backwards into your bladder rather than out of your body when you orgasm.
• If you have delayed ejaculation, you can’t ejaculate inside your partner’s vagina. This may be a psychological problem.
• Anorgasmia means 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 your 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
• chemotherapy
• being overweight or obese
• having small testicles
• having varicoceles – these are swollen veins in your scrotum
• your scrotum being too warm
• having a job that exposes you to certain chemicals – for example, pesticides
• some medicines – for example, sulfasalazine (which is used to treat rheumatoid arthritis and inflammatory bowel disease)
• stress

It’s also worth remembering that fertility may reduce as you get older, although not as much as it does in women.

Living with male infertility

If there’s no underlying reason for your fertility problems, your doctor will reassure you that it can take time for you and your partner to conceive. It can take some couples two years to get pregnant naturally without any specific medical help. You may find it upsetting and stressful if you and your partner are having trouble conceiving for any length of time. Even if there’s a chance your partner may become pregnant naturally, it’s reassuring to know that help and support are available.

If you’re feeling stressed, it’s important to find ways to deal with your thoughts and feelings before it affects your relationship with your partner. Stress can reduce your desire to have sex, and how often you have sex, which can lead to further difficulties conceiving. You may feel your family and friends are putting pressure on you to have children too. This can also affect your relationship.

It may help you and your partner if you speak to other people who understand what you’re going through. You can join a support group to meet with other couples in a similar situation. This 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. Your clinic can give you details of a specialist fertility counsellor. They may be able to help you explore your feelings and find ways to cope if you’re struggling. You can also talk through the different treatments and which options are available to you.