Male infertility

Male infertility is the term used to describe being unable to get pregnant naturally with a female partner, despite regular unprotected sexual intercourse. 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 around 8 in every 10 couples under 40. But for 1 in 7 couples, it can sometimes take a while. Try not to worry if it doesn’t happen straightaway.

If you haven’t managed to conceive a baby after a year of trying, speak to your GP. It could be a sign of fertility problems for you or your partner or for both of you.

Causes of male infertility

There are many reasons why you may have trouble conceiving. This could be a problem with your sperm or your hormone levels. But sometimes doctors can’t find any 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 a different shape

You may not have any sperm at all. This may be caused by low or no sperm production in the testicles. This is called non-obstructive azoospermia. Or it may be caused by a blockage in the sperm-delivering tube (vas deferens) or no sperm-delivering tube. This is called obstructive azoospermia. This may be because:

• the tubes didn’t develop when you were a baby
• you have scarring after an infection or surgery such as an inguinal hernia repair operation

Hypogonadism

If you have hypogonadism, you don’t make enough or any of the hormone testosterone. This may affect your sperm count and sex drive (libido). It may also mean you can’t get an erection and ejaculate. You may be born with hypogonadism. But it can also develop after:

• an illness
• treatment such as chemotherapy or radiotherapy
• taking certain medicines – for example, spironolactone (a water tablet or diuretic)

Ejaculation disorders

• Several problems can affect how you ejaculate (release semen).
• Common causes include psychological problems, your lifestyle and underlying medical conditions such as type 2 diabetes.
• Erectile dysfunction – you can’t keep an erection for long enough to have sex.
• Retrograde ejaculation – your semen is ejaculated backwards into your bladder when you orgasm.
• Delayed ejaculation means you can’t ejaculate inside your partner’s vagina.

Other things that affect fertility

Male fertility can be affected by lots of other things too, including:

• smoking
• alcohol
• illegal drugs such as cannabis and cocaine
• testosterone replacement therapy or anabolic steroids
• having mumps after you’ve gone through puberty
• being overweight or obese
• your age – being over 55
• varicoceles – swollen veins in your scrotum
• your scrotum being too warm
• exposure to chemicals such as pesticides
• medicines such as sulfasalazine (used to treat rheumatoid arthritis and inflammatory bowel disease) and finasteride (a hair loss prevention tablet)
• stress
• having small testicles or an injury to your testicles
• a genetic disease

Symptoms of male infertility

There aren’t any specific male infertility symptoms. But if surgery, a medical condition or low hormone levels are causing infertility, these causes may lead to some symptoms. These symptoms may include:

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

Low testosterone levels may also 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

Diagnosis of male infertility

If you’ve been trying for a baby for over a year, you and your partner (if you have one) may wish to see your GP.

Common questions

Your GP will ask you how long you and your partner have been trying for a baby and if 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 exposes you to chemicals or other hazards

Initial tests

Your GP may ask to examine you and do some tests.

A sample of semen (for a sperm analysis test) can show if you’re producing enough healthy sperm. You may be able to take a sample at home or in a clinic. You’ll need to collect the sample (through masturbation) 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 the sperm move
• the size and shape of your sperm

If this test shows up any problems, you’ll need to repeat the test around three months 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 check for:

• low hormone levels (for example, testosterone)
• evidence of diabetes (because erectile dysfunction can be a sign of diabetes)

Further tests

If your sperm count is low, a fertility specialist may suggest further tests and investigations. You may need:

• to give a urine sample to check for retrograde ejaculation
• an ultrasound scan of your testes if you’re not producing any sperm
• tests for genetic conditions that may affect sperm production
• 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.

Treatment for male infertility

Most infertility treatments are prescribed by a specialist doctor. There are lots of treatment choices. You may find it helpful to read more information about infertility treatments.

If a health condition is causing your fertility problems, treating it may increase your chances of conceiving.

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, your doctor may prescribe medicines such as pseudoephedrine to help close the opening to your bladder. This means sperm will be ejected forwards through your urethra rather than backwards into your bladder.

If you have trouble getting and keeping an erection, several medicines may help. These include:

• sildenafil (Viagra®)
• tadalafil (Cialis®)
• alprostadil

Always read the patient information leaflet that comes with your medicine and ask your pharmacist or GP for advice if you have any questions.

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. You remove the band after 30 minutes.

Surgery

Depending on the cause of your infertility, surgery may improve your chances of conceiving. This includes:

• an operation to remove a blockage in the tubes that take sperm from your testicles to your penis (obstructive azoospermia)
• a vasectomy reversal if you’ve had a vasectomy (surgery to stop sperm going into your semen) – this would involve 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. But the National Institute for Health and Care Excellence (NICE) doesn’t recommend this as a treatment. Some research suggests that surgery may improve your chances of pregnancy, but there’s not enough evidence to show it increases the chance of having a baby naturally.

Assisted conception

Assisted conception means help to get pregnant using ways other than having sex. The right type of assisted conception for you will depend on why you’re finding it hard to get pregnant.

These are the main assisted conception techniques.

• In vitro fertilisation (IVF). This 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.
• Intracytoplasmic sperm injection (ICSI). This involves injecting individual eggs with sperm in a laboratory before they’re 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).
• Intra-uterine insemination (IUI). This 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).

You can find out more about all types of assisted conception, including their success rates and risks, from the Human Fertilisation & 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. This 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 (talking therapy) may help you talk about the impact stress is having – ask your fertility clinic to refer you or find a counsellor yourself.