Male Fertility
Symptoms, Causes & Treatment
Everything you need to know about male fertility: what causes poor sperm quality, how it is investigated, and the treatment options available — from lifestyle changes to IVF and ICSI.
What Is Male Infertility?
Male fertility refers to a man's ability to cause pregnancy in a fertile female partner. It depends on the production of sufficient numbers of healthy, motile sperm capable of fertilising an egg. Fertility problems are more common than many people realise – approximately 1 in 7 couples in the UK have difficulty conceiving, and male factors are responsible for, or contribute to, around 50% of these cases.
Despite this, male fertility is often overlooked in the initial assessment of a couple struggling to conceive. Men are frequently reluctant to raise the issue, and there is a persistent cultural misconception that fertility problems predominantly affect women. In reality, a male factor is identified in approximately 30% of infertile couples as the sole cause, and in a further 20% it contributes alongside a female factor.
The primary determinant of male fertility is semen quality – specifically sperm concentration (count), motility (movement), morphology (shape), and overall volume. These parameters can be assessed through a semen analysis, which is the cornerstone of male fertility investigation and should be arranged alongside (not after) female fertility investigation when a couple has been trying to conceive unsuccessfully.
When should you seek help? Current guidance recommends that couples who have been having regular unprotected intercourse for 12 months without conception should seek a clinical assessment. This is reduced to 6 months for couples where the woman is over 35, or immediately if there are known risk factors for male infertility.
What Are the Signs of Male Infertility?
Male infertility typically has no obvious symptoms — most men are physically well and produce normal ejaculate despite a significant abnormality in sperm quality. Symptoms, when present, may reflect an underlying hormonal or structural cause.
Inability to conceive after 12 months of unprotected sex · Low sperm count (oligospermia) · Absent sperm (azoospermia) · Poor sperm motility (movement) · Abnormal sperm morphology (shape) · Reduced ejaculate volume · Hormonal symptoms: low libido, erectile dysfunction, gynaecomastia · History of undescended testes, testicular injury, or mumps orchitis
Sudden testicular pain or swelling — may indicate torsion or infection requiring emergency care · Lump in the testicle — requires urgent investigation to exclude testicular cancer · Signs of hormonal disorder: visual disturbance, severe headache (pituitary) · Retrograde ejaculation: cloudy urine after orgasm without visible ejaculate
Seek urgent medical attention if you notice a lump or swelling in the testicle, sudden testicular pain, or cloudy urine after orgasm (suggesting retrograde ejaculation). These require prompt investigation to exclude testicular cancer or other serious pathology.
What Causes Male Infertility?
Male infertility is caused by problems affecting sperm production, sperm transport, or sperm function. In up to 40% of cases, no identifiable cause is found (idiopathic infertility). In many others, the cause is identifiable and treatable.
Azoospermia (no sperm) or oligospermia (low count) may be caused by varicocele, blockage of the vas deferens, Klinefelter syndrome, or previous infections. Semen analysis is the essential first investigation.
Low LH, FSH, or testosterone from pituitary or hypothalamic dysfunction can impair sperm production. Hyperprolactinaemia is a treatable cause of secondary hypogonadism and male infertility.
Blockages in the epididymis, vas deferens, or ejaculatory ducts prevent sperm from reaching semen. May follow infection (chlamydia, gonorrhoea), surgery, or vasectomy.
Varicocele (enlarged testicular veins) is the most surgically correctable cause of male infertility, affecting 15% of men and up to 40% of infertile men. It raises scrotal temperature and impairs sperm quality.
Anabolic steroids, chemotherapy, radiation to the pelvis, and some medications (sulfasalazine, some antihypertensives) can significantly impair sperm production or function.
Smoking, excessive alcohol, obesity, heat exposure (hot baths, tight underwear), recreational drugs, and chronic stress all adversely affect sperm quality and count.
Key Risk Factors
How Is Male Infertility Investigated?
Investigation should begin with a semen analysis for the male partner and a gynaecological assessment for the female partner simultaneously. A GP can refer for both. If the semen analysis is abnormal, further hormonal and structural investigations are undertaken to identify the underlying cause.
How Is Male Infertility Treated?
Treatment depends on the identified cause. Where a reversible cause is found — such as varicocele, hormonal deficiency, or obstruction — targeted treatment can restore or improve fertility. Where no reversible cause is found, assisted conception using processed sperm is the primary path to parenthood.
Supportive Measures
Lifestyle optimisation takes at least 3 months to show improvement in semen parameters (the duration of one sperm production cycle). Stopping smoking, reducing alcohol, avoiding anabolic steroids, maintaining a healthy weight, and reducing heat exposure to the testes all support sperm quality alongside any medical treatment.
When Fertility Treatment Doesn’t Work
Not all cases of male infertility are treatable, and not all assisted conception cycles succeed. If IVF/ICSI cycles have failed, a specialist should review the cause. Surgical sperm retrieval (TESA/PESA) may be possible for men with azoospermia. Donor sperm is a further option. Psychological support for both partners is an important and often overlooked part of the fertility journey.
When Should You Seek Help for Male Fertility?
You develop sudden severe testicular pain — this may indicate testicular torsion, which requires emergency surgery within 6 hours to save the testicle.
You have been trying to conceive for 12 months without success · You notice a lump or change in the testicle · You have a history of chemotherapy and are concerned about fertility · You are considering anabolic steroids and want to understand the fertility implications.
How Can You Protect Male Fertility?
While not all causes of male infertility can be prevented, several important lifestyle factors have a significant and evidence-based impact on sperm quality.
Avoid anabolic steroids, smoking, excessive alcohol, and heat exposure to the testes (hot baths, saunas, tight underwear). These all impair sperm production.
Prompt STI treatment prevents epididymitis and ductal scarring that can permanently obstruct the vas deferens. Use barrier contraception and attend regular sexual health screens.
Excess body fat disrupts testosterone and oestrogen balance, impairing sperm production. Even modest weight loss improves semen parameters in overweight men.
Consider sperm banking before chemotherapy, radiotherapy, or surgery that may affect fertility. This is the most reliable fertility preservation strategy.
Take regular folic acid (400mcg daily for at least 3 months before trying to conceive), maintain a healthy weight, stop smoking, and reduce alcohol — all support conception and healthy pregnancy.
Heat suppresses sperm production for 3 months. Avoid hot baths, jacuzzis, and saunas when trying to conceive. Switch from tight briefs to loose boxers — scrotal temperature affects sperm quality.
Speak to a Clinician About Male Fertility
Through The GP Service, you can speak to a licensed clinician online, discuss your fertility concerns confidentially, and receive referrals for semen analysis and specialist assessment without a long wait.
Expert clinical advice, when you need it.
Male Fertility FAQs
Male factor infertility contributes to approximately 50% of all infertility cases. A semen analysis is the essential first investigation and should be performed before extensive female investigations. The test measures sperm count, motility (movement), morphology (shape), and volume. If the result is abnormal, it should be repeated after 2–3 months as sperm quality varies. Sperm production takes approximately 74 days, meaning lifestyle changes or treatments take at least 3 months to show improvement in semen parameters.
Yes. Anabolic steroids suppress the pituitary hormones (LH and FSH) that stimulate sperm production via negative feedback on the hypothalamic-pituitary-gonadal axis. This can result in azoospermia (complete absence of sperm) within months of use. Recovery after stopping steroids is possible but can take 12–24 months, and in some men may be incomplete. Men on or recovering from anabolic steroid use who wish to conceive should be assessed by a specialist.
Yes. Two male fertility investigations that are often overlooked but important are: (1) Anti-sperm antibody (ASA) testing — in men with poor motility and no other cause, antibodies can coat the sperm surface and impair penetration of the egg. ASA affects 5–10% of infertile men. (2) DNA fragmentation testing — high levels of DNA damage within sperm (measured by the sperm DNA fragmentation index, DFI) can cause recurrent IVF failure or miscarriage even when conventional semen analysis is normal. Antioxidant therapy and varicocele repair may reduce DNA fragmentation. These tests are typically performed at specialist andrology clinics.
Yes. Stopping anabolic steroids allows natural testosterone production to recover, but this can take 12–24 months or longer, and may be incomplete in some men. During this period, semen analysis is typically severely abnormal or showing azoospermia. Recovery can be accelerated with hCG injections and FSH therapy under specialist supervision. Men who wish to have children after steroid use should be assessed by a reproductive endocrinologist. The longer and higher the dose of steroids used, the longer recovery takes. Men considering fertility treatment should stop steroids at least 12 months before any ART cycle.
Yes. Hypertension in pregnancy — particularly pre-eclampsia (hypertension with proteinuria after 20 weeks) — is a serious condition affecting 2–5% of pregnancies. It can cause maternal complications (seizures, stroke, organ failure) and fetal growth restriction or preterm birth. Safe antihypertensives in pregnancy include labetalol, nifedipine, and methyldopa. ACE inhibitors and ARBs must be avoided in pregnancy due to fetal toxicity. Women with pre-existing hypertension should have their medication reviewed before or at the start of pregnancy.
The most common causes of bilateral ankle swelling are venous insufficiency (varicose veins and poor venous return), medications (particularly calcium channel blockers such as amlodipine), and inactivity. Heart failure is an important cause that must be excluded, particularly if accompanied by breathlessness. Bilateral swelling is rarely DVT — DVT almost always affects one leg at a time. If both ankles swell consistently at the end of the day and improve overnight, venous insufficiency and medication side effects are the most likely explanations.
Post-thrombotic syndrome (PTS) is a complication affecting 20–50% of people after DVT, causing chronic pain, swelling, skin changes, and — in severe cases — venous ulceration in the affected leg. It results from valve damage in the deep veins caused by the clot. The most effective prevention is wearing correctly fitted class 2 graduated compression stockings for at least 2 years after DVT. Early ambulation after DVT (walking is safe and beneficial), adequate anticoagulation, and compression therapy all reduce the risk. Severe PTS may require specialist vascular assessment.
Lymphoedema is chronic, progressive swelling caused by damage to the lymphatic system. Unlike pitting oedema from venous causes, lymphoedema is typically non-pitting, affects the foot and toes (not just the ankle), and does not improve with overnight elevation. Common causes include cancer treatment (lymph node removal or radiotherapy), infection (particularly recurrent cellulitis), and primary lymphatic abnormalities. It is managed — not cured — with complex decongestive therapy (manual lymphatic drainage, compression garments, skin care, and exercise). Early specialist referral to a lymphoedema clinic is important.