Male Infertility: Causes, Risks & Treatment Options

Infertility is a deeply emotional and stressful journey for couples who dream of becoming parents. When pregnancy does not happen despite repeated efforts, it often brings feelings of disappointment, confusion, and even guilt. While infertility is often seen as a woman’s issue, research shows that male infertility accounts for nearly 40–50% of all infertility cases worldwide. This means that in almost half the cases, the challenges of conception can be traced back to male factors.

Male infertility is not a rare problem; it is a medical condition that can affect any man, regardless of age or lifestyle. The reasons behind it are varied, ranging from sperm-related issues, hormonal imbalances, and genetic conditions to lifestyle habits such as smoking, stress, or poor diet. Environmental factors like heat, chemical exposure, and certain medications can also reduce a man’s fertility potential. Unfortunately, because of stigma and lack of awareness, men often delay seeking medical help, which can further add to the emotional strain.

What is Male Infertility?

Male infertility is defined as a man’s inability to achieve a pregnancy with his partner despite one year of regular, unprotected intercourse. However, it is important to understand that infertility is not just about having a low sperm count. In reality, male fertility is influenced by a wide range of factors such as sperm quality, hormone levels, sexual health, lifestyle choices, and even environmental exposures. For example, a man may have enough sperm, but if those sperm are not strong swimmers, not well-shaped, or affected by hormonal imbalance, conception may still be difficult.

Because the causes are often hidden and not always obvious, the first and most basic test for male infertility is usually a semen analysis, which helps doctors evaluate sperm count, movement, and structure. From there, further investigations can be done to identify underlying issues.

Major Causes of Male Infertility

There are several reasons why male infertility happens. Let’s break them down:

1. Sperm-Related Problems

When any of these factors are affected, the chances of conception are reduced. Let’s understand the main sperm-related issues:

Low sperm count (Oligospermia):
This condition occurs when semen contains fewer than 15 million sperm per millilitre, which is below the healthy range. A lower sperm count reduces the likelihood of sperm successfully reaching and fertilizing the egg, impacting male fertility.
No sperm (Azoospermia):
In some men, the semen contains no sperm at all. This could be due to a blockage that prevents sperm from mixing with semen, or because the testicles are not producing sperm.
Poor sperm motility:
Even with a normal sperm count, successful fertilization requires active, straight movement. Poor motility prevents sperm from swimming effectively through the female reproductive tract, reducing their chances of reaching and fertilizing the egg..
Abnormal sperm shape (Teratozoospermia):
The shape of sperm is vital for fertilisation. Healthy sperm have an oval head and long tail to swim and penetrate the egg, while abnormal forms with irregular heads or tails may struggle to fertilise effectively.

2. Hormonal Imbalances

Hormones are chemical messengers that control almost every reproductive function in the male body, especially sperm production. When these hormones are out of balance, it can directly lead to fertility problems.

Low testosterone levels:
Testosterone, the main male sex hormone, plays a key role in sperm production, sex drive, and reproductive health. Low levels may reduce sperm count, lower libido, cause fatigue, and affect sexual function, leading to infertility.
Pituitary gland or thyroid issues:
Testosterone, the key male sex hormone, supports sperm production, sex drive, and reproductive health. Low levels may reduce sperm count and lead to low energy, poor libido, and sexual difficulties, often resulting in infertility.
Impact of hormones on sperm production:
Healthy sperm production requires proper hormonal balance, especially testosterone, pituitary, and thyroid hormones. Any imbalance may reduce fertility, so doctors recommend hormone tests. Treatments like hormone therapy, lifestyle modifications, or medications often restore balance and improve sperm quality.

3. Genetic Conditions

These conditions may not always show visible symptoms, but can have a strong impact on fertility.

Klinefelter Syndrome (extra chromosome):
Klinefelter syndrome occurs when a male is born with an extra X chromosome (XXY). This affects testicular development, causing low testosterone, small testes, and reduced sperm production, often leading to infertility. Treatments like hormone therapy and fertility techniques may help.
Y-Chromosome Deletions:
The Y chromosome carries genes vital for sperm production. Microdeletions in this chromosome may cause low or absent sperm count and can be passed to male offspring. Genetic testing helps detect such conditions early.
Cystic Fibrosis-Related Problems:
Cystic fibrosis, a genetic disorder, often causes male infertility due to absent or blocked vas deferens, preventing sperm from mixing with semen. Despite normal sperm production, fertility procedures like surgical sperm retrieval with IVF or ICSI enable fatherhood.

4. Varicocele (Enlarged Veins in the Scrotum)

A varicocele is an enlargement of the veins inside the scrotum, similar to varicose veins in the legs. This disrupts blood circulation and raises scrotal temperature, which negatively impacts sperm production and function. As sperm are heat-sensitive, even a minor temperature rise can reduce their quality, count, and motility, making fertilization difficult. Left untreated, varicocele is a common cause of male infertility. Fortunately, it is highly treatable with surgical procedures like varicocelectomy or minimally invasive techniques. Treatment helps restore proper blood flow, lowers scrotal temperature, and often leads to improved sperm health and fertility.

5. Infections & Medical Issues

Sexually Transmitted Infections (STIs)
Sexually transmitted infections like chlamydia and gonorrhea can harm the male reproductive tract, causing scarring or blockages that block sperm flow. Even post-treatment, lasting damage may impact fertility, making early diagnosis and timely care essential.
Mumps After Puberty
If mumps occurs after puberty, it may spread to the testes (orchitis), causing pain, swelling, and sometimes lasting damage. This can reduce or stop sperm production, leading to fertility challenges and difficulty in conceiving.
Prostate or Urinary Tract Infections (UTIs)
Infections in the prostate, epididymis, or urinary tract can disrupt sperm production and transport. They may cause inflammation, discomfort, or blockages, interfering with ejaculation and reducing fertility if left untreated.
Chronic Health Conditions
Chronic health issues like diabetes, kidney disease, and celiac disease can impact male fertility. Diabetes may cause erectile dysfunction or retrograde ejaculation, while celiac disease affects hormones and sperm quality. Managing these conditions supports health and fertility.

6. Lifestyle & Environmental Factors

Smoking, Alcohol, and Drug Use
Smoking, excessive alcohol, and recreational drugs harm male fertility. They damage sperm DNA, reduce count and motility, lower testosterone, and disrupt hormone balance—leading to poor-quality sperm and reduced chances of fathering a child.
Obesity and Unhealthy Diet
Being overweight or obese disrupts hormone balance, especially testosterone, vital for sperm production. Excess fat raises scrotal temperature, and poor diets high in processed foods, sugar, and unhealthy fats reduce key nutrients needed for healthy sperm development.
Stress and Lack of Sleep
Chronic stress disrupts fertility hormones like testosterone and pituitary signals needed for sperm production. Combined with poor sleep, it disturbs hormone balance, lowering sperm count, reducing libido, and increasing the risk of erectile dysfunction.
Exposure to Heat, Chemicals, or Radiation
Prolonged heat exposure from saunas, hot tubs, or laptops can impair sperm production, as testes need cooler temperatures. Similarly, contact with chemicals, pesticides, metals, or radiation harms sperm quality. Protective measures are advised in such conditions.

7. Sexual & Ejaculation Problems

Erectile Dysfunction (ED)
Erectile dysfunction (ED) is the inability to achieve or sustain an erection firm enough for intercourse. It may result from stress, anxiety, unhealthy habits, or medical conditions like diabetes and heart disease, affecting conception.
Premature Ejaculation
This condition occurs when a man ejaculates too soon during intercourse, sometimes even before penetration. Though sperm is present, the early timing prevents it from reaching the woman’s reproductive system effectively, lowering the chances of conception.
Retrograde Ejaculation
In retrograde ejaculation, semen flows backwards into the bladder instead of exiting through the penis. Caused by nerve damage, diabetes, surgeries, or medications, it prevents sperm from reaching the egg, leading to male infertility.
Blockages in Sperm-Carrying Tubes
Sometimes, physical blockages in the vas deferens or epididymis prevent sperm from mixing with semen, leading to little or no sperm in the ejaculate. These blockages may arise from infections, injuries, or congenital conditions.

8. Medications & Treatments

Chemotherapy and Radiation
Cancer treatments like chemotherapy and radiation effectively target cancer cells but may also harm healthy testicular cells, reducing or stopping sperm production. This damage can be temporary or permanent, so doctors often suggest sperm banking beforehand.
Anabolic Steroids
Many men use anabolic steroids to enhance muscle and performance, but long-term use can suppress natural testosterone and sperm production, sometimes causing infertility. Fertility usually improves after stopping steroids, though recovery may take several months.
Certain Antibiotics, Antifungals, or Antidepressants
Certain prescription medicines, such as antibiotics, antifungals, and antidepressants, can temporarily affect sperm production or quality. These effects are often reversible, but never stop medication without medical advice—consult a doctor for safe alternatives.

Risk Factors for Male Infertility

Certain factors increase the chances of infertility:

Age (Fertility Declines After 40)
Male fertility gradually decreases with age, especially after 40. Sperm count, motility, and quality may drop, and the risk of genetic abnormalities increases, potentially affecting conception and raising the chances of miscarriage.
Family History of Infertility
Genetics can influence male fertility. A family history of low sperm count, hormonal imbalances, or genetic disorders may increase the likelihood of infertility. Early fertility testing is recommended for men with such a background who plan to start a family.
Occupations with Chemical or Heat Exposure
Jobs involving chemicals, heavy metals, pesticides, or prolonged heat—like welding, farming, or factory work—can reduce sperm quality. Long-term exposure to toxins or high temperatures may negatively affect sperm production and overall male fertility.
Tight Clothing or Prolonged Hot-Tub Use
Sperm production requires slightly cooler temperatures. Wearing tight clothing or frequent use of hot tubs, saunas, or steam rooms can raise scrotal temperature, potentially lowering sperm count and motility over time if done regularly.

When Should You See a Doctor?

Trying Without Success for 12 Months
Couples who have tried to conceive for a year without success should consult a fertility specialist. For those over 35, seeking help after six months is advised, as fertility naturally declines with age, making early intervention crucial.
History of Testicular, Hormonal, or Genetic Issues
Men with past testicular problems, surgeries, hormonal imbalances, or genetic conditions are at higher risk of infertility. Early consultation with a doctor helps identify issues promptly and allows timely treatment to improve fertility outcomes.
Symptoms Like Low Sex Drive, Erectile Problems, or Testicular Pain/Swelling
A drop in libido, difficulty with erections, or testicular pain, swelling, or lumps may indicate hormonal, infectious, or structural issues affecting fertility. Early medical evaluation ensures proper diagnosis and timely treatment before conditions worsen.
Importance of Early Medical Help
Seeking fertility advice early saves valuable time and increases treatment success. Early evaluation allows more options—from lifestyle changes and medications to advanced procedures—helping couples achieve pregnancy more efficiently and with fewer delays.

Myths vs. Facts About Male Infertility

Myth: Infertility is only a woman’s problem.
Fact: Men contribute to nearly half of infertility cases.

Myth: Masturbation causes infertility.
Fact: Normal masturbation does not affect fertility.

Myth: Tight underwear always causes infertility.
Fact: It can affect sperm health, but it’s not the main cause.

Myth: Infertility means no chance of fatherhood.
Fact: Many treatments, like IVF or ICSI, can help men become fathers.

How Male Infertility is Diagnosed

Semen Analysis
This is usually the first and most important test for diagnosing male infertility. In a semen analysis, doctors examine a sample of semen under a microscope to check:

Sperm count (the number of sperm present).
Sperm motility (how well the sperm can move or swim).
Sperm morphology (the shape and structure of the sperm).

Blood Tests
Blood tests help identify hormonal or genetic issues that might be interfering with sperm production. Doctors usually check for testosterone levels and other hormones like FSH (Follicle-Stimulating Hormone), LH (Luteinizing Hormone), and thyroid hormones. In some cases, genetic testing may also be recommended to look for conditions such as Y-chromosome deletions or Klinefelter syndrome that affect fertility.
Ultrasound
A scrotal or transrectal ultrasound is used to look inside the reproductive system. This imaging test can detect varicocele (enlarged veins in the scrotum), blockages in the sperm-carrying tubes, or other abnormalities in the testes and surrounding areas. By identifying these structural issues, doctors can determine whether surgical or medical treatment is needed.

Treatment Options for Male Infertility

Lifestyle Changes
A healthy diet, regular exercise, stress management, quitting smoking, limiting alcohol, and adequate sleep can improve sperm health, hormone balance, and overall fertility. Maintaining a healthy weight further supports reproductive function.
Medications
Doctors may prescribe hormone therapy, antibiotics, or other medications to treat infections, correct hormonal imbalances, boost sperm production, or support sexual health, depending on the underlying cause of infertility.
Surgery
Surgical options like varicocele repair, removing blockages, or correcting structural issues in the reproductive tract can restore sperm flow, improve sperm quality, and enhance fertility chances.
Assisted Reproductive Techniques (ART)
If natural conception is not possible, advanced fertility techniques can help couples achieve pregnancy:

IUI (Intrauterine Insemination): Healthy sperm are collected, processed, and directly placed into the woman’s uterus during ovulation to increase chances of fertilization.
IVF (In Vitro Fertilization): Eggs are collected from the woman and fertilised with sperm in a laboratory. The resulting embryo is then transferred to the uterus.
ICSI (Intracytoplasmic Sperm Injection): A single healthy sperm is injected directly into an egg in the lab, which is especially helpful when sperm count or motility is very low.
Sperm Retrieval Procedures: If sperm are not present in the semen, they can often be collected directly from the testes or epididymis using medical techniques. These sperm can then be used for IVF or ICSI.

Prevention & Healthy Habits for Male Fertility

Maintain a Healthy Weight
Being overweight or underweight can disrupt hormone levels, including testosterone, which impacts sperm production. Maintaining a healthy weight through a balanced diet and regular exercise supports hormone balance, improves sperm quality, and enhances overall reproductive health.
Eat Fertility-Friendly Foods
A nutrient-rich diet boosts male fertility. Foods high in zinc, vitamins C and E, and antioxidants protect sperm from damage and improve quality. Include fruits, vegetables, nuts, seeds, whole grains, and lean proteins for optimal reproductive health.
Avoid Smoking, Drugs, and Excess Alcohol
Smoking, recreational drugs, and excessive alcohol harm sperm count, motility, and DNA integrity. Quitting these habits not only improves fertility but also promotes general health, hormone balance, and sexual function.
Protect Yourself from Heat and Chemicals
Excessive heat from saunas, hot tubs, or laptops and exposure to chemicals, pesticides, or heavy metals can damage sperm. Limiting these risks, using protective gear, and avoiding prolonged exposure help preserve male fertility.
Get Enough Sleep and Manage Stress
Chronic stress and poor sleep reduce testosterone and impair sperm quality. Prioritising 7–8 hours of sleep, practising relaxation techniques like meditation or yoga, and maintaining work-life balance improve hormone balance and overall reproductive health.

Conclusion

Male infertility is common but often treatable, stemming from sperm issues, hormonal imbalances, lifestyle factors, or medical conditions. Modern medicine, combined with healthy habits, can significantly improve fertility outcomes. Infertility is not the end of the journey—timely medical care, emotional support, and advanced treatments have helped countless couples achieve parenthood. At Thakral Hospital & Fertility Centre, with over 25 years of expertise, cutting-edge technology, and compassionate care, we support couples in overcoming fertility challenges. With guidance at every step, hope and the dream of parenthood remain within reach.

Understanding Male Infertility: Common Causes & Risk Factors