When a couple struggles to get pregnant, the woman is often the first person people look at. A lot of times, she’s the one scheduling appointments, undergoing tests, tracking her cycle, and trying to figure out what could be wrong.
But there’s something many couples may be overlooking. According to a World Health Organization study involving 8,500 couples across 25 countries, male factors contribute to 45.1% of infertility cases. That’s a significant number, yet infertility is still widely treated as though it’s only a woman’s problem.
This puts a lot of pressure on women, who may face repeated tests and treatments, along with the emotional strain and social judgment that can come with struggling to conceive. Meanwhile, men may hesitate to get tested because of the stigma surrounding male infertility.
It’s time to give male fertility the attention it deserves. Too many couples may be missing important answers because men’s reproductive health is often overlooked. The good news is that understanding the problem is an important first step toward finding solutions, and couples may have more treatment options than they realize.
Male factors contribute to nearly half of infertility cases, but the issue is often overlooked
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For many couples, getting pregnant isn’t always as straightforward as they hoped. The World Health Organization estimates that around 1 in 6 people of reproductive age experience infertility during their lifetime. But what many people may not realize is that difficulties with conception can involve either partner’s reproductive health, or even both.
Male-factor infertility occurs when a problem with a man’s reproductive system makes it harder for him to conceive with a partner after up to 12 months of frequent unprotected intercourse. This can happen when his body doesn’t produce enough healthy reproductive cells, when they don’t function or move properly, or when a blockage prevents them from being released.
Female-factor infertility, on the other hand, involves problems with a woman’s hormones or reproductive organs that can make it harder for her to get pregnant. In some cases, both partners have reproductive health issues that affect their chances of conceiving.
When both factors are present, doctors need to understand how they interact before choosing the most suitable treatment approach. This is why the American Society for Reproductive Medicine advises that both partners undergo a fertility evaluation together, so doctors can get a clearer picture of what may be affecting the couple’s ability to get pregnant.
The American Urological Association also recommends that men with suspected fertility problems receive an assessment from a specialist in male reproductive health. This allows doctors to investigate possible causes, identify treatable conditions, and determine what options are available to help the couple conceive.
Society’s expectations of masculinity make it harder for men to talk about infertility and admit they need help
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When fertility problems involve a man’s reproductive health, he may not find it easy to acknowledge that something could be wrong or talk openly about it. Part of the reason is that having children is often tied to society’s views of masculinity. Men are expected to be able to father children, so struggling to conceive can feel like a personal shortcoming rather than a medical issue.
Research into men’s experiences of infertility shows how deeply these expectations can affect them. In a qualitative study of men diagnosed with male-factor infertility, researchers found that some felt their diagnosis challenged their sense of masculinity. Shame and embarrassment also made it harder for them to discuss their experiences, leaving some to cope with the situation in isolation.
This can also make it difficult for men to seek medical help. Some may worry that getting tested will confirm something they fear or expose them to judgment from their partners, families, or wider communities. Others may avoid the subject because they associate fertility problems with a lack of virility.
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The stigma surrounding infertility also affects women, who often carry a greater share of the emotional and social burden. A review of research across African countries found that women are more likely than men to seek fertility treatment and often face greater pressure because of childlessness.
Another study on infertility-related stigma in Africa also found that women are frequently blamed for not having children, even when male factors are involved.
This doesn’t mean men don’t experience distress or deserve support. A male-factor diagnosis can be deeply upsetting, particularly when a man feels it challenges his identity or his hopes of becoming a father. But when shame keeps him from seeking help and society places much of the responsibility for conception on women, both partners can end up struggling without the support they need.
Changing this starts with treating fertility as a shared concern. Men should be able to discuss their reproductive health and seek medical advice without feeling that it makes them any less masculine. Couples should also be encouraged to approach fertility care together, so neither partner has to carry the burden alone.
These health conditions and everyday habits may be contributing to male infertility
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There are several things that can affect a man’s ability to conceive with his partner. Some are linked to health conditions, while others may involve everyday habits, medications, or age. Here are some of the main factors couples should know about:
1. Medical conditions
A varicocele is a medical condition that can affect a man’s fertility. It happens when the veins around the testicles become enlarged. This can interfere with normal function and affect the body’s ability to produce the healthy cells needed for pregnancy.
Infections can also affect the testicles or the tubes that carry these cells. Some infections can cause inflammation or scarring, making it harder for them to travel through the reproductive system. Hormonal imbalances and inherited conditions can affect fertility as well.
One example is Klinefelter syndrome. Men with this genetic condition are born with an extra X chromosome, which can affect how their testicles develop and how much testosterone their bodies produce. As a result, some may produce very few of the cells needed for conception, while others may not produce any.
2. Smoking, alcohol, and drug use
The European Association of Urology identifies smoking, heavy alcohol consumption, obesity, and low physical activity as factors associated with poorer reproductive health.
Anabolic steroids, which are often used by men who want to build muscle or improve athletic performance, can interfere with the body’s natural hormone production and reduce its ability to produce the cells needed for conception. Research has also linked recreational drug use to changes in reproductive health that may affect fertility.
3. Frequent exposure to high temperatures
The testicles need to stay slightly cooler than the rest of the body to support fertility. Spending a lot of time exposed to high temperatures may interfere with this process. For example, regularly spending long periods in hot baths or saunas may raise the temperature around the testicles. Some studies have also suggested that wearing tight-fitting underwear every day may affect the production and quality of male reproductive cells.
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4. Certain medications and medical treatments
Chemotherapy and radiation used to treat cancer, for example, can damage the cells responsible for producing the male reproductive cells needed for conception. Depending on the treatment, the effects may be temporary or permanent.
Testosterone medication can also suppress the body’s natural production, even when it is prescribed to treat low testosterone. Men who hope to have children should discuss these possible effects with their doctors before starting treatment or changing any prescribed medication.
5. Age and other health conditions
Although male fertility tends to change more gradually than female fertility, the quality of the cells needed for conception may decline as a man gets older, making pregnancy more difficult to achieve. According to a study, men aged 40 and older are more likely to report difficulty conceiving.
Other health conditions, such as diabetes, may also affect reproductive function. This does not mean older men or those living with long-term health conditions cannot father children, but these factors may be important when investigating fertility problems.
The encouraging news is that some of these factors can be addressed. Quitting smoking, cutting back on heavy drinking, maintaining a healthy weight, and avoiding anabolic steroids may help support fertility. Certain underlying conditions, such as infections or hormonal problems, may also respond to medical treatment.
Still, changing a few habits may not solve every fertility problem. Some men need more specialized care, depending on the cause. Seeing a urologist or fertility specialist can help identify the underlying issue and determine which tests or treatments may be needed.
This is what to expect during a fertility checkup and the tests doctors may recommend
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Evaluating both partners at the same time can help doctors identify possible fertility problems sooner and decide which treatment may give a couple the best chance of conceiving.
For men, one of the first tests is usually a semen analysis. This involves examining a semen sample in a laboratory to see how much fluid it contains, how many male reproductive cells are present, how well they move, and whether they have a normal shape. These details help doctors understand whether anything may be affecting a man’s fertility.
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If the results are outside the normal range, the test may need to be repeated because findings can vary from one sample to another. National Institute for Health and Care Excellence recommends repeating an abnormal test, usually after around three months. If the results show a serious problem, the repeat test may be done sooner.
A recent illness, fever, medication, or other temporary health changes may affect the findings, so retesting can give doctors a clearer picture.
Depending on the results, a doctor may recommend a physical examination to check the testicles for signs of conditions such as varicocele or other abnormalities. Blood tests can help identify hormonal problems, including low testosterone or changes in the hormones that control the production of male reproductive cells.
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In some cases, further investigations, such as genetic tests or imaging scans, may be needed. The doctor decides which tests are appropriate based on the man’s medical history, examination, and initial results.
Couples should not wait too long before seeking help if they are struggling to conceive. A fertility evaluation is generally recommended after 12 months of trying without success, although men may need to be assessed sooner if they have a known condition that could affect fertility.
Getting tested is not about placing blame on either partner. It’s about finding out what may be making conception difficult and giving doctors the information they need to recommend the next steps. For men, starting with a urologist or fertility specialist can help ensure the right tests are done, and any underlying problems are properly investigated.
Couples dealing with male infertility have several treatment options to consider
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Finding out that a man has fertility problems does not mean that a couple has run out of options. Depending on what is causing the difficulty, treatment may help improve his fertility, correct an underlying condition, or make it possible for the couple to conceive with medical assistance. The key is to find an approach that fits the man’s condition and the couple’s needs.
Here are some of the options doctors may recommend:
1. Treating underlying medical conditions
If an infection is affecting a man’s reproductive system, treating it with the appropriate medication may help prevent further complications and improve his reproductive health. Hormonal conditions may also respond to treatment, particularly when the body is not producing enough of the hormones needed for normal testicular function.
Some men have conditions that require more specialized care. For example, treating a hormonal imbalance may help restore the body’s ability to produce healthy reproductive cells. However, the treatment depends on the specific problem, and not every condition can be corrected with medication.
2. Making changes to everyday habits
For some men, healthier lifestyle choices may improve fertility. This can include quitting smoking, reducing heavy alcohol consumption, maintaining a healthy weight, and avoiding recreational drugs and anabolic steroids.
These changes may support better reproductive health, although they’re not a guaranteed solution. They are particularly useful as part of a wider treatment plan when lifestyle factors may be contributing to the problem.
3. Medication and hormone treatment
When fertility problems are linked to certain hormonal conditions, doctors may prescribe medication to help the body produce the hormones needed for normal reproductive function. One important thing men should know is that testosterone medication is not always suitable when they are trying to have children.
Although it may be prescribed to treat low testosterone, taking it on its own can suppress the body’s natural production of reproductive cells and make conception more difficult. Men who are concerned about their fertility should discuss alternative treatment options with a specialist rather than stopping or changing prescribed medication themselves.
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4. Surgery to correct certain problems
Some fertility problems can be treated with surgery. One example is a varicocele, where enlarged veins around the testicles may interfere with their normal function. A procedure called varicocele repair can help improve fertility in some men, particularly those who have an enlarged vein that can be felt during examination, infertility, and abnormal semen analysis results.
Surgery may also help when a blockage prevents reproductive cells from traveling through the reproductive tract. In some cases, doctors can repair the affected tubes and restore their normal function. If this is not possible, they may be able to retrieve reproductive cells directly from the testicles or the structures that store them for use in fertility treatment.
5. Assisted reproductive treatments such as IVF and ICSI
When medication or surgery cannot resolve the problem, or when natural conception remains difficult, couples may be offered assisted reproductive techniques.
One option is in vitro fertilization (IVF), which involves collecting eggs from the woman and combining them with male reproductive cells in a laboratory. If fertilization occurs, the resulting embryo can then be transferred into the woman’s womb.
Another option is intracytoplasmic sperm injection (ICSI). This is a specialized form of IVF in which a single male reproductive cell is injected directly into an egg to help fertilization happen. It may be recommended when the number of available cells is very low, their movement is poor, or they need to be retrieved through a medical procedure.
These treatments can give some couples a chance to conceive even when the man’s fertility problem cannot be corrected through medication or surgery. However, the most suitable option depends on the findings from both partners’ evaluations, their overall health, and other factors that may affect the chances of success.
Getting a male infertility diagnosis can be difficult, but it doesn’t automatically mean a couple cannot have children. Some underlying conditions can be treated, while others may require fertility procedures to help achieve a pregnancy. Working with a urologist and fertility specialist can help couples understand what is possible, weigh the benefits and limitations of each option, and make informed decisions about their next steps.
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