The Complete Guide to Male Fertility
Causes, Tests & Solutions
Male fertility describes the fertilising potential of a man and includes complex biological processes such as the production and transport of sperm, as well as the ability to fertilise an oocyte. As sperm is necessary for the fertilisation and formation of an embryo, their health is incredibly important: 1 in 7 couples face fertility issues. Of these, approximately 50% of infertility cases are attributable to male factor infertility, meaning that physical or biological issues on the male side are causing the couple not to successfully conceive. There are many causes, testing options and remedies for male factor infertility, which will be discussed in this guide. Although plenty of information will be outlined here, it is always important to discuss your individual case with your specialist of choice as every situation is different and there is no “one-fix fits all”.
What Is Male Fertility?
Male fertility is defined as the ability to naturally conceive. Conversely, infertility is defined as the inability to conceive within 12 months of unprotected, sexual intercourse (or 6 months in patients >35 years of age). There are several indicators that can evaluate male fertility, including sperm concentration, motility, morphology and DNA quality of the sperm. Sperm concentration/count evaluates the number of sperm cells per millilitre and in the entire ejaculate. The WHO has set the lower reference to 16 million sperm per millilitre, with lower values pointing towards potential issues during the development of sperm cells. Sperm motility evaluates the movement patterns and speed, as this is required for the sperm to reach and fertilise the egg in the female reproductive system. Morphology is an essential indicator in male fertility as sperm with abnormal forms have shown to have difficulties reaching the oocyte (tail problems) or carry abnormal genetic content that may hinder fertilisation. The DNA quality of sperm can be evaluated through various tests, but it overall shows what fraction of sperm carry DNA breakage. This may contribute to discontinuation of a natural pregnancy should the oocyte be unable to repair these DNA breakages. All these indicators, or parameters, can be affected at different stages of sperm development (spermatogenesis) and thus in different sections of the male reproductive tract. Spermatogenesis begins within the seminiferous tubules, where germ cells undergo cell division. After several maturation and transformation processes, i.e. meiosis, sperm travel to the epididymis. Within this long tube that resides along the testes, further sperm maturation occurs through which sperm gain motility. During ejaculation, sperm are transported from the epididymis to the vas deferens, which will eventually lead into the urethra to be expelled. Overall, the formation of sperm takes approximately 12 weeks.
The testes are located outside the body as this biological process is highly sensitive to temperature. As such, testes should ideally be kept 2-3°C cooler than body temperature and exposure to heat including hot baths or excessive exercise should be avoided. Lifestyle factors also have an immense impact on spermatogenesis. As such, diet, body composition, smoking, exercise and drug abuse can all affect male fertility.
Common Causes of Male Fertility Issues
There are common causes of male fertility issues and since the formation of sperm only takes 12 weeks, sometimes semen analysis results can look very different when repeating the test after a few lifestyle changes have been implemented.
Low sperm concentrations, or oligozoospermia, can have various reasons, including infections, increased body temperature due to i.e. a fever or excessive exercise, genetic conditions, as well as medications and lifestyle factors. Poor sperm motility can also be caused by genetic and environmental factors, heat exposure and medication.
Both these parameters can also be affected by hormone imbalances. As such, low levels of testosterone, LH or FSH may lead to decreased spermatogenesis. Apart from biological processes, these imbalances may also be expressed through physical changes, i.e. lower libido. Imbalances may also arise from testosterone supplementation and have shown to negatively affect semen parameters when not prescribed by a medical doctor.
Aforementioned genetic conditions including anomalies in sex chromosomes, may affect semen parameters. These can include Klinefelter syndrome with which very little or no sperm can be found in the ejaculate. In these cases, assisted reproductive technologies like testicular sperm retrieval may be used in conjunction with ICSI. Another denominator are deletions on the Y-chromosome, in the region that is essential for spermatogenesis. In patients with a Y-chromosome deletion, it is important to evaluate how large the deletion is and whether any sperm is produced.
A physical factor that can cause infertility is a varicocele – a swollen vein in the scrotum that introduces heat to the testicles. This is one of the most common causes of infertility, with approximately 40% of patients presenting with this condition. Most varicoceles can be embolised after which sperm parameters have shown to oftentimes improve. Other structural abnormalities in the testicles, including undescended testicles or obstructions, may also impair sperm production or expulsion of sperm.
As previously mentioned, lifestyle factors can have a significant effect on male fertility. Smoking, alcohol and drug consumption have shown to significantly increase oxidative stress which in turn leads to DNA fragmentation. This is also induced by heat, which may arise from excessive exercise, inflammation, infection or regular hot baths. Diet also plays a crucial part in fertility, with a healthy, balanced diet that includes lots of healthy fatty acids and proteins and little sugar or fat. Environmental toxins have further shown to affect biological processes including the formation of gametes (sperm, oocytes). As has been extensively shown in news media outlets, microplastics or unhealthy fumes that arose with increased consumerism negatively affects male fertility also.
How Male Fertility Is Diagnosed?
The WHO defines infertility as being unable to naturally conceive within 12 months of unprotected, regular intercourse. This time frame is shortened for couples with an increased maternal age (>35), in this case, couples may present at specialist facilities sooner, after 6 months of actively trying to conceive.
Usual diagnostic workups begin with discussing the health history of the patient and his family. In this instance, should the father of the patient have already had issues conceiving, this may be indicative of inheritable or congenital issues.
Secondly, patients are advised to have a semen analysis done – these analyse the ejaculate of a patient within one hour of production, including parameters such as volume, motility, concentration and morphology. More thorough semen analyses may report on macroscopic findings, i.e. appearance and viscosity, pH, antisperm antibodies, vitality or the presence of leucocytes.
Additional tests can be offered, including analyses into the DNA make-up of sperm (aneuploidy testing), the levels of DNA fragmentation, oxidative stress levels in semen, or whether a microbial imbalance is present (semen culture or microbiome testing).
Patients can also be recommended to perform blood tests – either to gain insights into their genetics (Karyotype), and/or hormone levels. Depending on the type of test and outcome, medication may be prescribed to aid biological processes such as spermatogenesis.
Another worthwhile examination is performing an ultrasound of the testes, either scrotal or transrectal. This test may reveal important information on structural abnormalities or the presence of a varicocele.
Ways to Improve Male Fertility
1. Lifestyle changes
Lifestyle changes have previously shown to ameliorate many parameters, including sperm motility, concentration, morphology, oxidative stress levels and DNA Fragmentation. As such, weight plays a huge role in sperm quality as increased weight may cause a hormone imbalance which in turn affects spermatogenesis. Concurrently, diet is equally important – couples who are trying to conceive should avoid greasy, sugary fast food and instead focus on a healthy, balanced diet with lots of vegetables, fruits and nuts.
Exercise, so long as not performed excessively, also improves male fertility. With increased blood flow, more oxygen is distributed to all parts of the body, decreasing oxidative stress (and concurrent DNA fragmentation) as well as improving sperm counts. Exercise further reduces stress and improves sleep quality, all factors that can improve sperm quality.
Should there not be sufficient time to apply lifestyle changes or the cause of infertility appears to be more complex, medical interventions can be offered too.
Hormone imbalances can often be treated with hormone therapy, and we do have specialists in-house who may be able to help in this instance. Similarly, should an ultrasound or examination reveal the presence of a varicocele, this can be repaired during minimally invasive surgery. Treatment may be as simple as an embolization, meaning the blockage of enlarged veins on the scrotum.
Read Our Blog On Natural Ways To Improve Male Fertility.
2. Medical Interventions
Should none of the aforementioned regimes help, assisted reproductive technologies (ART) can be utilised also. These include in-vitro fertilisation, or IVF and intracytoplasmic sperm injection, or ICSI. During IVF, a retrieved oocyte is incubated with prepared sperm in a petri dish to enable fertilisation. This procedure is usually performed when the semen sample has a high concentration and motility. The ICSI procedure on the other hand encompasses the injection of a sperm cell directly into the oocyte. This would usually be performed for samples with severely low sperm concentrations/motility (oligozoospermia). Finally, the fertilised egg is transferred to the female’s uterus where it can implant.
IVF and ICSI offer further testing opportunities to ensure that the embryo is healthy, in particular for couples with advanced maternal age. This includes Preimplantation genetic testing (PGT) for aneuploidy, checking the embryos chromosomes for an abnormality in chromosome numbers (aneuploidy). Another type of PGT is PGT-M (for monogenic disorders), a technology that assesses whether an embryo is carrying a disease allele of a disorder inherited in the family.
Read Our Blog On Medical Treatments For Male Fertility.
3. Supplements
Lastly, PGT can also test for structural chromosome rearrangements (PGT-SR).
As part of fertility treatment, men may be recommended to use supplements, including Zinc, CoQ10, folic acid, vitamin D or L-carnitine. Firstly, zinc promotes male fertility by supporting spermatogenesis, testosterone production and provides additional protection against oxidative damage. Coenzyme Q10 supplementation can be recommended due to its antioxidant properties, which has previously shown to improve sperm quality, i.e. motility, concentration and morphology. Similar results were shown in men following the intake of folic acid and l-carnitine. Vitamin D has various benefits – while not only improving overall sperm parameters, this vitamin can also affect hormone regulation including testosterone, as well as affecting calcium levels within the sperm which are essential for capacitation and the acrosome reaction prior to oocyte fertilisation.
Male Fertility Over Time
Similar to advanced maternal age, paternal age also plays a role when discussing gametes. With increased paternal age, particularly over 40 years of age, sperm quality decreases: Motility, concentration and morphology all decrease with advancing age. In addition, DNA fragmentation levels rise with age. This is due to increasing oxidative stress levels in the testes as well as declining cellular DNA repair mechanisms. It is noteworthy that with increasing age, the stem cells from which sperm arise are increasingly exposed to environmental toxins, further increasing cellular stress levels and DNA lesions. Equally, sperm mitochondria (“the powerhouse of the sperm”) may become dysfunctional, which again induces the production of reactive oxygen species that negatively affect DNA integration.
All these factors arising with advancing age may therefore impact the time to conception – increased paternal age can lead to longer times to achieve pregnancy.
DNA fragmentation that, as established, increases with age, may impair fertilisation and implantation. Furthermore, should a sperm with a high DNA fragmentation index (DFI) and high DNA stainability (HDS) fertilise an oocyte, this can lead to chromosomal errors in the embryo should the oocyte be unable to correct these damages. This may result in developmental risks for the embryo or even miscarriage.
Read Our Blog On Age, Environment & Genetics for Male Fertility.
When to See a Specialist
The WHO defines infertility as the inability to naturally conceive within 12 months of regular, unprotected intercourse. Therefore, should there be difficulties achieving pregnancy after 12 months, or 6 months for couples >35 years of age, the NHS sees this as an indicator to see a specialist. We at Fertility Solutions however advocate for an early diagnosis, leaving more time to investigate and solve the potential issue rather than wasting time to diagnosis, and would suggest seeking a fertility specialist after 6 months of trying to conceive.
During a male fertility consultation, the overall health history relating to fertility is discussed, including lifestyle factors. This may encompass diet, exercise, current medication, job type (indicating how active the patient is during the day/long periods of sitting), smoking-, alcohol-, or drug use as well as whether the testes are exposed to high temperatures, i.e. through hot baths or saunas. Previous examinations or tests performed can also be discussed. Should the consultation be for the couple, female factors can further be discussed, in addition to best time in the cycle to conceive as well as frequency of intercourse.
A crucial part that will direct the course of the consultation and treatment is to choose the appropriate clinic and consultant for oneself. First and foremost, a knowledgeable clinician should be chosen that both partners are comfortable with. Not only this is important, but to also pick a consultant who is considering both parties equally, i.e. not only looking into either the male- or only the female factor. For the male factor it would be recommended to seek a urologist or andrologist, preferably someone with extensive knowledge regarding the history and options of a patient. It would further be advantageous should the andrologist work according to the standards of accrediting bodies, such as ISO standards in a UKAS accredited laboratory. This accreditation reflects on the quality in place and ensures a standardisation in test performance and thus results.
FAQs About Male Fertility
Can male infertility be treated?
Most types of male infertility can be treated – either through changes in lifestyle, medication, surgery or hormone therapy.
How long does it take to improve sperm quality?
It can take as little as 12 weeks to change the results of a semen analysis – the duration for one cycle of spermatogenesis to occur. Therefore, repeated testing is recommended following implementation of even minor changes including lifestyle changes, i.e. quitting smoking, decreasing the amount of hot baths. Thus, on occasion and depending on the cause of male factor infertility, lifestyle changes alone can improve semen parameters.
Does frequent ejaculation lower sperm count?
A common myth suggests that longer abstinence periods would improve semen quality, however research has shown that more frequent ejaculation is favourable as more sperm is produced by the body, increasing motility, concentration and sometimes morphology.
Conclusion
Male fertility challenges are often treatable and manageable with the right support and guidance. Taking action early makes a real difference—simple lifestyle changes and timely testing can significantly improve outcomes. Awareness is key, and understanding your options empowers you to take control of your fertility journey. If you’re ready to take the next step, book a confidential consultation with Fertility Solutions today or browse our specialist blogs to learn more about specific topics that may affect you.
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