When a couple can’t get pregnant, the questions usually land on her first. Her cycle, her age, her hormones. Yet in about half of couples who struggle to conceive, the man’s health is part of the story.
Fertility for men is still a quiet topic, often brushed off with a joke, even though one simple test answers a lot. Here’s what shapes male fertility, which checks to ask for, who to see and what your options are if the news isn’t what you hoped.
Why Men’s Health and Fertility Go Hand in Hand
Sperm are a surprisingly honest report card. The habits that strain your heart or your waistline tend to show up in a sperm count too. Smoking, heavy drinking, extra weight and poorly managed diabetes are the usual suspects.
The link runs the other way as well. The guideline from the Urological Association tells doctors to talk with men who have abnormal sperm results about their wider health. Poor sperm production can be an early warning sign of other problems.
For plenty of men, a fertility workup is the first real checkup in years.
Men’s Health Awareness Month
In the US, June is Men’s Health Month, and Men’s Health Week ends on Father’s Day. Then November brings Movember, when men grow mustaches to raise money and attention for prostate cancer, testicular cancer and mental health.
Men put off doctor visits, and that habit costs them. Fertility rarely makes the official list, but it should.
If you’ve been meaning to book a physical, let this month be the nudge. Ask whether a fertility check makes sense too, especially if you’d like to start a family in the next year or two.
Male Infertility by the Numbers
About 1 in 6 adults worldwide face infertility at some point
About 1 in 8 American men aged 25 to 44 report some form of infertility
Up to 4 in 10 men with infertility have a varicocele
What Causes Male Infertility?
Sometimes the cause is obvious, but more often it isn’t: in up to 30% of cases, doctors never pin down a single reason.
Most problems still fall into a few familiar groups:
To reach and fertilize an egg, sperm need to show up in decent numbers, swim forward and have the right shape. A low sperm count gets the headlines, but poor sperm motility, meaning sluggish swimmers, matters just as much.
Some men have no sperm in the semen at all. That can come from a blockage or from the testicles making very few sperm, and the two need very different treatment.
A varicocele is a cluster of swollen veins in the scrotum, a bit like a varicose vein in the leg. It can overheat the testicles and drag down sperm quality.
Up to 15% of all men have one, and it turns up far more often in men with fertility problems.
A urologist can usually spot it in a simple exam, and minor surgery is an option. Past infections, injuries, undescended testicles in childhood, a vasectomy and some cancer treatments can also play a role.
Testosterone therapy, whether gels, shots or pellets, can shut down sperm production, because it tells the brain to stop sending the signals that keep sperm coming.
The American Society for Reproductive Medicine advises men who want biological children to avoid testosterone treatment until they’re done trying.
In most cases, sperm counts recover after stopping, but it can take months.
What about low testosterone in men who also want kids? There are fertility-friendly ways to treat it.
A specialist may suggest clomiphene or hCG for men whose low levels come from a pituitary problem. Both are used off-label for this purpose and need regular blood tests.
Men make sperm for life, but quality slips with age, more clearly after 40. Daily habits weigh in too. Smoking, heavy drinking, anabolic steroids and obesity are all linked to poorer sperm.
Heat is another quiet culprit. Long soaks in a hot tub or regular sauna sessions warm the testicles.
Even underwear may matter a little: men who mostly wore boxers had about 25% higher sperm concentration than men who didn’t, according to Harvard studies.
Signs of Fertility Problems in Men
People often search for signs of fertility in men, hoping the body will drop a hint. Usually it doesn’t.
Most men with fertility problems feel completely fine, which is exactly why male factor infertility is so easy to miss. Still, see a doctor if you notice:
- Pain, swelling or a lump in the scrotum
- Low sex drive or trouble with erections
- Less facial or body hair than you used to have
- Very little fluid when you ejaculate
- A past injury, surgery or cancer treatment involving the testicles
The most common clue is simply time. If your partner is 35 or older, six months of trying with no result is enough to start testing.
Fertility Tests for Men: What to Check and Which Doctors to See
A men fertility test is quick, private and far less invasive than most of the tests women go through. Ideally, both partners get checked at the same time, not one after the other.
Fertility Tests for Men
A semen analysis is the starting point and the most useful fertility test for men.
You give a sample, usually after two to five days without ejaculating, and a lab checks sperm count, movement, shape, volume and more.
Sperm counts swing up and down from week to week, so if the first test looks off, doctors often repeat it.
If sperm numbers are low or you have symptoms like a low sex drive, blood work comes next.
It usually checks testosterone and FSH, the hormone that tells the testicles to make sperm. Some doctors add LH, prolactin or thyroid tests.
A urologist will examine the testicles and the veins around them. A scrotal ultrasound isn’t routine, but it helps when the exam leaves questions.
When the count is very low or no sperm are found, genetic tests can look for chromosome problems or missing pieces of the Y chromosome. A sperm DNA test is usually saved for couples who’ve had repeated miscarriages.
Which Doctors to See
You don’t have to guess where to start. A quick guide to who does what:
| Doctor | When to see them | What they do |
|---|---|---|
| Primary care doctor | First stop or yearly physical | Orders basic blood work, reviews your medications, refers you on |
| Urologist | Abnormal sperm results, pain or a lump | Examines the testicles, treats veins and blockages |
| Reproductive urologist | Very low or zero sperm count | Focuses on male infertility, including sperm retrieval surgery |
| Reproductive endocrinologist | When the couple is ready for treatment | Leads IUI and IVF at a fertility clinic |
Some couples go straight to a fertility clinic for men or a center that treats both partners under one roof. When the clock matters, that saves weeks.
Are At-Home Sperm Tests Worth It?
An at home fertility test kit can be a fine first peek. Most only estimate sperm concentration, and a few add movement. A sperm fertility test in a lab also looks at shape, volume and details no kit can see.
If you’ve been trying for a while, book a full male fertility test at a lab.
How to Increase Fertility in Men
Sperm take about 74 days to mature. So any change you make today shows up in a test roughly two to three months from now.
If you’re wondering how to increase fertility in men, start with the basics:
- Quit smoking. Smokers tend to have lower sperm counts and slower swimmers.
- Go easy on alcohol, and if you use anabolic steroids, ask a doctor how to stop safely.
- Work toward a healthy weight, since obesity is tied to lower sperm quality.
- Keep things cool. Skip the long hot tub sessions and switch to loose cotton boxers.
- Get blood pressure, blood sugar and cholesterol checked, then treat what you find.
A fertility diet for men looks a lot like any heart-healthy plate: vegetables, fruit, whole grains, nuts and fish, with fewer processed meats and sugary drinks.
Do Fertility Supplements Work?
Men fertility supplements are a booming business, and fertility vitamins for men fill entire store shelves. But the science is thin.
The AUA and ASRM guidelines call the benefit of antioxidants and vitamins for male infertility questionable. Search CoQ10 fertility or L-carnitine online and you’ll find big promises, yet the evidence isn’t strong enough for a firm recommendation.
When Male Infertility Means Exploring Other Paths
Sometimes treatment fixes the problem. Sometimes it doesn’t, or time is short. Either way, a diagnosis of male infertility rarely ends the road to parenthood.
IVF With ICSI
With ICSI, an embryologist injects a single sperm directly into each egg during IVF.
It needs only a handful of healthy sperm, which changed the outlook for men with very low counts or poor movement. The sperm can come from a fresh sample, a frozen one or a surgical retrieval.
Surgical Sperm Retrieval
Even with no sperm in the semen, the testicles may still make some.
A reproductive urologist can retrieve sperm straight from the testicle or the epididymis, and the lab then uses it for ICSI. A microscope-guided method called micro-TESE is the go-to when production is very low.
Donor Sperm
When no usable sperm can be found, or when there’s a genetic condition a man would rather not pass on, donor sperm is a well-established route.
Donor Eggs and Gestational Surrogacy
Male factor problems often come alongside female ones, such as a low egg supply or a uterus that can’t safely carry a pregnancy. Then IVF with frozen donor eggs, surrogacy or both may offer the best odds.
These paths also open the door for gay couples and single men who want a genetic child.
Sperm from the intended father is paired with donor eggs, and in gestational surrogacy another woman carries the pregnancy with no genetic link to the baby.
How ADONIS Fertility Solutions Can Help
ADONIS Fertility Solutions has helped families for 25 years, with 14 clinics and more than 15,000 babies born.
Programs look at both partners from the start: a semen analysis is part of the man’s workup before IVF, so male factor problems surface early.
When donor eggs, surrogacy or both are the right fit, ADONIS handles the whole process, from donor and surrogate selection to step-by-step surrogate screening and a notarized agreement before any medical procedure.
ADONIS reported a 75% pregnancy rate for fresh cycles that combine egg donation and surrogacy.
Single dads and same-sex couples are welcome in the programs in Mexico, priced from $56,900 to $103,900, and financing of up to $35,000 can spread the cost.
Not sure where to begin? See how the process works step by step, write to support@adonisfertilitysolutions.com or call +1 929 338-6312.
