Male Infertility: Causes, Symptoms, Tests, and Treatments Explained
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Male infertility is a factor in up to half of all couples who cannot conceive after a year of unprotected sex. It usually has no symptoms other than being unable to cause a pregnancy. Common causes include varicocele (enlarged scrotal veins), infections, hormone imbalances, blockages, chromosome problems, lifestyle factors, and environmental exposures. Diagnosis typically starts with a semen analysis, and treatments range from surgery and hormone therapy to assisted reproductive technology such as IVF and ICSI. Lifestyle changes, including quitting smoking and limiting alcohol, can also support sperm health [1][2].
Quick Answer: What is male infertility?
Male infertility is a condition that is a factor in up to half of couples who cannot conceive after one year of regular unprotected sex. It usually has no symptoms besides inability to cause a pregnancy. Causes include low sperm count, poorly functioning sperm and blockages. A semen analysis is the first test, and many cases are treatable. [1] [2]
What the research says
Antioxidant supplements may help, but the evidence is low quality and inconclusive. A Cochrane systematic review of 61 randomized trials (6,264 subfertile men) found, in low-quality evidence, higher live birth (odds ratio 1.79, 95% CI 1.20 to 2.67; 7 trials, 750 men) and clinical pregnancy (odds ratio 2.97, 95% CI 1.91 to 4.63; 11 trials, 786 men) with antioxidants than with placebo or no treatment. When studies at high risk of bias were removed, there was no evidence of increased live birth, and antioxidants may cause more mild gastrointestinal upset. The authors concluded that the evidence is inconclusive and larger trials are needed (Smits et al., Cochrane Database Syst Rev, 2019 [3]).
Average sperm counts have fallen worldwide. A systematic review and meta-regression of 223 studies (semen samples collected from 1973 to 2018) found that mean sperm concentration among unselected men from all continents fell by 51.6% and total sperm count by 62.3%. The yearly rate of decline doubled, from 1.16% since 1972 to 2.64% since 2000. These are population-level trends, not a diagnosis for any one man (Levine et al., Hum Reprod Update, 2023 [4]).
What Is Male Infertility?
Nearly 1 in 7 couples cannot have a child after at least one year of regular unprotected sex. In up to half of these couples, male infertility is at least part of the reason [1].
Male infertility means that problems related to sperm make it hard for a couple to conceive. The issues generally fall into three groups: too few sperm, sperm that do not work well, or blockages that keep sperm from going where they need to go. Illnesses, injuries, long-term health conditions, lifestyle choices, and other factors can all play a role. Not being able to have a child can cause significant stress for you and your partner, and there are treatments for many of the underlying causes [1].
What Are the Symptoms of Male Infertility?
The main sign of male infertility is not being able to cause a pregnancy. There may be no other symptoms at all. Most men with low sperm counts or reduced sperm quality feel completely fine, which is why testing is so important once a couple has been trying to conceive without success [1].
When to See a Doctor
Situation | What to do |
Unable to cause pregnancy after 1 year of regular unprotected sex | See a healthcare professional |
Unable to cause pregnancy after 6 months if the partner is over 35 | See a healthcare professional sooner |
How does conception work, and what must sperm do?
Understanding the four requirements of conception makes the causes of male infertility easier to understand [1]:
Make healthy sperm. This starts with the growth of the male reproductive organs during puberty. At least one testicle must work, and the body must make testosterone and other hormones to keep making sperm.
Get sperm into the semen. Tubes carry sperm from the testicles and mix them with semen. Ejaculation takes the sperm out of the penis.
Have enough sperm in the semen. This is the sperm count. A low count is fewer than 15 million sperm per milliliter of semen or fewer than 39 million per ejaculate. The lower the count, the lower the odds that one sperm will fertilize an egg.
Have sperm that works and moves. This is called motility. For fertilization, sperm must be able to reach the egg and get inside it.
Male infertility is a problem with sperm production or delivery.
What Causes Male Infertility?
Causes fall into several broad groups: medical conditions, environmental exposures, and health and lifestyle factors. Any of these can affect the number, quality, or movement of sperm. Sometimes there is more than one cause [1].
Medical Causes
Varicocele is a swelling of the veins that drain the testicle. It is the most common cause of male infertility that can be fixed. Experts do not know exactly how it causes infertility, but it may be linked to blood flow that is not typical, and it leads to lower sperm quantity and quality.
Infections such as inflammation of the epididymis (the coiled tube at the back of the testicle) or of the testicles, and some sexually transmitted infections including gonorrhea or HIV, can affect sperm making or cause scarring that blocks sperm. Most of the time the testicles can still make sperm, but infections sometimes cause lifelong testicle damage.
Ejaculation issues include retrograde ejaculation, in which semen enters the bladder during climax instead of coming out the tip of the penis. Diabetes, spinal injuries, certain medicines, and surgery of the bladder, prostate, or urethra can cause it.
Antibodies that attack sperm develop when the immune system sees sperm as harmful and tries to get rid of them.
Tumors, cancerous and non-cancerous, can affect the reproductive organs directly or through glands that release hormones, such as the pituitary. Surgery, radiation, or chemotherapy to treat tumors can also affect fertility.
Undescended testicles that did not move from the belly into the scrotum before birth are likely to lower fertility.
Hormone imbalances can result from conditions of the testicles or of the hypothalamus, pituitary, thyroid, and adrenal glands. Low testosterone is called male hypogonadism.
Tube problems such as blockages can result from surgery, infection, injury, or improper formation, and can occur in the testicle, the epididymis, the vas deferens, near the ejaculatory ducts, or in the urethra.
Chromosome issues are inherited conditions that can keep the male organs from forming well. Examples include Klinefelter syndrome, in which a male is born with two X chromosomes and one Y chromosome, and cystic fibrosis.
Trouble having sex includes erectile dysfunction (ED), ejaculating too soon, painful sex, and a penis that is not formed well, such as hypospadias, in which the opening of the urethra is under the penis. Mental and relationship issues may also be involved.
Certain medicines can lower fertility, including testosterone replacement therapy, long-term anabolic steroids, chemotherapy medicines, some ulcer medicines, and some arthritis medicines.
Surgeries including vasectomy, scrotal or testicular surgeries, prostate surgeries, and surgeries for testicular and rectal cancers can keep sperm from reaching the ejaculate.
Environmental Causes
Industrial chemicals, including pesticides, herbicides, organic solvents, and painting products, may be part of low sperm counts.
Heavy metals, such as lead, may also cause infertility.
Radiation and X-rays can lessen sperm making. It often returns to the usual amount in time, but high doses can lessen it long term.
Heat on the testicles may lower sperm count for a time. Some studies suggest saunas and hot tubs do this, and more research is needed on whether long laptop use or tight clothing raises scrotal temperature enough to cut sperm making.
Health, Lifestyle, and Other Causes
Drug use: anabolic steroids can cause the testicles to shrink and lower the sperm count, and cocaine or marijuana may cut the number and quality of sperm for a time.
Alcohol: drinking can lower testosterone, cause ED, and lower sperm count, and liver disease from heavy drinking may also lead to fertility issues.
Tobacco smoking may lower sperm count, and secondhand smoke may also affect male fertility.
Body weight: obesity can harm fertility by affecting sperm and causing hormone changes.
These causes are described by Mayo Clinic [1].
Summary Table of Causes
Category | Examples | How it affects fertility |
Varicocele | Enlarged scrotal veins | Lowers sperm quantity and quality; most common fixable cause |
Infections | Epididymitis, orchitis, STIs | Scarring can block sperm passage |
Ejaculation issues | Retrograde ejaculation | Semen enters the bladder instead of exiting the penis |
Hormone imbalances | Low testosterone, pituitary problems | Reduces sperm production |
Blockages | Surgery, infection, injury | Keeps sperm from traveling |
Chromosome issues | Klinefelter syndrome, cystic fibrosis | Inherited cause of fertility problems |
Environmental | Chemicals, heavy metals, radiation, heat | Damages or reduces sperm |
Lifestyle | Smoking, alcohol, drugs, obesity | Lowers sperm count and quality |
Common causes of male infertility range from varicocele to hormone imbalances and blocked tubes.
What are the risk factors for male infertility?
Several factors raise the chances of fertility problems [1]:
Risk factor group | Examples |
Lifestyle | Smoking, alcohol, illicit drugs, obesity |
Testicle issues | Injury, vasectomy, major belly, pelvic, or scrotal surgery, excess heat, undescended testicles |
History | Past or present infections, toxin exposure |
Family history | Born with a fertility condition or having a blood relative with one |
Medical conditions | Obesity, tumors, sickle cell disease, celiac disease, sleep apnea or poor sleep |
Treatments | Certain medicines, cancer surgery, radiation |
What complications can male infertility cause?
Male infertility can affect more than the ability to have children. Complications include stress and relationship problems from not being able to have a child. Fertility treatments can also be costly and complex, adding financial and emotional strain. Men with infertility also have a higher risk of certain cancers, including testicular cancer [1].
How Is Male Infertility Diagnosed?
Diagnosis often involves both partners, and sometimes no cause is found. The process typically starts with a physical exam and medical history, followed by one or more tests [2].
Physical Exam and Medical History
Your healthcare professional will examine the genitals and ask about family conditions, long-term health conditions, injuries, surgeries, and your sex life. They may also ask whether you have fathered children and about your experience of puberty [2].
Semen Analysis
The semen analysis is the central test. You provide a sample by masturbating into a special container at a medical office, or by using a special condom during sex at home. The lab measures the sperm count, the morphology (shape) and motility (movement) of the sperm, and checks for infection or other problems. Because sperm counts vary between samples, several tests over time are usually done. If your semen analysis is typical, your healthcare professional may suggest that your partner be tested first [2].
Other Tests
Scrotal ultrasound uses sound waves to look at the tissues in the scrotum and can show a varicocele or other problems in the testicles.
Transrectal ultrasound uses a small, lubricated wand placed in the rectum to check the prostate and look for blockages of the tubes that carry semen.
Hormone testing is a blood test that measures testosterone and other hormones made by the pituitary, hypothalamus, and testicles.
Post-ejaculation urinalysis looks for sperm in the urine, which may indicate retrograde ejaculation.
Genetic tests can show small changes in the Y chromosome, which can cause a very low sperm count, and can diagnose congenital or inherited conditions.
Testicular biopsy removes small tissue samples with a needle. If sperm production is normal, the problem is likely a blockage or transport issue elsewhere.
Diagnostic Tests at a Glance
Test | What it checks | What it can reveal |
Semen analysis | Sperm count, shape, movement, infections | Low count, poor motility, abnormal shape |
Scrotal ultrasound | Tissues in the scrotum | Varicocele, testicle problems |
Transrectal ultrasound | Prostate and semen tubes | Blockages |
Hormone blood test | Testosterone and other hormones | Hormone imbalances |
Post-ejaculation urinalysis | Sperm in urine | Retrograde ejaculation |
Genetic tests | Chromosome changes | Inherited conditions |
Testicular biopsy | Tissue from the testicle | Whether sperm is being made |
What are the treatment options for male infertility?
Often, no exact cause of male infertility is found, but treatment may still lead to pregnancy. For most couples, both partners are checked, and your partner may need treatment as well [2].
Surgery can correct a varicocele, repair a blocked vas deferens, or reverse a vasectomy. When there are no sperm in the ejaculate, sperm retrieval surgery can often collect sperm from the testicles, epididymis, or bladder.
Treating infections: antibiotics may cure an infection of the reproductive tract, though they do not always bring fertility back.
Treating sexual problems: medicines or counseling can help conditions such as ED or ejaculating too soon.
Hormone treatments and medicines may help when high or low hormone levels, or problems with how the body uses hormones, are the issue.
Assisted reproductive technology (ART) involves getting sperm through ejaculation, surgery, or from a donor and placing it into the female partner. In vitro fertilization (IVF) mixes sperm with an egg in a lab, and intracytoplasmic sperm injection (ICSI) puts a single sperm directly into an egg.
When treatment does not work. Rarely, there is no treatment for male fertility problems. In that case, your healthcare professional may suggest that you and your partner consider donor sperm or adoption [2].
Treatment | Best for |
Surgery | Varicocele repair, blockage repair, vasectomy reversal, sperm retrieval |
Antibiotics | Reproductive tract infections |
Medicines or counseling | Erectile dysfunction, premature ejaculation |
Hormone therapy | Hormone imbalances |
ART (IVF, ICSI) | Low sperm count, poor motility, no sperm in the ejaculate |
Donor sperm or adoption | When treatment fails or is not possible |
Treatment depends on the cause and ranges from surgery and medicines to assisted reproduction.
Which lifestyle and home remedies help with male infertility?
Several everyday steps may support fertility [2]:
Have sex more often. Having sex every day or every other day, beginning at least five days before your partner's ovulation, raises the chances of conception.
Time your sex. Pregnancy is most likely around ovulation, in the middle of the menstrual cycle. Because sperm can live for a few days, have sex 5 to 7 days before the expected ovulation date and until two days after it.
Avoid lubricants that harm sperm. Products such as Astroglide or K-Y jelly, lotions, and even spit might keep sperm from moving and working. Ask your healthcare professional about sperm-safe options.
Live a healthy lifestyle. Eat healthy foods, stay at a healthy weight, get enough sleep, and exercise most days.
Protect your health. Stop or limit alcohol, quit smoking, and avoid illicit drugs.
Can supplements and alternative approaches help male infertility?
Some studies show that certain supplements may help male fertility by improving sperm count or quality. These include coenzyme Q10, folic acid combined with zinc, L-carnitine, selenium, vitamin C, and vitamin E. Talk with a healthcare professional before taking any supplement: there is no good proof these products work, and some may cause side effects or interact with other medicines [2][3].
How can couples cope with male infertility?
Coping with infertility is hard. You cannot know how long treatment will take or whether it will work [2].
Set limits. Treatments can be costly and insurance may not cover them. Decide as a couple how many and what kind of procedures you can handle, how much you are willing to spend, and how you will handle your feelings.
Take a break. Some couples stop treatment for a few months and then try again.
Think about other choices. Considering donor sperm or eggs, or adoption, early may relieve worry and help with loss of hope.
Talk about your feelings. Support groups and counseling can help before and after treatment.
Manage stress. Options include yoga, meditation, deep breathing, massage therapy, and counseling such as cognitive behavioral therapy. Stay in touch with your partner, family, and friends.
How should you prepare for a male infertility appointment?
You may first see your main healthcare professional, who may then refer you to a specialist [2].
Preparation step | Details |
Before semen analysis | Do not ejaculate for at least 2 to 5 days before the sample |
Bring your partner | They may need testing and can help track information |
Check insurance | Testing is costly; coverage varies |
Make lists | Medicines, vitamins, and supplements with dosages (including muscle-building substances and alcohol, tobacco, marijuana, or other drugs), male family members with fertility issues, and your questions |
Helpful questions to ask: What might be causing my infertility? What other conditions are possible? What tests do I need, and does my partner need tests? What treatments exist? Should I see a specialist? Expect questions about the age you went through puberty, any sex problems such as trouble with erections or ejaculating too soon, whether you have fathered a child, and whether you have had a vasectomy or belly, pelvic, or scrotal surgery [2].
What is the bottom line on male infertility?
Male infertility is far more common than most people realize, playing a role in up to half of all couples who cannot conceive. It usually shows no symptoms other than the inability to cause a pregnancy, which is why testing matters once a couple has been trying for a year, or six months if the female partner is over 35.
Many causes are identifiable and many are treatable. A semen analysis, hormone testing, and imaging can pinpoint the problem, and options range from simple lifestyle changes to surgery, hormone therapy, and advanced treatments such as IVF and ICSI. If you have been trying to conceive without success, do not wait: talk to a healthcare professional early and bring your partner along. Ready to take the next step? Start with a semen analysis and a conversation with your healthcare professional. The earlier you understand what is going on, the more options you will have.
Frequently Asked Questions
Can male infertility have no symptoms?
Yes. The main sign of male infertility is simply not being able to cause a pregnancy. There may be no other symptoms at all, which is why semen testing is recommended after a year of trying.
How low is a low sperm count?
A low sperm count is defined as fewer than 15 million sperm per milliliter of semen or fewer than 39 million sperm per ejaculate. Lower counts reduce the odds that sperm will fertilize an egg.
What is the most common fixable cause of male infertility?
Varicocele, a swelling of the veins that drain the testicle, is the most common cause of male infertility that can be treated with surgery. It lowers sperm quantity and quality.
Can infections cause male infertility?
Yes. Infections such as epididymitis, orchitis, gonorrhea, and HIV can cause scarring that blocks sperm. Most often the testicles can still make sperm, but sometimes infections cause lifelong damage.
What is retrograde ejaculation?
Retrograde ejaculation happens when semen enters the bladder during climax instead of coming out of the penis. It can be caused by diabetes, spinal injuries, certain medicines, or bladder, prostate, or urethra surgery.
What tests diagnose male infertility?
Diagnosis starts with a semen analysis. It is often followed by a scrotal ultrasound, transrectal ultrasound, hormone blood tests, post-ejaculation urinalysis, genetic tests, and sometimes a testicular biopsy.
Can smoking affect male fertility?
Yes. Tobacco smoking may lower sperm counts, and secondhand smoke may also affect male fertility. Quitting is one of the recommended lifestyle steps.
What lifestyle changes help male fertility?
Recommended steps include quitting smoking, limiting or avoiding alcohol, avoiding illicit drugs, staying at a healthy weight, getting enough sleep, exercising, and avoiding things that overheat the testicles.
What is IVF and ICSI?
In vitro fertilization (IVF) mixes sperm with an egg in a lab. Intracytoplasmic sperm injection (ICSI) puts a single sperm directly into an egg. Both are forms of assisted reproductive technology.
Can supplements improve male fertility?
Some studies suggest coenzyme Q10, folic acid with zinc, L-carnitine, selenium, vitamin C, and vitamin E may improve sperm count or quality, but there is no good proof they work. Always talk with a healthcare professional first.
When should we see a doctor about infertility?
See a healthcare professional after one year of regular unprotected sex without pregnancy, or after six months if the partner is over 35. Both partners are usually evaluated.
Related Articles
External Resources
Related Reading
Electroejaculation: Purpose, Procedure and Results explains electroejaculation.
Vasectomy: Procedure, Recovery, Effectiveness and Risks explains how a vasectomy works as permanent birth control, how it is confirmed and what reversal involves.
Learn more in our guide to Semen Analysis: Purpose, How to Prepare and What Results Mean.
References
Mayo Clinic. Male infertility - Symptoms and causes. Mayo Clinic. August 8, 2026. https://www.mayoclinic.org/diseases-conditions/male-infertility/symptoms-causes/syc-20374773
Mayo Clinic. Male infertility - Diagnosis and treatment. Mayo Clinic. August 8, 2026. https://www.mayoclinic.org/diseases-conditions/male-infertility/diagnosis-treatment/drc-20374780
Smits RM, Mackenzie-Proctor R, Yazdani A, et al. Antioxidants for male subfertility. Cochrane Database Syst Rev. 2019;3(3):CD007411. PMID 30866036. https://doi.org/10.1002/14651858.CD007411.pub4
Levine H, Jørgensen N, Martino-Andrade A, et al. Temporal trends in sperm count: a systematic review and meta-regression analysis of samples collected globally in the 20th and 21st centuries. Hum Reprod Update. 2023;29(2):157-176. PMID 36377604. https://doi.org/10.1093/humupd/dmac035
Medical disclaimer
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. The clinical information in this guide reflects source material last reviewed in August 2026.
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