Male infertility: common causes, diagnosis and fertility treatment options

For many couples, the journey towards pregnancy can be filled with uncertainty and emotions. Although fertility problems are often associated with women, male factors play an important role, contributing to around one third of infertility cases.

For this reason, assessing both partners from the beginning is essential to understand what may be affecting conception and to identify the most appropriate path forward.

Thanks to advances in reproductive medicine, many men with fertility problems can now achieve their goal of becoming biological fathers.

What is male infertility?

Male infertility describes any condition that affects a man’s ability to achieve a pregnancy with his partner.

These difficulties may be related to different aspects of sperm function, including sperm quantity, movement, shape, or the ability of sperm to fertilise an egg.

One important aspect of male infertility is that it often has no visible symptoms. Many men only discover there is an issue after undergoing a fertility assessment.

How is male fertility evaluated?

The evaluation usually begins with a consultation with a fertility specialist, who will review the medical history and look for factors that may influence sperm production or sperm function.

The assessment may include previous illnesses or infections, conditions during childhood that affected the testicles, previous surgery or injuries, lifestyle factors such as smoking, alcohol or drug use, current medication, and possible exposure to heat or chemicals at work or in the environment.

A physical examination may also form part of the fertility evaluation.

Semen analysis: the first step in assessing sperm quality

The main test used to evaluate male fertility is a semen analysis.

This laboratory assessment measures several important parameters, including:

• Semen volume
• Sperm concentration
• Total sperm count
• Motility (how well sperm swim)
• Morphology (the shape of sperm)

Although a semen analysis provides valuable information, it is only one part of the overall fertility assessment. Additional tests may sometimes be required.

Why has sperm quality changed in recent decades?

Research published over recent decades suggests that sperm quality has declined in many parts of the world.

Although the exact reasons are still being investigated, several factors are thought to contribute, including:

• Smoking
• Obesity
• Poor diet
• Chronic stress
• Environmental pollution
• Exposure to endocrine-disrupting chemicals
• Increasing paternal age

Not every man exposed to these factors will develop infertility, but they may negatively affect sperm production and function.

Medical conditions associated with male infertility

Male infertility can have different causes, including medical conditions that affect the testicles, hormones or sperm production.

Varicocele

A varicocele is an enlargement of the veins surrounding the testicle. It is one of the most common reversible causes of male infertility and may affect sperm production by increasing testicular temperature.

Undescended testicles (cryptorchidism)

If one or both testicles fail to descend into the scrotum during childhood, sperm production may be affected later in life, particularly if treatment was delayed.

Testicular infections

Certain infections, including mumps after puberty, may damage testicular tissue and reduce sperm production.

Hormonal disorders

Hormonal imbalances affecting testosterone or the pituitary gland can interfere with normal sperm production.

Genetic conditions

Some men with severe abnormalities, such as azoospermia (absence of sperm) or very low sperm counts, may benefit from genetic testing to identify an underlying cause.

Can male infertility be treated?

Treatment depends on the underlying diagnosis.

In some cases, improving lifestyle habits or treating an underlying medical condition may improve fertility.

When natural conception is unlikely, assisted reproductive treatments offer excellent alternatives.

Depending on each couple’s circumstances, options may include:

• Intrauterine insemination (IUI)
• In vitro fertilisation (IVF)

These techniques have helped millions of couples achieve pregnancy worldwide.

When should you seek medical advice?

A fertility evaluation may be recommended if:

• You have been trying to conceive for 12 months without success (or 6 months if your partner is over 35).
• You have a history of testicular surgery, chemotherapy or undescended testicles.
• A previous semen analysis showed abnormal results.
• You simply want reassurance before trying for a baby.

Early assessment can often reduce unnecessary delays and help identify the most appropriate treatment sooner.

Male fertility is part of the fertility journey

Infertility is a shared condition, not a female one.

Assessing both partners from the beginning provides the best opportunity to identify the cause and choose the most appropriate treatment.

At URE Centro Gutenberg, our fertility specialists perform a comprehensive evaluation of both male and female fertility to help couples move forward with confidence.

Planning treatment in Spain? We offer free online consultations for international patients, allowing you to discuss your situation with one of our fertility specialists before travelling.