Understanding Male Infertility: A Comprehensive Guide

Male factor infertility is often overlooked, yet it contributes to 50% of cases where couples struggle to conceive. Even when female factors are identified, assessing male fertility remains crucial. By understanding the role male fertility plays, couples can take a more comprehensive approach to their journey. This guide covers key aspects of male reproductive health, from awareness and testing to understanding specific conditions like varicocele, and the support options available.

Evaluating male fertility isn’t just beneficial — it’s essential

Raising Awareness About Male Infertility

Male infertility can be present even when no obvious symptoms are apparent. In many cases, it remains undiagnosed until couples face challenges conceiving. While it’s common to focus on female reproductive health, it's important to remember that male factors contribute to half of all infertility cases. This is particularly significant in cases of recurrent miscarriage or unexplained infertility. Evaluating male fertility isn’t just beneficial — it’s essential. Although a semen analysis is often the first step, relying solely on this test can sometimes miss important underlying issues. Further investigations provide a clearer understanding of sperm health and fertility potential.

Essential Male Fertility Tests

When assessing male fertility, comprehensive testing goes beyond a basic semen analysis. Here are some key tests that may be recommended:

Semen Analysis: This is the most common test used to assess sperm health. It evaluates sperm concentration (the number of sperm), motility (how well they move), morphology (the shape and structure of sperm), and semen volume. Other parameters important to note are viscosity, presence of debris or white blood cells, and pH. Some clinics may also investigate antisperm antibodies which, if present at high levels, may hamper the sperm's ability to reach and bind to the egg. While helpful, a semen analysis alone may not reveal DNA damage or other underlying issues, so it should be the starting point rather than the sole diagnostic tool.
DNA Fragmentation Test: This test measures the integrity of sperm DNA. Even if a semen analysis appears normal, sperm with high levels of DNA fragmentation may reduce the chances of fertilisation and increase the risk of miscarriage. DNA fragmentation may be increased by factors such as oxidative stress, infections, or lifestyle factors, and targeted interventions could help improve outcomes. Check back to my previous post to find out more about this particular test.
Seminal Microbiome Assessment: The male reproductive tract was once thought to be sterile, but we now know it has its own microbiome which plays a role in sperm health. An imbalance in the microbiome, or the presence of harmful bacteria, may negatively affect sperm quality, yet is often asymptomatic. Assessing the seminal microbiome can help to identify infections or inflammation that may otherwise go undetected. This is something I have covered a lot further in my social media during March, so check back on my IG grid. If the female partner experiences vaginal infections such as thrush or bacterial vaginosis, then this is a test that I strongly recommend looking into, as these intimate microbiomes are shared.
Further Testing: In cases where sperm concentration is low, additional evaluations may be recommended. A physical examination by a urologist can detect structural issues like varicocele. Hormone testing can assess levels of testosterone and other hormones essential for sperm production. Genetic testing, including karyotyping and Y chromosome microdeletion testing, may be considered if a genetic cause is suspected; this is usually in cases of extremely low sperm concentration, or total absence of sperm (azoospermia).

Understanding Varicocele

Varicocele is one of the most common causes of male infertility, contributing to about a third of cases, hence I'm singling it out here. It can present as primary or secondary infertility (= following a live birth). It occurs when the veins within the scrotum become enlarged, potentially leading to impaired sperm production and reduced testosterone levels. This may contribute to low sperm count, poor motility, and increased DNA fragmentation. Although not always, it is sometimes possible for you to detect if you have a varicocele; it may feel like a dull ache or heaviness in the testicle which may be worse after physical activity or on standing, and to palpate it, it may feel like a "bag of worms". While not all varicoceles affect fertility, it’s worth investigating if there are concerns about sperm quality.

Diagnosis typically involves a physical examination or an ultrasound. Fortunately, there are effective management options. Depending on the severity, treatment may involve lifestyle changes, medical therapies, or in some cases, minor surgical procedures to repair the varicocele and improve sperm quality.

If you notice any irregularities when assessing your testicles, I always advise seeking a medical opinion.

Supporting Male Fertility

Supporting male fertility involves a combination of nutritional, lifestyle, and emotional well-being approaches.

Food always comes first, and a diet rich in antioxidants, omega-3 fatty acids, and key nutrients like zinc, selenium, and folate supports sperm health; the Mediterranean diet is a great one to centre your dietary pattern around. Supplements may be supportive for some individuals, however, it’s essential to exercise caution with high levels of antioxidants — while they may reduce oxidative stress, excessive supplementation may also lead to reductive stress, which can further harm sperm quality; professional guidance is recommended.

Dark coloured berries are a fantastic source of dietary antioxidants

Managing stress is also crucial, as chronic stress may negatively impact hormone balance and sperm production. Mindfulness, regular exercise (although not intense!), and seeking support through therapy or counselling can all contribute to better outcomes. It’s also important to acknowledge the emotional toll of fertility struggles on men. Fertility challenges are often seen as a “women’s issue,” leaving men without the support they need. Male fertility organisations offer resources and peer support to ensure men don’t feel alone in their journey.

Taking the Next Step

Understanding male fertility is a key part of a comprehensive fertility journey. If you're navigating fertility challenges, seeking further testing or support could provide clarity and actionable insights.

To help you get started:

a leading male fertility company (TestHim) offers a free questionnaire to guide you in understanding your fertility status and exploring next steps.
You can also access Support Resources from HIMfertility (a male fertility support organisation).
If you'd like personalised support and guidance, I'm here to help. Book a free call with me to explore how we can work together to support your fertility journey.

📞 Book Your Free Call Here

Every step taken to understand male fertility matters. Let’s continue the conversation and ensure men receive the support they need on their fertility journey.

Sarah