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What You Need To Know About Male Factor Infertility

04.16.2023 / Clara Siegmund
What You Need To Know About Male Factor Infertility

You and your partner have decided you want to have a baby. Congratulations! But it’s been a while, and you’re having some trouble. You may find yourself starting to wonder what is going on. Did you know that male factor infertility could be to blame?

Infertility is usually defined as the inability to get pregnant after one year of unprotected sex. Male factor infertility is when that inability is caused by infertility in a male partner. Infertility can feel isolating but it's more common than you may think: 15-20% of heterosexual couples trying to conceive deal with infertility. And either individual (or both) may have something to do with it.

If you suspect you might be having issues with male factor infertility, there are lots of treatment options available to you. With teamwork, and the help of your doctor, you and your partner can increase your chances of a successful pregnancy.

What It Is     Causes     Risk factors     Symptoms     Diagnosing     Treatment


What is male factor infertility?

Male factor infertility is when the male partner is infertile, either from low or abnormal sperm production, or troubles with the delivery of sperm.

Male factor infertility is more common than we might think. In fact, men and women experience infertility at comparable rates: in infertility among heterosexual couples, around 33% of cases are related to male factor infertility, 33% to female infertility, and 33% to infertility issues with both partners or to unknown factors.

Causes of male factor infertility

Male factor infertility can have several different causes, including genetic conditions, hormonal imbalances, and problems with testicular or ejaculatory functions.

Genetic conditions

Is male factor infertility genetic? Certain genetic conditions may lead to problems with male fertility. They include klinefelter syndrome, chromosomal microdeletion, and myotonic dystrophy.

These conditions can cause abnormal development of male reproductive organs. This can affect reproductive function, including testosterone levels, sperm production, and sperm count. If you have a diagnosis of a genetic condition and you’re dealing with male factor infertility, there may be a connection.

Hormonal imbalances

When your hormones are out of balance, your ability to conceive may be affected. 

Fertility hormones, and the glands that produce them, influence reproductive function. For example, low sperm production, which can lead to fertility issues, can be caused by:

  • Low testosterone levels
  • High prolactin levels
  • Abnormal levels of follicle stimulating hormone (FSH)

Hormonal imbalances can also cause other health issues, and should be monitored by a doctor.

Problems with testicular or ejaculatory functions

Certain issues can disrupt testicular function or ejaculatory function, such as:

  • Retrograde ejaculation
  • Varicocele
  • Antibodies that attack sperm
  • Undescended testicles
  • Blockages in the tubes that transport sperm

Retrograde ejaculation occurs when semen enters the bladder instead of being ejaculated out of the penis, resulting in very little to no ejaculate (meaning very little to no sperm). Varicocele refers to enlarged veins in the testicles, and can affect the number and shape of sperm. Tubal blockages can occur due to infections, trauma from injury, or abnormal development. 

When testicular and/or ejaculatory functions are blocked, your fertility can be impacted.

Other causes

Other possible causes of male infertility include:

  • Cancer treatments like chemotherapy, radiation, or surgery to remove a testicle
  • Certain medications, such as antibiotics, antifungal medicines, and some blood pressure medication
  • Long-term anabolic steroid use
  • Injury trauma to the testicles
  • Groin, testicle, penis, or scrotum surgery
  • Exposure to certain environmental toxins

Risk factors of male infertility

Some factors, such as lifestyle habits or health conditions, may increase your risk for infertility. These include:

  • High alcohol consumption
  • Tobacco intake
  • Use of certain illicit substances
  • Frequent exposure of the testicles to high temperatures
  • Severe stress
  • Depression
  • Obesity

>>MORE: Alcohol and Fertility: What's the Link?

Your age can also have an effect on fertility. Though age is a bigger factor for women and fertility, men over 40 are more likely to report difficulty conceiving.

Symptoms of male factor infertility

You may not have any obvious signs or symptoms of infertility, other than the infertility itself. Some people, however, can exhibit symptoms that could indicate fertility issues. These might be:

  • Pain, lumps, or swelling in your testicles
  • Small, firm testicles
  • Issues with ejaculation or inability to ejaculate
  • Difficulty maintaining an erection
  • Reduced sex drive and desire

Diagnosing male factor infertility

In general, if a couple hasn’t conceived after one year of trying, infertility issues may be at the root of the problem. In this case, both individuals should consider seeing fertility specialists.

It’s important to recognize that infertility is often emotionally draining. Both people in the couple may be dealing with feelings of anger, sadness, confusion, and inadequacy. Talking about your emotions, both with each other and with mental health professionals, can help. It’s completely possible, and beneficial, to address your physical and emotional well-being while on your journey to pregnancy.

>>MORE: Oova 101: How Support Systems Can Help You Navigate Infertility

Talk to your doctor

For the physical side of things, you can start by making an appointment with your general practitioner. 

During your visit, you’ll undergo a physical examination, including an examination of your genitals. Be prepared for a thorough review of your medical history, including questions about:

  • Your sexual history
  • Any history of infertility with previous partners
  • Chronic health conditions
  • Medication you take
  • Previous surgeries

The next step in diagnosing male infertility is a semen analysis. A semen sample will be sent to a lab to measure:

  • Semen volume
  • Sperm concentration
  • Total sperm count
  • Sperm morphology (shape)
  • Sperm motility (movement)

You’ll likely give multiple semen samples for analysis over a period of time. This ensures accurate results, as sperm count can vary significantly from sample to sample. The results of these analyses will determine next steps.

Visit a male fertility specialist

If your semen analyses come back with abnormal results, your doctor will likely recommend that you see a fertility specialist. For male infertility, you’ll see a reproductive urologist.

Your reproductive urologist will run more tests to determine the cause of your fertility issues. Some examples of tests this doctor might perform are:

  • Scrotal ultrasounds
  • Transrectal ultrasounds
  • Post-ejaculation urinalysis
  • Hormone testing
  • Genetic tests

Scrotal ultrasounds check for conditions like varicocele. Transrectal ultrasounds look for tube blockages. Post-ejaculation urinalyses determine whether retrograde ejaculation is occurring.

The results of these tests will help you and your doctor decide what treatment path you’ll take.

How do you treat male factor infertility?

There are several treatment options available to people dealing with male factor infertility. Your reproductive urologist will make recommendations and help you through your treatment.


Depending on your case, one option may be surgery. Surgical procedures can:

  • Correct varicocele
  • Reverse a prior vasectomy
  • Retrieve sperm directly from the testicles using various sperm retrieval techniques

Hormone treatments

If the problem is hormonal, you might undergo hormone treatments. Hormone therapy or hormone medications can correct imbalances by restoring hormones to normal levels, which can improve fertility.

Assisted reproductive technologies (ART)

If other treatment options aren’t working, your doctor might recommend that you and your partner try assisted reproductive technologies (ART). In this case, your reproductive urologist will coordinate closely with a reproductive endocrinologist (REI), a female infertility specialist. ART treatments include:

  • Intrauterine insemination (IUI): sperm are injected directly into the uterus
  • In vitro fertilization (IVF): sperm are combined with eggs, and an embryo is then transferred to the uterus
  • Intracytoplasmic sperm injection (ICSI): a single sperm is injected directly into an egg, and the embryo is then transferred to the uterus

Assisted reproductive technology can be highly successful in treating male factor infertility, with some sources saying 90% of all infertile males have the potential to conceive their own child.

The bottom line

Our society tends to think that women’s bodies are always to blame for infertility, but this is not the case. Anyone can experience infertility — men, women, trans men, trans women, and non-binary people alike. This is why it’s so important that you and your partner get tested for infertility if you’re having trouble getting pregnant. You’re in this together.

Thinking more largely, blame and guilt have no place in the conversation around infertility. Infertility is no one’s “fault,” it’s just something that can happen to people, and it’s often out of our control.

If you’re having trouble trying to conceive, the first step for anyone, men included, is to see a doctor. With treatment, you and your partner can increase your chances for a successful pregnancy.


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