Because issues with fertility often only become clear once you’re trying to have a baby, there’s a misconception that infertility is primarily a problem for women and people who are able to get pregnant. However, infertility affects men and people who produce sperm just as much. Approximately 15% of heterosexual couples are unable to conceive within one year of trying, and this is due in whole or in part to male factor infertility in roughly half of those cases (1).

Unfortunately, there is reason to be concerned about male factor infertility today. Recently, researchers have been sounding the alarm about an accelerating incidence of male infertility. A meta-analysis of studies published in Human Reproduction Update in 2022 examined declining sperm counts around the world. They found that the average sperm count worldwide has declined by approximately 51% from 1973 to 2018. Additionally, the decrease in sperm count has gone from a 1.16% decrease each year in 1972 to a 2.74% decrease in 2020 (2).

If you suspect you or your partner are having an issue producing or delivering sperm, or have been diagnosed with male factor infertility, you’re not alone and there are steps you can take to address it.

6 Second Snapshot

• Male factor infertility occurs when there’s an issue with sperm quality or concentration.
• There’s an accelerating incidence of male factor infertility around the world.
• The most important thing you can do if you suspect that you have male factor infertility is to see your doctor to identify whether that’s the case and what the cause might be.
• A variety of treatment options are available to help you conceive, including surgical sperm removal and in vitro fertilization (IVF).

What is male factor infertility?

Male factor infertility occurs when there is an issue with sperm quality or concentration. These issues include:

• Azoospermia - no sperm in semen
• Oligospermia - low sperm concentration in the semen (<15 million sperm per milliliter)
• Sperm motility - how well the sperm swim
• Sperm morphology - the size, shape, and maturity of the sperm

Male factor infertility can also be caused by difficulty delivering sperm to the egg. Causes include erectile dysfunction, difficulty ejaculating, or structural problems that block the passage of semen.

If you are in a heterosexual relationship and have had unprotected intercourse for a year without conceiving, your reproductive endocrinologist will likely order tests for both you and your partner to determine the reason you’re experiencing infertility. Your RE may also make a referral to a urologist, a doctor that specializes in treating diseases of the male urinary and reproductive systems. Male factor infertility is diagnosed when semen analysis detects one or more or these issues in one of two sperm samples taken 1-4 weeks apart. To help determine the cause of infertility, your physician may order additional tests, such as ultrasounds, bloodwork to test your hormone levels, genetic tests, or a testicular biopsy.

What causes male factor infertility?

There’s a wide range of causes and risk factors for male factor infertility. Some risk factors only have a temporary effect on fertility, which is why clinicians often take sperm samples on different dates before diagnosing infertility.

Common causes of male factor infertility include:

• Varicocele - Enlarged veins (similar to varicose veins) inside the scrotum can affect sperm production. Varicoceles can cause some discomfort but often go undetected. About 40% of men tested for infertility have a varicocele. These are easily repaired by a urologist.
• Undescended testes - If undescended testes are fixed when the person is young, it does not impact fertility. However, if one or more testes remain undescended into adulthood, it can result in low sperm count (3).
• Genetic problems - Chromosomal abnormalities, such as occur with Klinefelter Syndrome or cystic fibrosis, can affect sperm quality and quantity (4).
• Previous or ongoing cancer treatment - Radiation and chemotherapy can affect sperm quality and quantity, sometimes temporarily and sometimes permanently.
• Vasectomy - Due to the high cost of assisted reproductive technologies, a vasectomy reversal could be an effective (5) and more cost-efficient option.

Common risk factors for male factor infertility include:

• Daily habits - Alcohol (6) and tobacco use (7), excessive caffeine intake, illicit drug use, frequent exposure of the testes to heat (saunas or hot tubs), exposure to pesticides, exposure to air pollution, and poor diet can all contribute to lowering sperm count (8).
• Medications - Antibiotics, anabolic steroids, medications to treat depression or high blood pressure.
• Recent illness - Having a fever can affect sperm count for several months (9).
• Infection - Sexually transmitted diseases, previous mumps infection, and infections of the genitals can cause scarring and blockages within the reproductive system (8).
• Injury - Trauma to the testes, such as twisted testes, can affect fertility.
• Age - Male fertility declines after about age 40 (10).
• Weight - Excess weight and obesity are related to low sperm count (11).
• Depression - May affect semen quality and quantity (12).

An infertility diagnosis can be a wake-up call for improving your health. Male factor infertility may indicate a variety of health problems both now and in the future, including cardiovascular disease, hypertension, diabetes, and autoimmune diseases (8). By taking steps to improve your fertility, you may also be taking critical steps toward improving your overall health.

What are my treatment options if I have male factor infertility?

Though it’s increasingly common to experience infertility, there’s still a social stigma around infertility that may prevent you from seeking and getting help. It may be helpful – and empowering – to know that in the majority of cases, there are assisted reproductive technologies available that can help you conceive.

Here are some methods your clinician may use to help you overcome infertility.

• Intrauterine Insemination (IUI) - If you have mild male factor infertility, your clinician can place sperm directly in your partner or surrogate’s uterus during ovulation. This is often the first line of treatment, and is less costly than IVF.
• In Vitro Fertilization (IVF) - During IVF, eggs and sperm are retrieved, combined in a laboratory to create an embryo or embryos, then implanted in the uterus. If you have a low sperm count, your clinician can place your sperm in a dish with the retrieved eggs to allow for fertilization. Your clinician may also choose to do ICSI (described below) to fertilize the eggs.
• Intracytoplasmic Sperm Injection (ICSI) - If you are producing sperm with poor motility or morphology, your clinician can select the best individual sperm in your sample to inject directly into the egg during the fertilization part of the IVF process.
• Surgical Sperm Retrieval - Your clinician may choose to extract sperm directly from the testicle. That sperm can then be used to fertilize the eggs during IVF.

If your infertility is caused by a structural issue, your doctor may recommend a surgical procedure to help restore healthy function in your testes.

Tips for improving sperm quality

The most important thing you can do if you suspect you are experiencing infertility is to consult with your physician or urologist to determine whether there is an issue and find out what might be causing it. However, there are some daily habits you can address to improve your sperm quality and quantity.

Because sperm take three months to grow and mature before they’re ready to be released through semen, healthy habits now can affect your sperm health later on. These include maintaining a healthy weight, avoiding toxins (such as pesticides, phthalates, and air pollution), improving your diet (13), and lowering or eliminating regular consumption of alcohol, caffeine, and tobacco.

If you are taking medications, talk to your medical provider about whether they may be affecting your sperm count or quality, and whether there are alternatives that are available to you.