Male fertility
Infertility is often viewed as a women’s health issue and male factors are typically overlooked.1 However, male infertility is an important global health issue,2 with research showing that male factors contribute in up to half of infertility cases.2,3 Therefore, men’s health is a key part of the fertility journey. Male infertility may be categorised as primary, meaning the individual has not yet fathered any children, or it may be categorised as secondary infertility, meaning the individual has fathered children previously, but is struggling to conceive again.4
Male infertility is characterised by the inability to produce sperm, or by abnormalities in sperm count, movement, or shape,5 and is driven by a range of factors that affect sperm health.2 These include, age, lifestyle habits, genetic predispositions, hormonal imbalances, underlying urological disorders, and environmental influences.2
Fortunately, many of these factors can be identified and, in some cases, improved with the right support and guidance. Whether you are planning for a family in the future or have already started trying to conceive, understanding male fertility can help you take informed, proactive steps towards parenthood.
What affects sperm health
It is important to identify the contributing factors to male infertility, and how they interplay so that you are able to take the necessary steps towards understanding how to improve your sperm health.2
Age
Advancing paternal age is associated with declining sperm health. As paternal age increases, sperm quality gradually decreases. This is primarily driven by DNA damage and a greater likelihood of new genetic changes.2
Genetic factors
Genetic factors account for around 15% of male infertility cases.5
The leading cause for testicular failure to produce sperm is due to a chromosomal abnormality called Klinefelter syndrome. It’s where a male who would chromosomally be XY, is born with an additional “X” chromosome.2 There are also genetic defects known as “Y chromosome microdeletions” that directly impact the genes responsible for the development of mature sperm cells. This can cause low or absent sperm counts.2
Although genetics can contribute to fertility problems, current testing methods can only identify a genetic cause in only around one in five men who undergo a fertility assessment. In many cases, the exact reason for infertility remains unknown, even after thorough investigation.5
Lifestyle habits
Weight
Diet
Conversely, men who had diets high in fruits, vegetables, and legumes had better sperm health that those who didn’t have diets rich in those items.6 Additionally, sperm count has been shown to be higher in those who consume whole grains, legumes, vegetables, fruit, chicken and fish versus those who consume a predominantly western diet of processed meats and snacks. Therefore, diet plays an important role in semen quality.6
Smoking and alcohol
Alcohol consumption has been associated with reduced testosterone production and evidence suggests that semen quality tends to decline as alcohol intake increases. Therefore, drinking more alcohol may have a greater effect on fertility.6
Stress
Typical psychological stress can impact testosterone production, which as a result has a detrimental effect on normal sperm production. It has been shown that men with higher levels of depression and anxiety had significantly lower sperm counts than those who had normal depression and anxiety scores.6
Medical conditions
There are a number of different medical conditions that affect the urinary or male reproductive system that have been shown to affect male fertility. These conditions may impact sperm production, obstruct sperm transport, or interfere with insemination.2
One in five men have a condition called varicocele, an enlargement of the network of veins found in the scrotum. It is the leading, treatable cause of male infertility, occurring in up to 40% of cases of primary infertility, and 80% of those with secondary infertility.2 The condition can cause testicular heat stress that impairs sperm development and DNA integrity. Fortunately, once treated, semen quality significantly increases and can improve subsequent pregnancy rates.2
In up to 15% of male infertility cases characterised by the absence of motile, viable sperm, there is usually a biological obstruction that physically blocks sperm from being released into ejaculate.2 In these cases, sperm production, quality and motility is normal, therefore it may be possible for patients to receive reconstruction surgery to return sperm to the ejaculate. However, if this approach is not feasible, a treatment called Intracytoplasmic Sperm Injection (ICSI) can be used to help couples achieve a pregnancy using retrieved sperm.2
What does male fertility testing look like?
As male infertility is multifactorial, diagnosing infertility problems involves a variety of different tests, but the approach should be individualised to the patient.1,7
In the first instance, tests will involve:7
- A general physical examination, including genital examination to check for any obvious signs of injury or underlying medical conditions.
- A detailed medical history to identify if there are any inherited conditions, chronic conditions, illnesses, or previous surgeries that may affect your fertility. Your healthcare provider may ask intimate questions such as, “at what age did you start puberty?” and “Have you had any sexual problems in this relationship, including difficulty maintaining an erection, ejaculating too soon or not being able to ejaculate?”. These may feel very personal, and intruding, but this is information that can help your healthcare provider determine what may be impacting your fertility.
- Semen analysis to examine your sperm count and quality, and look for any abnormalities, including any signs of infection.
Some people may not be comfortable providing a semen sample, but you can discuss the most appropriate method with your healthcare provider. A semen sample provides important information to your healthcare team regarding your sperm count, quality, motility and may help to indicate whether further testing may be required.
Further tests may involve:7
- An ultrasound of your scrotum or rectum
This can help identify varicocele, or any other structural abnormalities that may impact your fertility. - Post-ejaculation urinalysis
This is a simple urine test that looks to see if there are sperm present in the urine. If present, it could indicate that your sperm are travelling back into the bladder, which could affect the sperm count in your ejaculate. - Testicular biopsy – specialist procedure
In select circumstances, your healthcare provider may need to perform a specialist procedure which involves taking sperm samples directly from the testicles. If samples confirm normal sperm production, it indicates that there may an issue with sperm transport. - Genetic testing
Your healthcare provider may request genetic testing to identify any conditions caused by genetic abnormalities. - Hormone testing
Blood tests may be required to look into testosterone levels or any other possible hormonal irregularities.
Ongoing testosterone and anabolic steroid treatment
It is important to note that testosterone treatment is not a treatment for infertility, and testosterone therapy can markedly suppress sperm production. If you are using testosterone or anabolic steroids then tell your healthcare provider, as externally administered testosterone can reduce or stop sperm production.8
Is there anything I can do to help increase our chances of conceiving?
Lifestyle can have a huge impact on male fertility. Adopting good lifestyle habits can help support your fertility, even if you are undergoing additional testing.2
Regular exercise is beneficial to maintain a healthy weight and BMI, but it has also been shown to improve sperm count and motility.6
Eating a colourful diet rich in fruits, vegetables and legumes (such as lentils) can help support sperm quality. Additionally, eating foods that provide vitamin E, vitamin C, zinc, and antioxidants can all help support fertility and overall health. Supplementation can also be used to boost vitamin and antioxidant consumption to help support male fertility.6 Some vitamins and antioxidant supplements have been studied in male infertility, but evidence that they improve fertility or the chance of pregnancy is inconsistent. Speak to your healthcare professional before starting supplements.9
Limiting unhealthy habits, such as alcohol consumption and smoking can also contribute towards improving your fertility. In addition, managing stress and improving sleep quality and duration can support your overall wellbeing, and minimise the risk of making harmful lifestyle choices.6 Simple wellbeing practices such as yoga, massage therapy, counselling, and communicating with people you trust, can all help manage emotional stress and may help you feel better supported as you navigate your fertility journey.7
If you and your partner have been unsuccessful at trying to conceive, or you are concerned about your fertility, speak with your healthcare provider. They will be able to support you and provide further advice and information.