What Causes Male Infertility?

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Infertility is the inability to produce healthy, fertile sex cells (sperm is made in the testis of males and egg cells in the ovary of females) and the inability to conceive after regular intercourse over twelve months or longer. In many cases where this is the case, couples may look towards fertility treatment options to help them conceive and start or grow their family. Infertility may be caused by hormonal changes, structural changes in the reproductive organs or cells, genetic defects, health problems, diseases or sexually transmitted infections.

Signs Of Infertility In Males 

Multiple signs and symptoms indicate infertility, but most of them could be associated with other diseases or issues. 

Decreased Sex Drive

Virility is the term used to indicate a man’s strength, his energy and his sex drive. A low virility level may indicate infertility, associated with a low sex drive and possible hormonal imbalances.

Ejaculation Issues

The inability to release semen from the body may indicate a problem with fertility and is a good indicator that it is time to see the doctor. There may be a physical explanation for this occurring or a psychological reason.

Scrotal or Testicular Swelling

Red and shiny testicles could be due to cysts, testicular torsion, varicocele (swollen veins in the testicles causing a lump), cancer or some trauma where the testicles got hurt or knocked. Infections such as mumps or epididymitis may also cause pain in the testicles.

Inability to Maintain an Erection

Erection problems are usually associated with hormonal levels, especially when there is a reduction in the hormone level. The physical aspect, stress, tiredness, too much alcohol and hormonal part of erectile problems will cause problems attempting to conceive.

Gonads: Small and Firm

The gonads, or testicles of a male, are where the sperm is stored. Hypogonadism could be the reason for smaller testicles since this condition is present or noted when the body of a male is not producing enough testosterone. Undescended gonads may also be the reason for smaller testicles in males.

Most Common Causes of Infertility in Males

Producing healthy sperm is imperative for fertilisation. Without healthy sperm, conceiving a child with your female partner will not be possible. Some problems encountered with sperm may be: non-swimming sperm (immobile), shaped abnormally, or the sperm has not matured.

Conditions that may cause these problems include inflammatory conditions or infections, pituitary gland or hormonal imbalances and issues, an autoimmune disease where antibodies are produced against your sperm, lifestyle factors like smoking, drug use, environmental toxin exposures or alcohol abuse, and genetic disorders.

A blockage may occur in the urethra of the male penis (this will block the sperm from exiting during ejaculation). Congenital disabilities, infections, inflammatory conditions or genetic defects can also cause blockages. Previous surgery may have left a scar that can also cause a blockage.

Erectile dysfunction and premature ejaculations can cause infertility problems as well. Treatment for diseases like kidney disease, liver disease or seizures may influence ejaculation and erections as well in a male.

Who Is At Risk of Developing Infertility?

Previous conditions, medications or infections may put you at risk of developing infertility as a male. Some of the initial conditions include: prostate infections, genital infections, torsion of the testicles, puberty that occurred early in life or late, testicles and genitals being exposed to reoccurring hot temperatures (hot shower, laptop heat, etc.), hernia repair or testicles that did not drop or descend. Various medications may also have a detrimental effect on male fertility. Medicines for depression, psoriasis, hypertension or stomach ulcers may cause infertility.

Tests and diagnosis

A physical examination would be the first test to assess if your vitals are normal and if the macroscopic structure of the reproductive organ is normal. After a physical exam, the doctor may request a few laboratory tests.

 Semen Analysis 

This is when the patient’s sperm is assessed for any abnormalities in the amount of sperm produced (the volume), the pH level of the sperm (how acidic it is) and how the consistency of the sperm (how uniform it looks). The motility of the sperm (how well they swim or move) and how they look structurally under a microscope (the morphology) will also be used to determine the cause of infertility.

Hormone Tests

Various blood tests may be performed to check the hormone level of the male. Testosterone and Follicle-stimulating hormone (FSH) are the two hormones usually the culprits if infertility is suspected. A high or low level of either of these hormones may cause issues with the production of semen or the inability to have intercourse. Other hormones, which are usually not tested but could be tested if everything else is normal, are prolactin, estradiol and luteinising hormone (LH).


Ultrasound may be used to determine any structural problems inside the reproductive organ or blockages.


After the semen analysis, a biopsy of the testicle might be taken. A biopsy will be done if the results indicate a very low to no sperm count during the semen analysis. A Histopathologist will then view this to determine the cause.

Male Infertility In A Nutshell

In summary, male infertility, characterised by difficulties producing healthy sperm or conceiving, can arise from hormonal, structural, genetic, and lifestyle factors. Signs may include a decreased sex drive, problems with ejaculation or erections, and abnormal testicles.

Certain pre-existing conditions or medicines can elevate this risk. Diagnosis typically involves a physical examination, lab tests including semen analysis and hormone tests, and possibly ultrasounds or biopsies. Understanding these aspects can promote early detection and more effective treatment, though professional healthcare advice remains paramount.

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