Male infertility makes up 30% of general infertility diagnosis and is caused by changes in the amount and quality of sperm produced. In many cases, treatment can be offered that improves the quality of sperm.

A couple is considered infertile when a woman cannot get pregnant after 12 months or more of regular unprotected sexual intercourse. Just because you are having difficulty conceiving after 12 months of trying, doesn’t mean you cannot have children naturally as getting pregnant can take longer for some couples.

Infertility has many causes. In 25% of cases, a cause cannot be identified. Causes in men include:

• Poor quality semen – this can be low sperm count or no sperm at all, sperm that don’t move properly so have difficulty reaching the egg and sperm that are abnormally shaped making it harder to fertilise an egg.
• Testicle problems – infections (like STIs), cancer, surgery, injury or undescended testicle can cause damage to the testicles which affects the quality of semen and sperm.
• Ejaculation problems – resulting in difficulty releasing semen during sex.
• Hypogonadism – this is the term for abnormally low levels of testosterone (the male sex hormone)
• Medicines and drugs – sulfasalazine, anabolic steroids, chemotherapy and some herbal remedies can reduce sperm production, count and mobility.
• Lifestyle factors – increasing age, being overweight, alcohol excess, smoking and stress can all affect fertility.

Men’s fertility analysis begins with examining medical history: it is important to know about the patient’s development, past diseases, genital injuries, duration of trying to conceive, medications, past surgeries, stress levels and history of smoking, alcohol consumption and illicit drug use. Genital defects can be determined during a physical examination.

Investigation of fertility problems in men will involve a blood test for hormones, semen analysis to assess the amount and quality of sperm and an ultrasound scan to look for problems in the testicles.

Treatment will depend on the cause but can include:

Medicines – There are medicines available for low testosterone levels and ejaculation problems or to treat infections causing infertility

Surgery – Surgery can be done to remove blockages to the release of sperm or to extract sperm if there is a structural problem

Assisted conception – Commonly known as IVF or IUI, or egg and sperm donation.

• IVF – is when an egg is fertilised outside of the body in a laboratory and then placed in the womb. Usually, fertility medicines are taken as part of this treatment.
• IUI – is when sperm are inserted into the womb artificially. The sperm are first collected and the best quality ones are selected.
• Egg and sperm donation – Either eggs, sperm or both can be donated and placed in to the womb using IVF.

It is important to consult a doctor as early as possible if problems are noticed in children or teenagers to improve fertility for later in life. It is beneficial to address lifestyle factors like smoking and drinking alcohol. There is a link between increased temperature of the scrotum and reduced semen quality but there is no strong evidence to suggest that wearing loose-fitting underwear will improve fertility.