What Causes Male Factor Infertility? A Complete Guide to Sperm Health, Testing, and Next Steps
Written by: Dr. Susan Fox, DACM, L.Ac., FABORM
Credentials: Fertility Coach, Founder of Health Youniversity
Reviewed/Updated: June 2026
Reading Time: 16 min read
Medical disclaimer: This article is educational and does not replace medical advice from your reproductive endocrinologist, OB-GYN, maternal-fetal medicine specialist, urologist, dietitian, mental health professional, or licensed healthcare provider.
Key Takeaways
Male factor infertility means sperm production, sperm movement, sperm shape, semen delivery, hormones, anatomy, genetics, or sexual function may be contributing to difficulty conceiving.
Male factor infertility can involve low sperm count, poor sperm motility, abnormal morphology, varicocele, blockages, ejaculation problems, hormone issues, infections, genetic factors, lifestyle factors, or unexplained causes.
WHO states that male reproductive infertility is most commonly caused by problems with semen ejection, absent or low sperm levels, or abnormal sperm shape and movement.
AUA/ASRM guidance recommends that male and female partners be evaluated in parallel during infertility evaluation, rather than testing only one partner first.
Semen analysis is usually the first test for male factor infertility, but results should be interpreted with medical history, physical exam, hormones, genetics, lifestyle, and partner factors.
Health Youniversity’s whole-body fertility approach connects sperm health to the same four pillars used across fertility preparation: Nutrition, Circulation, Lifestyle, and Emotional Support.
Quick Answer
Male factor infertility is infertility related to sperm count, sperm movement, sperm shape, semen delivery, hormone function, reproductive anatomy, genetics, sexual function, or overall male reproductive health. Common causes include low sperm count, poor motility, abnormal morphology, varicocele, blockages, ejaculation problems, infections, hormonal disorders, genetic conditions, heat exposure, smoking, alcohol, certain medications, and unexplained sperm issues. The first step is usually semen analysis, followed by a reproductive history, physical exam, and additional testing when needed.
Introduction
When a couple has trouble getting pregnant, the focus often falls first on the person carrying the pregnancy.
But fertility is not one-sided.
Sperm health matters for natural conception, IUI, IVF, fertilization, embryo development, and sometimes pregnancy loss. If sperm is part of the plan, male factor infertility should be evaluated early—not after months or years of female-focused testing.
The Health Youniversity infertility pillar already frames infertility as involving female factors, male factors, both partners, or unexplained causes. This supporting article goes deeper into the male side: what causes male factor infertility, what semen analysis can show, what tests may be needed, what treatments may help, and how whole-body fertility preparation can support sperm health.
Who Is This Guide For?
This guide is for you if:
You and your partner have been trying to conceive without success.
A semen analysis showed low sperm count, low motility, abnormal morphology, or low semen volume.
You are preparing for IUI, IVF, or IVF with ICSI.
You have a history of varicocele, infection, testicular injury, surgery, cancer treatment, anabolic steroid use, or testosterone therapy.
You have ejaculation problems, erectile dysfunction, low libido, or pain.
You have experienced recurrent pregnancy loss and want to know whether sperm health should be evaluated.
You want to support sperm health before natural conception, IVF, or egg freezing with embryo creation later.
You want a whole-body fertility preparation plan that includes both partners.
What Is Male Factor Infertility?
Male factor infertility is difficulty achieving pregnancy due to sperm, semen, hormonal, genetic, anatomical, ejaculation, or sexual function factors in the male partner.
In practical terms, male factor infertility may mean:
Not enough sperm are produced.
Sperm do not move well.
Sperm shape may affect function.
Sperm cannot leave the reproductive tract properly.
Semen is not ejaculated normally.
Hormones are not supporting sperm production.
Genetic factors affect sperm development.
A medical condition, medication, infection, or lifestyle factor is interfering with fertility.
WHO defines infertility as a disease of the male or female reproductive system marked by failure to achieve pregnancy after 12 months or more of regular unprotected intercourse. WHO also notes that infertility may be due to male factors, female factors, both, or unexplained factors.
Male factor infertility does not mean a man can never have a child.
It means sperm health or semen delivery may need evaluation, treatment, support, or assisted reproductive technology.
What Male Factor Infertility Is Not
Male factor infertility is often misunderstood.
It is not:
A measure of masculinity
Always permanent
Always obvious from sexual function
Always caused by age or lifestyle
Always solved by supplements
Always treated only with IVF
Something that should be tested only after female testing is complete
A reason for shame or blame
Many people assume that if a man can ejaculate, sperm health must be fine.
The better way to understand it is this: ejaculation and sperm quality are not the same thing. A semen analysis can show sperm count, movement, shape, volume, and other details that cannot be guessed from sexual function alone.
Why Does Male Factor Infertility Matter?
Male factor infertility matters because it is common, often under-evaluated, and sometimes treatable.
AUA/ASRM guidance states that failure to conceive within 12 months is due in whole or in part to the male in approximately one-half of infertile couples. The guideline also emphasizes that male evaluation matters because it can identify treatable conditions, irreversible conditions that may still be managed with ART, genetic issues, lifestyle factors, and health conditions that need medical attention.
Here’s why that matters.
If sperm is not evaluated early, a couple may spend time and money pursuing female-focused testing or treatment while missing a correctable male factor. AUA/ASRM specifically recommends that evaluation proceed in parallel for both male and female partners to optimize treatment success.
The Health Youniversity infertility pillar makes the same strategic point: fertility evaluation should not focus only on the person carrying the pregnancy, and semen analysis should be requested early when sperm is involved.
How Does Male Factor Infertility Happen?
Male factor infertility can happen when sperm production, sperm transport, semen delivery, or sperm function is disrupted.
Area
What Can Go Wrong
Why It Matters
Sperm production
Too few sperm are made
Fewer sperm may reduce the chance of fertilization
Sperm motility
Sperm do not move well
Sperm need movement to reach and fertilize the egg
Sperm morphology
Sperm shape is abnormal
Shape may reflect sperm development or function concerns
Semen volume
Too little semen is ejaculated
May suggest blockage, ejaculation issue, or gland function concern
Sperm transport
Sperm are blocked from leaving
Sperm may be produced but not present in ejaculate
Hormones
Testosterone, FSH, LH, or prolactin issues
Hormones help regulate sperm production and sexual function
Genetics
Chromosomal or Y-chromosome issues
May affect sperm production and future offspring counseling
Sexual function
Erectile or ejaculation problems
Sperm may not reach the reproductive tract at the right time
Think of sperm health as a process, not one number.
A semen analysis is a starting point, but the cause behind an abnormal result often requires more context.
What Causes Male Factor Infertility?
1. Low Sperm Count
Low sperm count means there are fewer sperm in the semen than expected.
This is also called oligospermia. If no sperm are found in the ejaculate, it is called azoospermia.
Low sperm count can be related to:
Varicocele
Hormonal problems
Genetic conditions
Testicular injury
Prior infection
Heat exposure
Cancer treatment
Certain medications
Testosterone or anabolic steroid use
Lifestyle factors
Unknown causes
NICHD notes that a complete lack of sperm, called azoospermia, is the cause of infertility in about 15% of infertile men, and that hormone imbalance or blockage of sperm movement can cause it.
What to ask your provider:
“Is this low sperm count mild, moderate, or severe, and what could be causing it?”
2. Poor Sperm Motility
Poor sperm motility means sperm are not moving well enough.
Sperm need to move through cervical mucus, the uterus, and fallopian tube area to reach the egg during natural conception. Even during IUI or IVF, sperm movement can influence which treatment is recommended.
Poor motility may be associated with:
Varicocele
Oxidative stress
Infection or inflammation
Heat exposure
Smoking
Certain medications
Testicular dysfunction
Longer abstinence intervals
Unknown causes
WHO lists abnormal sperm movement, or motility, as one of the common male reproductive system causes of infertility.
What to ask your provider:
“Is motility low enough to affect natural conception or IUI, and would IVF with ICSI be considered?”
3. Abnormal Sperm Morphology
Abnormal sperm morphology means sperm shape is outside the expected reference range.
Morphology looks at sperm structure. It does not tell the whole fertility story by itself, but it may help guide treatment decisions when combined with sperm count, motility, semen volume, and clinical history.
Abnormal morphology may be linked with:
Sperm production issues
Varicocele
Heat exposure
Oxidative stress
Environmental exposures
Lifestyle factors
Genetic or testicular factors
Unknown causes
WHO identifies abnormal sperm shape, or morphology, as one of the common male reproductive system causes of infertility.
What to ask your provider:
“Is morphology the only abnormal result, or are count and motility also affected?”
4. Varicocele
A varicocele is an enlargement of veins in the scrotum that can affect sperm production and quality.
Mayo Clinic describes varicocele as the most common reversible cause of male infertility and notes that it can reduce sperm quantity and quality.
A varicocele may be associated with:
Low sperm count
Poor motility
Abnormal morphology
Testicular discomfort
Testicular size differences
Heat or blood flow changes in the testicle
AUA/ASRM guidance says surgical varicocelectomy should be considered in men attempting to conceive who have palpable varicocele, infertility, and abnormal semen parameters, except for azoospermic men.
What to ask your provider:
“Do I have a palpable varicocele, and could it be contributing to my semen analysis results?”
5. Ejaculation Problems
Ejaculation problems can prevent semen from reaching the reproductive tract effectively.
Possible ejaculation-related issues include:
Retrograde ejaculation
Delayed ejaculation
No ejaculation
Low semen volume
Ejaculatory duct obstruction
Medication-related ejaculation issues
Diabetes-related nerve changes
Spinal cord injury
Prior prostate, bladder, or urethral surgery
Mayo Clinic explains that retrograde ejaculation happens when semen enters the bladder during orgasm instead of exiting through the penis, and that causes can include diabetes, spinal injuries, medications, or surgery of the bladder, prostate, or urethra.
What to ask your provider:
“Could low semen volume or ejaculation changes suggest retrograde ejaculation or obstruction?”
6. Blockages in the Male Reproductive Tract
A blockage can prevent sperm from appearing in the ejaculate even if sperm are being produced.
Blockages may involve the epididymis, vas deferens, ejaculatory ducts, or other parts of the reproductive tract.
Possible causes include:
Prior infection
Prior surgery
Vasectomy
Congenital absence of the vas deferens
Ejaculatory duct obstruction
Scarring
Trauma
AUA/ASRM guidance notes that history, physical examination, semen parameters, and hormone studies can help differentiate obstructive azoospermia from non-obstructive azoospermia.
What to ask your provider:
“If no sperm are found, is this more likely a production problem or a blockage problem?”
7. Hormonal Problems
Hormonal problems can affect sperm production, libido, erections, and ejaculation.
Sperm production depends on communication between the brain, pituitary gland, and testicles.
Hormones such as FSH, LH, testosterone, and prolactin can be involved.
Hormonal causes may include:
Low testosterone
Pituitary disorders
Elevated prolactin
Thyroid issues
Hypogonadotropic hypogonadism
Testosterone therapy or anabolic steroid use
Obesity or metabolic issues
AUA/ASRM guidance states that endocrine evaluation with FSH and testosterone is not recommended as a primary first-line test for all men, but is indicated when oligospermia is present, especially below 10 million sperm/mL, and additional hormone testing may be indicated in certain testosterone or libido contexts.
What to ask your provider:
“Do my semen results or symptoms suggest hormone testing is needed?”
8. Infections and Inflammation
Infections can affect sperm production, sperm health, or sperm transport.
Mayo Clinic notes that some infections can interfere with sperm production or sperm health, or cause scarring that blocks sperm passage. Examples include epididymitis, orchitis, and some sexually transmitted infections.
Infection-related factors may include:
Epididymitis
Orchitis
Prostatitis
STIs such as gonorrhea or HIV
Prior untreated reproductive infection
Inflammatory semen findings
What to ask your provider:
“Do my history, symptoms, or semen analysis suggest infection or inflammation?”
9. Genetic or Chromosomal Factors
Genetic factors can affect sperm production and may matter for fertility treatment planning.
Genetic causes may include:
Klinefelter syndrome
Y-chromosome microdeletions
Congenital absence of the vas deferens
Cystic fibrosis gene-related concerns
Chromosomal rearrangements
AUA/ASRM guidance notes that Y-chromosome microdeletions are the second most common known genetic cause of male infertility, and men with severe oligospermia or azoospermia may need genetic evaluation depending on their results.
The 2024 AUA/ASRM update adds newer guidance, including revised thresholds for Y-chromosome microdeletion testing and indications for pelvic MRI in certain infertile males.
What to ask your provider:
“Do my sperm results suggest karyotype testing, Y-chromosome microdeletion testing, or genetic counseling?”
10. Heat Exposure and Testicular Environment
Sperm production is sensitive to the testicular environment, including heat.
Heat-related factors may include:
Frequent hot tub or sauna use
Tight heat-trapping clothing
Laptop heat exposure on the lap
Occupational heat exposure
Fever or illness
Varicocele-related temperature changes
Heat does not explain every sperm issue, but it can be a modifiable factor for some people.
What to ask your provider:
“Are there heat exposures I should reduce while trying to improve sperm parameters?”
11. Medications, Testosterone, and Medical Treatments
Some medications and treatments can affect sperm production or sexual function.
Potential contributors may include:
Testosterone therapy
Anabolic steroids
Chemotherapy
Radiation
Some blood pressure medications
Some antidepressants
Some prostate medications
Some pain medications
Prior pelvic or testicular surgery
Testosterone deserves special attention. Many people assume testosterone improves male fertility because it is associated with masculinity or libido. But external testosterone can suppress the body’s sperm production system and may significantly reduce sperm count.
What to ask your provider:
“Could any medication, supplement, hormone, or prior treatment be affecting sperm production?”
12. Lifestyle, Metabolic, and Environmental Factors
Lifestyle factors do not explain every case of male infertility, but they can influence sperm health and overall reproductive readiness.
WHO notes that lifestyle factors such as smoking, excessive alcohol intake, and obesity are associated with higher chances of infertility in both men and women.
Male fertility may be affected by:
Smoking
Vaping
Heavy alcohol use
Marijuana or recreational drugs
Poor sleep
Chronic stress
Obesity
Poor metabolic health
Environmental toxins
Workplace exposures
Poor nutrition
Sedentary lifestyle
The goal is not to blame lifestyle.
The goal is to identify high-impact, modifiable factors while also getting the right medical evaluation.
What to ask your provider:
“Which lifestyle factors are most likely to matter for my semen results, and what changes should I prioritize?”
13. Idiopathic or Unexplained Male Infertility
Idiopathic male infertility means semen results are abnormal, but the cause is not clearly identified.
This can be frustrating, but it is not uncommon.
The cause may involve subtle issues in sperm production, oxidative stress, DNA integrity, genetics, environmental exposure, endocrine function, or testicular biology that standard testing does not fully explain.
AUA/ASRM notes that the causes of male infertility, including genetic causes, are still not fully explained and that diagnostic and treatment options continue to evolve.
What to ask your provider:
“What has been ruled out, what is still unknown, and what next step is most reasonable?”
Male Factor Infertility Causes by Category
Category
What It Affects
Examples
Sperm production
How many sperm are made
Low sperm count, azoospermia, testicular dysfunction
Sperm function
How sperm move or fertilize
Poor motility, abnormal morphology
Anatomy/transport
Whether sperm can exit properly
Blockage, absent vas deferens, ejaculatory duct obstruction
Vein/blood flow factors
Testicular environment
Varicocele
Hormones
Signals for sperm production
Low testosterone, FSH/LH issues, prolactin concerns
Infection/inflammation
Sperm health or passage
Epididymitis, orchitis, STIs
Genetics
Sperm production and offspring counseling
Klinefelter syndrome, Y-chromosome microdeletions
Sexual/ejaculatory function
Semen delivery
Erectile dysfunction, retrograde ejaculation, low semen volume
Lifestyle/environment
Whole-body sperm health
Smoking, alcohol, heat, toxins, obesity, sleep
Idiopathic
No clear cause found
Abnormal semen analysis with unclear reason
What Does a Semen Analysis Show?
A semen analysis is usually the first test for male factor infertility.
Semen Analysis Measure
What It Means
Why It Matters
Semen volume
Amount of fluid ejaculated
Low volume may suggest collection issue, obstruction, or ejaculation concern
Sperm concentration
Number of sperm per milliliter
Low concentration may reduce chances of fertilization
Total sperm count
Total sperm in the sample
Helps assess overall sperm availability
Motility
Percentage of sperm moving
Sperm need movement for natural conception and IUI
Progressive motility
Sperm moving forward effectively
Often more useful than movement alone
Morphology
Sperm shape
May reflect sperm development or functional concerns
pH and liquefaction
Semen environment
Abnormal findings may suggest gland or infection issues
White blood cells, if reported
Possible inflammation
May lead to infection or inflammation evaluation
AUA/ASRM guidance emphasizes that multiple significant abnormalities in semen parameters increase the relative risk of infertility and that semen results should be interpreted in clinical context.
One abnormal semen analysis does not always define the whole picture.
Many clinicians repeat semen analysis because sperm parameters can vary based on illness, abstinence interval, collection issues, heat exposure, medications, and timing.
Male Factor Infertility vs. Female Factor vs. Combined Factors
Type
What It Means
What to Ask
Male factor infertility
Sperm count, movement, shape, semen delivery, hormones, anatomy, or genetics may be involved
“Has semen analysis been done, and should a reproductive urologist review it?”
Female factor infertility
Ovulation, fallopian tubes, uterus, ovarian reserve, hormones, or pelvic factors may be involved
“Are we checking ovulation, tubes, uterus, ovarian reserve, and relevant hormones?”
Combined factor infertility
Both partners have contributing factors
“How do these factors interact, and what should we address first?”
Unexplained infertility
Standard testing has not identified a clear cause
“What has been ruled out, and what are the next reasonable options?”
Health Youniversity’s infertility pillar uses this same structure to show that infertility should not be reduced to one partner or one lab result.
When Should Men Get Fertility Testing?
Men should be evaluated when a couple meets infertility criteria or when there are known male risk factors.
Situation
Recommended Action
Couple has tried for 12 months without pregnancy
Begin fertility evaluation, including semen analysis
Female partner is 35 or older and trying for 6 months
Begin evaluation sooner, including semen analysis
Female partner is over 40
Consider immediate evaluation
Prior abnormal semen analysis
Repeat and review with a clinician
History of testicular injury, surgery, or cancer treatment
Seek evaluation sooner
Varicocele or testicular pain/swelling
Consider reproductive urology evaluation
Ejaculation problems or erectile dysfunction
Seek evaluation sooner
History of testosterone or anabolic steroid use
Seek evaluation sooner
Recurrent pregnancy loss
Ask whether male evaluation, genetic testing, or sperm DNA fragmentation testing is appropriate
Preparing for IVF or IUI
Complete semen analysis before treatment planning
AUA/ASRM recommends that male and female partners receive concurrent evaluation during infertility assessment, and the initial male evaluation should include reproductive history and semen analysis.
What Tests Help Diagnose Male Factor Infertility?
Testing should be individualized.
Test or Evaluation
What It Helps Assess
Reproductive history
Prior fertility, timing, surgeries, medications, exposures
Physical exam
Testicle size, varicocele, vas deferens, anatomy
Semen analysis
Count, motility, morphology, volume, semen quality
Repeat semen analysis
Confirms whether abnormal results persist
FSH and testosterone
Hormone context when sperm concentration is low
LH and prolactin
Additional endocrine context when indicated
Genetic testing
Karyotype or Y-chromosome microdeletion testing in select severe cases
Scrotal ultrasound
Sometimes used for testicular or varicocele concerns
Post-ejaculatory urine test
May help assess retrograde ejaculation
Pelvic MRI
May be considered in select suspected obstruction cases based on updated guidance
Sperm DNA fragmentation
May be considered in select cases, including recurrent pregnancy loss discussions
The 2024 AUA/ASRM update specifically notes new guidance around Y-chromosome microdeletion testing thresholds, pelvic MRI indications, and testicular sperm use in certain nonazoospermic males.
How Is Male Factor Infertility Treated?
Treatment depends on the cause, severity, semen results, partner factors, age, timeline, and goals.
Treatment Option
What It May Help With
Key Consideration
Lifestyle and whole-body support
Modifiable sperm health factors
Helpful, but not a cure for every cause
Medication changes
Medication-related sperm or ejaculation issues
Never stop prescribed medication without medical guidance
Hormonal treatment
Specific endocrine causes
Requires specialist evaluation
Infection treatment
Infection or inflammation
Depends on diagnosis
Varicocele repair
Palpable varicocele with abnormal semen parameters
May help select patients
Surgery for obstruction
Blockage or ejaculatory duct obstruction
Depends on anatomy and diagnosis
IUI
Mild male factor infertility
Requires enough motile sperm after preparation
IVF with ICSI
Severe sperm count/motility/morphology issues
One sperm can be injected into one egg
Sperm retrieval
Azoospermia or severe sperm transport issues
May be paired with IVF/ICSI
Donor sperm
Severe or untreatable sperm factors
Requires medical, emotional, and legal counseling
The IVF pillar page notes that IVF with ICSI may be recommended when sperm needs to be injected directly into an egg, especially in male factor situations.
A good male fertility plan should answer: “What is the cause, what can be corrected, what needs ART, and what is the fastest responsible path forward?”
Can Lifestyle Changes Improve Male Factor Infertility?
Lifestyle changes can support sperm health, but they cannot fix every cause of male infertility.
Lifestyle support may help with:
Oxidative stress
Inflammation
Metabolic health
Sleep quality
Hormone balance
Heat exposure
Toxic exposure
General reproductive health
But lifestyle changes cannot always reverse azoospermia, genetic causes, severe obstruction, major testicular damage, or every case of varicocele-related infertility.
Health Youniversity’s Preconception Plan emphasizes that fertility is not only about diagnosis, labs, stress levels, weight, or food. It includes nutrition, hydration, supplementation, circulation to reproductive organs, low toxic burden, and emotional mindset.
The goal is not to replace medical care.
The goal is to support sperm health while getting the right evaluation and treatment.
The Health Youniversity Four-Pillar Framework for Sperm Health
Health Youniversity’s fertility method centers on four pillars: Nutrition, Circulation, Lifestyle, and Emotional Support.
1. Nutrition
Nutrition supports whole-body fertility by helping regulate inflammation, metabolic health, hormone balance, and cellular health.
For sperm health, this may mean focusing on:
Protein
Colorful plants
Healthy fats
Fiber-rich carbohydrates
Hydration
Provider-approved supplementation
Blood sugar stability
This does not mean chasing a perfect fertility diet.
It means giving the body consistent support for sperm production and reproductive health.
2. Circulation
Circulation matters because the reproductive organs need healthy blood flow and a supportive environment.
For male fertility, circulation support may include:
Walking
Strength training, if appropriate
Gentle movement
Avoiding prolonged sitting
Supporting metabolic health
Evaluating varicocele when present
The goal is not extreme exercise.
The goal is steady movement that supports whole-body and reproductive health.
3. Lifestyle
Lifestyle is especially important for sperm because sperm production is sensitive to heat, toxins, medications, sleep, inflammation, and metabolic health.
Lifestyle support may include:
Stop smoking or vaping.
Reduce or avoid recreational drugs.
Limit heavy alcohol use.
Avoid anabolic steroids and testosterone unless medically directed.
Reduce frequent hot tub or sauna exposure.
Review medications with a clinician.
Improve sleep.
Reduce avoidable environmental toxins.
4. Emotional Support
Male factor infertility can carry shame, silence, frustration, and pressure.
Emotional support may include:
Honest partner conversations
Therapy or coaching
Support groups
Stress regulation tools
Mind-body practices
Clear medical education
Reframing infertility as a shared health issue, not a personal failure
Support should not be reserved only for the person carrying the pregnancy.
If sperm is part of the fertility journey, emotional support belongs here too.
How to Get Started With Male Factor Infertility Testing
Step 1: Do Not Wait Until All Female Testing Is Complete
Start male and female evaluation in parallel when infertility criteria are met.
This matters because sperm issues can affect natural conception, IUI, IVF planning, and embryo development.
Practical tip: Ask for semen analysis early in the infertility workup.
Step 2: Schedule a Semen Analysis
A semen analysis is usually the first test.
Follow the lab’s instructions carefully, including abstinence timing, collection method, transport timing, and whether the full sample was collected.
Practical tip: If the result is abnormal, ask whether and when it should be repeated.
Step 3: Gather a Male Fertility History
Prepare a simple history before the appointment.
Include:
Prior pregnancies with any partner
Prior semen analysis results
Childhood surgeries
Testicular injury or torsion
Varicocele history
Cancer treatment
Infection or STI history
Medications and supplements
Testosterone or anabolic steroid use
Heat exposure
Smoking, alcohol, or drug use
Sexual or ejaculation concerns
Practical tip: Bring medication and supplement names, doses, and duration.
Step 3: Gather a Male Fertility History
Prepare a simple history before the appointment.
Include:
Prior pregnancies with any partner
Prior semen analysis results
Childhood surgeries
Testicular injury or torsion
Varicocele history
Cancer treatment
Infection or STI history
Medications and supplements
Testosterone or anabolic steroid use
Heat exposure
Smoking, alcohol, or drug use
Sexual or ejaculation concerns
Practical tip: Bring medication and supplement names, doses, and duration.
Step 4: Ask Whether a Reproductive Urologist Is Needed
A reproductive urologist specializes in male fertility.
This may be especially helpful for:
Severe low sperm count
Azoospermia
Varicocele
Hormone concerns
Ejaculation problems
Prior surgery or injury
Suspected obstruction
Genetic testing questions
Recurrent abnormal semen analyses
Practical tip: Ask, “Would a reproductive urologist change our plan?”
Step 5: Review Lifestyle and Medication Factors
Ask your clinician what is worth changing now.
Focus first on high-impact factors:
Smoking
Vaping
Marijuana or recreational drugs
Heavy alcohol
Testosterone or anabolic steroids
Heat exposure
Poor sleep
Unreviewed medications
Environmental or occupational exposures
Practical tip: Do not stop prescription medication on your own. Ask what can be safely changed.
Step 6: Build a Whole-Body Fertility Support Plan
Support sperm health while testing is underway.
Start with:
Consistent meals
Protein and fiber
Hydration
Sleep rhythm
Movement
Lower toxin exposure
Emotional support
Medical follow-up
Practical tip: Think in 2–3 month windows. Sperm development takes time, so changes often need consistency.
Common Mistakes to Avoid
1. Assuming Fertility Is Mostly a Female Issue
Male factors can contribute significantly to infertility.
Better approach: Test both partners early when sperm is part of the plan.
2. Delaying Semen Analysis
Some couples spend months on cycle tracking, supplements, and female testing before semen analysis.
Better approach: Ask for semen analysis at the beginning of evaluation.
3. Thinking One Semen Analysis Explains Everything
Semen results can vary.
Better approach: Repeat testing when recommended and interpret results with history, exam, and partner factors.
4. Ignoring Varicocele
Varicocele can be treatable in some cases.
Better approach: Ask whether a reproductive urologist should evaluate it, especially with abnormal semen parameters.
5. Using Testosterone Without Fertility Guidance
External testosterone can suppress sperm production.
Better approach: Tell your clinician about testosterone, anabolic steroids, or hormone therapies before fertility treatment.
6. Treating Supplements as the Whole Plan
Supplements are not a substitute for diagnosis.
Better approach: Review supplements with a clinician and focus on the cause of abnormal semen results.
7. Overlooking Emotional Impact
Male factor infertility can feel isolating and identity-challenging.
Better approach: Treat emotional support as part of care, not an afterthought.
Tools and Resources That Can Help
Semen Analysis Tracker
Use this to track semen volume, count, concentration, motility, progressive motility, morphology, pH, and notes from each test.
Male Fertility History Checklist
Prepare history around medications, surgeries, infections, heat exposure, testosterone, injury, prior pregnancies, and lifestyle.
Reproductive Urology Referral
Helpful when semen results are severely abnormal, repeated, unexplained, or linked with varicocele, obstruction, hormones, or genetic concerns.
Lifestyle and Exposure Checklist
Track smoking, vaping, alcohol, recreational drugs, hot tubs, medications, supplements, occupational exposures, and sleep.
Fertility Assessment Quiz
Use this as a first step to identify where you may need more support in the fertility journey.
Health Youniversity Preconception Plan
Health Youniversity’s Preconception Plan supports fertility preparation through nutrition, acupoint stimulation, guided imagery, qigong, recipes, sample menus, and individualized support for people preparing for natural conception, IVF, or egg freezing.
Reference Links
WHO: Infertility Fact Sheet — infertility definition, prevalence, and male reproductive system causes, including semen ejection, sperm levels, morphology, and motility. https://www.who.int/news-room/fact-sheets/detail/infertility
WHO: Infertility Health Topic — infertility overview, male/female/unexplained factors, and lifestyle associations. https://www.who.int/health-topics/infertility
AUA/ASRM: Diagnosis and Treatment of Infertility in Men, Part I — male infertility evaluation goals, reproductive history, semen analysis, hormone testing context, and parallel evaluation. https://www.asrm.org/practice-guidance/practice-committee-documents/diagnosis-and-treatment-of-infertility-in-men-auaasrm-guideline-part-i-2020/
AUA/ASRM: Diagnosis and Treatment of Infertility in Men, Part II — male factor contribution to infertility, treatment considerations, and varicocele guidance. https://www.asrm.org/practice-guidance/practice-committee-documents/diagnosis-and-treatment-of-infertility-in-men-auaasrm-guideline-part-i-2020/
AUA: Diagnosis and Treatment of Infertility in Men Guideline, Published 2020; Amended 2024 — updated male infertility guideline, genetic testing discussion, and guideline resources. https://www.auanet.org/guidelines-and-quality/guidelines/male-infertility
PubMed: Updates to Male Infertility: AUA/ASRM Guideline (2024) — 2024 update covering Y-chromosome microdeletion testing, pelvic MRI indications, and testicular sperm guidance. https://pubmed.ncbi.nlm.nih.gov/39145501/
AUA Press Release: 2024 Male Infertility Guideline Amendment — summary of updated evaluation and management guidance for the male partner in an infertile couple. https://www.auanet.org/about-us/media-center/press-center/american-urological-association-releases-male-infertility-guideline-amendment
Mayo Clinic: Male Infertility Symptoms and Causes — varicocele, infection, ejaculation problems, sperm antibodies, and common causes. https://www.mayoclinic.org/health/male-infertility/DS01038
NICHD: Possible Causes of Male Infertility — testicular function, hormone imbalance, blockages, azoospermia, and male contribution to infertility. https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/causes/causes-male
Health Youniversity Infertility — parent pillar article for infertility causes, diagnosis, testing, male factor infertility, and whole-body support.
Health Youniversity Preconception Plan — Four Pillars of Fertility: Nutrition, Circulation, Lifestyle, and Emotional Support.
FAQ
What is male factor infertility?
Male factor infertility means sperm count, sperm movement, sperm shape, semen delivery, hormones, anatomy, genetics, or sexual function may be contributing to difficulty conceiving. It can be the only factor, one of several factors, or part of unexplained infertility.
What is the most common cause of male infertility?
Common causes include low sperm count, poor motility, abnormal morphology, varicocele, ejaculation problems, blockages, infections, hormone problems, genetic factors, and lifestyle factors. WHO states that male reproductive infertility is most commonly caused by problems in semen ejection, absent or low sperm levels, or abnormal sperm shape and movement.
How is male infertility diagnosed?
Male infertility is usually diagnosed with reproductive history, semen analysis, and sometimes physical exam, hormone testing, genetic testing, imaging, or specialized sperm testing. AUA/ASRM recommends that the initial male evaluation include reproductive history and semen analysis.
Can a man have normal erections and still have male factor infertility?
Yes. Erections and sperm quality are different. A man can have normal sexual function and still have low sperm count, poor motility, abnormal morphology, or other semen abnormalities.
What does low sperm count mean?
Low sperm count means there are fewer sperm in the semen than expected. The cause may involve sperm production, hormones, varicocele, genetics, heat exposure, medications, prior infection, obstruction, or unknown factors.
Can varicocele cause infertility?
Yes. Varicocele can reduce sperm quantity and quality and is described by Mayo Clinic as the most common reversible cause of male infertility.
Can testosterone cause infertility?
Yes. External testosterone can suppress the hormonal signals needed for sperm production. Anyone trying to conceive should tell their clinician about testosterone therapy, anabolic steroid use, or hormone supplements.
Can lifestyle changes improve sperm health?
Lifestyle changes may help support sperm health, especially when smoking, heavy alcohol use, heat exposure, poor sleep, obesity, or toxin exposure are present. However, lifestyle changes cannot fix every cause, such as genetic factors, severe obstruction, or some forms of azoospermia.
Does male factor infertility always require IVF?
No. Treatment depends on the cause and severity. Some cases may be managed with lifestyle changes, medication changes, hormone treatment, varicocele repair, infection treatment, IUI, IVF with ICSI, sperm retrieval, or donor sperm.
When should a man see a fertility specialist?
A man should seek evaluation when a couple has been trying for 12 months without pregnancy, sooner if the female partner is 35 or older, or immediately if there are known male risk factors such as prior abnormal semen analysis, varicocele, testicular injury, cancer treatment, testosterone use, ejaculation problems, or prior reproductive surgery.
Conclusion
Male factor infertility is not rare, and it should not be an afterthought.
It can involve sperm count, motility, morphology, varicocele, ejaculation, blockages, hormones, infections, genetics, lifestyle, or unexplained factors. But the next step is not blame. The next step is information.
When semen analysis and male fertility evaluation happen early, couples can avoid wasted time, choose more appropriate treatment, and build a fertility plan that supports both partners.
If you are navigating infertility, preparing for IVF, trying naturally, or considering future fertility options, Health Youniversity’s Preconception Plan can help support your whole fertility foundation with nutrition, circulation, lifestyle guidance, and emotional care.
Take the Fertility Quiz, explore the Preconception Plan, or schedule a Fertility Assessment Call with Health Youniversity.
About The Author
Dr. Susan Fox
DACM, L.Ac., FABORM
Fertility Coach/Expert, Founder of Health Youniversity
Dr. Susan Fox, DACM, L.Ac., FABORM, is a fertility coach, Doctor of Acupuncture and Chinese Medicine, and Founder of Health Youniversity. She has 24 years of experience supporting women ages 30–45 navigating natural conception, IVF, IUI, PCOS, endometriosis, diminished ovarian reserve, and unexplained infertility. Her work blends Traditional Chinese Medicine, Functional Medicine, fertility education, nutrition, circulation support, lifestyle medicine, and emotional well-being to help women prepare their bodies for conception and pregnancy.
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