Male infertility is common and accounts for nearly half of all infertility cases. Understanding the signs of infertility in men is an important step toward identifying potential issues and getting the right support.
While infertility doesn’t always cause obvious symptoms, there are physical and hormonal changes that can hint at an underlying problem—from reduced sexual function and testicular discomfort to changes in hair growth or muscle mass.
This guide explains the most common indicators of male infertility, what may cause them, and when it’s time to consult a fertility specialist.
Male infertility is a common medical condition that occurs when a man’s reproductive system has issues that affect sperm production, function, or delivery, making conception difficult or impossible without assistance.
According to the World Health Organization (WHO), infertility is diagnosed when pregnancy isn’t achieved after 12 months or more of regular, unprotected sexual intercourse. A formal evaluation and clinical testing are required to confirm male infertility, typically after ruling out fertility issues in the female partner.
Overall, infertility affects about one in six couples worldwide.
Male infertility doesn’t always present with clear symptoms. Many men only discover a fertility issue after months of trying to conceive. However, certain physical or hormonal changes can serve as warning signs that it’s time to get checked. Below are some of the most common signs of infertility in men and what they may indicate.
Difficulty ejaculating—or producing little to no semen—can indicate a problem with the tubes that carry sperm, low testosterone levels, or nerve damage. Some men experience retrograde ejaculation, where semen travels backward into the bladder instead of out through the penis. If ejaculation seems painful or unusually low in volume, it’s important to speak with a doctor for evaluation.
Erectile dysfunction (ED) or difficulty maintaining an erection can sometimes point to hormonal imbalances, blood flow problems, or stress, all of which can impact fertility. While not every case of ED means infertility, ongoing issues with sexual function can interfere with regular intercourse and reduce the chances of conception.
A noticeable drop in libido (sex drive) often stems from low testosterone or other hormonal irregularities. Chronic stress, fatigue, or certain medications can also lower sexual desire, which may signal an underlying fertility issue when paired with other symptoms.
Discomfort, swelling, or lumps in the scrotum are signs that shouldn’t be ignored. They may indicate a varicocele (enlarged veins), infection, cyst, or a tumor (in rare cases). These conditions can impair sperm production or quality and should be assessed promptly by a healthcare provider.
Men with hormonal imbalances may notice decreased facial or body hair, loss of muscle mass, fatigue, or gynecomastia (breast tissue growth). These changes often point to low testosterone or pituitary gland disorders.
An unusual loss or reduction in the sense of smell can sometimes be linked to Kallmann syndrome, a rare genetic condition that affects hormone production and sexual development. Though uncommon, it can serve as an early sign of infertility due to inadequate levels of reproductive hormones.
A low sperm count is defined as fewer than 15 million sperm per milliliter of semen, or a total count below 39 million per ejaculate. It is one of the most direct indicators of male infertility. Because sperm count and motility can’t be observed visually, this sign is typically confirmed through a comprehensive semen analysis performed in a fertility clinic.
The most common causes of male infertility are problems related to the ejection of semen, motility of the sperm, morphology, and low level or absence of sperm. Many biological and environmental factors can also impact fertility.
Certain inherited disorders can interfere with normal sperm development or hormone production.
Examples include Klinefelter syndrome (an extra X chromosome that affects testicular growth and sperm production), myotonic dystrophy, and Y-chromosome microdeletions, where small missing genetic segments disrupt sperm formation. These conditions often require specialized genetic testing for diagnosis.
A varicocele is an enlargement of the veins within the scrotum that carry blood away from the testicles. When these veins become dilated, blood flow slows and the temperature around the testes rises. This heat buildup can reduce sperm count, affect sperm shape, and impair motility.
Infections such as mumps, epididymitis, or sexually transmitted infections (STIs) can cause inflammation of the testicles or damage the structures involved in sperm production. Physical trauma to the groin or testicles can also lead to scarring or impaired function, sometimes resulting in permanent fertility issues.
Men with oligospermia produce fewer sperm than normal, or their sperm may be poorly formed or move ineffectively. These abnormalities can significantly reduce the chances of fertilization, even if ejaculation and hormone levels appear normal.
Sometimes, sperm are produced in adequate numbers but have structural defects, such as irregular heads or tails, that prevent them from swimming effectively or fertilizing an egg. This condition is often identified through a semen analysis and may be linked to genetic factors, toxins, or testicular injury.
Cryptorchidism occurs when one or both testicles fail to descend into the scrotum during infancy. Because the testes are exposed to higher body temperatures within the abdomen, sperm production may be permanently impaired if the condition isn’t corrected early in life.
The brain plays a key role in regulating sperm production through hormones released by the pituitary gland and hypothalamus. Disorders affecting these glands, such as hypogonadism or pituitary tumors, can lead to low testosterone levels or disrupted hormone signaling, resulting in reduced sperm output.
Chronic illnesses, as well as medical treatments like chemotherapy, radiation therapy, or testicular surgery, can interfere with sperm production and hormone balance. In some cases, these treatments may cause temporary infertility, but in others, the effects can be long-term or permanent.
Everyday habits can also affect male fertility. Heavy alcohol use, smoking, illicit drug use, and anabolic steroid consumption are all linked to lower sperm quality and testosterone suppression.
Men should be evaluated for infertility if they have not participated in a successful pregnancy after 12 months of timed intercourse. They should be evaluated sooner if there are infertility risks below:
Diagnosis begins with a complete physical examination to determine the general state of health and identify any physical problems that may impact fertility.
A comprehensive semen analysis is usually ordered by a physician, which includes:
Not all male infertility is permanent or untreatable. With advanced modern technology and methods, the number of treatment options for male infertility has expanded.
Hormone therapy can help to increase the number of sperm. Some may be required to self-administer hormone injections such as Pergonal or Humegon. A doctor can also refer a patient to a urologist who prescribes them with antibiotics to correct a transient sperm abnormality if diagnosed with an infection.
Avoid damaging environmental factors, such as smoking, heat exposure, heavy exercise, toxicants, certain drugs, or excessive alcohol. Reduce stress levels, and maintain healthy body weight by exercising and eating a healthy diet.
Male infertility isn't always preventable. However, here are some known practices that can support male fertility:
For additional information on male factor infertility, please reach out to us or your primary care physician.
The only way to confirm male infertility is through medical evaluation and testing. A fertility specialist typically begins with a semen analysis to assess sperm count, motility, and morphology. Blood tests may also be used to check hormone levels, and imaging can help identify physical issues such as varicoceles or blockages.
If your husband has been diagnosed with infertility, the next step is to identify the underlying cause. Many cases are treatable, especially when related to hormone imbalances, infections, or lifestyle factors. Encourage him to meet with a urologist or fertility specialist to discuss treatment options, which may include medication, surgery, or assisted reproductive technologies like IVF or ICSI.
Emotional support and open communication as a couple are also essential during this process.
In many cases, yes. Male infertility is often treatable once the cause is identified. Hormonal therapy can correct imbalances, while surgery can repair varicoceles or blocked sperm ducts. Lifestyle changes, such as maintaining a healthy weight, quitting smoking, and reducing alcohol intake, can also improve sperm quality.
Even when natural conception isn’t possible, advanced fertility treatments like IVF or sperm retrieval offer paths to fatherhood.
It’s rare, but possible. Some men may produce no sperm at all (a condition called azoospermia) due to genetic disorders, severe testicular damage, or congenital absence of the vas deferens. However, complete infertility is uncommon, and even men with very low sperm counts can often conceive with medical assistance.
A fertility specialist can help determine whether treatment or sperm retrieval techniques could still make conception possible.