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28 September 2020

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Understanding male infertility

Dr Hossam Elzeiny

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Dr Hossam Elzeiny

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Male infertility isn’t something we often talk about, so here’s what you need to know. 

At a glance:

  • 1/3 of couples who present with fertility concerns are predominantly due to the male
  • Major contributors are problems with sperm, obstructions to the passage of sperm, functional and hormonal issues
  • Even though you can’t ‘prevent’ male infertility, there’s plenty you can do to decrease the possibility of it affecting you or your partner
  • Male infertility is a sensitive subject, but there are ways you can support him and it’s worth working with a fertility expert who can guide you along the way

If you have a male partner and are thinking about starting a family together, it’s important to be aware of how male infertility could affect your journey to parenthood. It isn’t something we typically talk about – the truth is, most of the emphasis tends to be on women’s fertility challenges – but given that male fertility is a factor for a significant number of couples struggling with fertility, it’s well worth being aware of.

“A third of couples who present with infertility are due to male factor infertility;” explains reproductive endocrinologist and infertility specialist Dr Hossam Elzeiny. “Another third are due to female factor and another third are due to a combination of male and female or unexplained.”

The major contributors to male infertility can be divided into four groups:

  • Problems with sperm (including low sperm count)
  • Obstructions to the passage of sperm
  • Functional problems (like impotence)
  • Hormonal problems

In 40 per cent of male infertility cases the cause is unknown, but seeing a specialist can help identify any factors that are evident. So let’s explore those a little further.

Male infertility

Problems with sperm

It’s believed that issues with sperm numbers or quality are due to genetic problems. Sperm problems include azoospermia, where the semen doesn’t contain any sperm; oligospermia, where ejaculation doesn’t contain enough sperm for conception; abnormal shaped sperm, meaning it can’t penetrate the surface of the egg; or poor motility, meaning the sperm swim badly or not at all.

Obstructions to sperm’s passage

These are responsible for one in three male infertility cases, so to better understand it, here’s a very quick biology lesson about how sperm moves through a man’s body.

After they’re made in the testicles, sperm pass through a series of tubes called the epididymis – a process which takes two to 10 days – followed by a larger tube called the vas deferens, which empties the sperm into the ejaculatory duct. From there, it’s mixed with seminal fluid from the seminal vesicles and the prostate gland. During ejaculation, muscular contractions force it into the urethra and out of the penis.

A blockage or absence of any of these tubes (due to vasectomy or injury, for example) can cause fertility problems.

Functional issues

Here are some of the issues that fall under the umbrella of functional issues:

  • Impotence – being unable to initiate or maintain an erection for sexual intercourse
  • Ejaculation problems – including premature ejaculation and retrograde ejaculation, when semen enters the bladder during orgasm instead of the penis. Retrograde ejaculation can be caused by conditions like diabetes, as well as spinal injuries and medications
  • Testicle issues – injury, infection or chemotherapy can damage the testicles, or they might not have descended correctly when the man developed as a baby
  • Health conditions – having conditions like multiple sclerosis and diabetes can affect fertility
  • Antibodies – if immune system cells mistakenly identify sperm as harmful invaders, they can attempt to destroy them
  • Hormonal problems – where hormone production is affected, fertility can be compromised as a result


Even though you can’t ‘prevent’ male infertility, there’s plenty you can do to decrease the possibility of it affecting you. Here’s how: 

  • Stay in a healthy weight range - obesity can adversely affect sperm and cause hormonal changes that reduce fertility
  • Avoid high doses of radiation and X-rays
  • Stop smoking. Men who smoke may have a lower sperm count than those who don’t, and second-hand smoke can also adversely affect male fertility
  • Steer clear of tight-fitting underwear which causes heat stress to the testicles
  • Try not to take long, hot baths or use hot tubs and saunas frequently
  • Avoid anabolic steroids (taken for body building or sports)
  • Limit exposure to pesticides, heavy metals and other toxins
  • Keep your stress levels in check, as stress can interfere with hormones needed to produce sperm
  • Limit your alcohol intake. Alcohol can lower testosterone levels, cause erectile dysfunction and decrease sperm production
  • Steer clear of illicit drugs

Supporting your male partner

Male infertility is a sensitive topic, so it’s important for men to find people they can count on to be supportive, starting with their partner. Society tends to focus on female infertility, so it can be difficult for men diagnosed with male infertility to feel supported.

If your partner has been diagnosed with male infertility, here are some ways you can help:

  • Encourage him to talk about it. There are male infertility support groups and online forums, and your fertility doctor might recommend a counsellor trained to offer support in this area
  • Avoid pressure. Allow him time and space to process the diagnosis, without pushing him to start making lifestyle changes, for example
  • Don’t place blame. Fertility is a team effort, so refer to any reproduction challenges as ‘our problem’ rather than ‘his’ or ‘your’ problem

Remember – if you need support, there is plenty available. See your GP or fertility expert for advice.






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