Around half of all fertility difficulty involves a male factor, yet men are often tested last. A semen analysis is simple, inexpensive and frequently identifies something that can be corrected.
Infertility is usually defined as a year of regular unprotected intercourse without conception, or six months where the female partner is over thirty five. A male factor contributes in around half of couples, either alone or alongside a female factor, which is why testing both partners together makes far more sense than testing one and waiting.
The male side is easy to assess. A semen analysis measures how many sperm there are, how well they move and how they are shaped. Those three numbers, combined with an examination and a hormone panel, identify the problem in most men.
The encouraging part is how often something correctable is found. Varicocele, hormone imbalance, infection, medication effects, heat exposure and blockage are all treatable, and treating them can improve the numbers enough to change the options available to a couple.
Difficulty conceiving affects a substantial minority of couples, and a male factor is involved in roughly half of those. Despite that, men are frequently investigated only after the female partner has been through extensive testing, which delays the whole process for everyone.
Sperm counts across many populations appear to have declined over recent decades, and factors such as obesity, smoking, heat exposure and anabolic steroid use are all recognised contributors that can be acted on.
Most men with a fertility problem feel entirely well, which is precisely why testing rather than waiting is the right approach.
Causes divide into problems making sperm, problems delivering sperm, and hormonal problems driving the whole system.
There is no reason to wait a full year if any of the following apply. Earlier testing simply gives more options.
Sudden severe testicular pain, particularly in a younger man, is an emergency. Twisting of a testicle cuts off its blood supply and must be treated within hours to save it. Attend hospital immediately rather than waiting for an appointment.
The male assessment is quick and inexpensive compared with the female investigation, so it should never be the last thing arranged.
How long you have been trying, previous pregnancies, childhood testicular problems, medicines, occupation, heat exposure and any history of steroid use. Sexual frequency and timing are covered too.
A sample given after two to five days of abstinence, assessed for volume, count, movement and shape. Because results fluctuate, an abnormal result is always repeated before conclusions are drawn.
Testicular size and consistency, the presence of a varicocele, and whether the tubes can be felt. This examination alone identifies several of the correctable causes.
Testosterone, LH, FSH and prolactin, with a scrotal ultrasound where examination suggests it. Genetic testing is added where the count is extremely low or absent.
Sperm production runs on a cycle of roughly three months, so any change made today shows up in a semen analysis about twelve weeks later. That is why treatment is judged over months rather than weeks, and why repeating the test too early is misleading.
Where low testosterone is part of the picture, it must be treated in a way that protects fertility rather than suppresses it, which is discussed fully in our testosterone therapy information.
The first stage is a consultation, a semen analysis and a hormone panel, which together cost a fraction of most fertility investigations. What follows depends on the findings. Lifestyle correction and medical treatment are relatively inexpensive. Surgical correction of a varicocele or a blockage is a one time figure quoted after examination. Assisted reproduction is arranged with a fertility unit and priced separately.
Treatment follows the cause. Several of the common causes are correctable, and correcting them can move a couple into a simpler treatment route.
Weight reduction, stopping smoking, moderating alcohol, avoiding prolonged heat and reviewing medicines. These measures improve the numbers in a meaningful proportion of men within one sperm cycle.
Ask about thisA day care procedure to tie off enlarged scrotal veins where they are large enough to feel and the semen analysis is abnormal. Improvement in the numbers is seen in many, though not all, men.
Ask about thisMedicines that stimulate the body's own testosterone and sperm production, used where hormone tests show a treatable pattern. External testosterone is avoided because it suppresses fertility further.
Ask about thisAntibiotics for confirmed infection, and surgical correction where the tubes are blocked after previous infection or surgery. Both can restore delivery in men whose production is normal.
Ask about thisWhere treatment does not sufficiently improve the count, sperm can often be retrieved directly for use in assisted reproduction, which is arranged in partnership with a fertility unit.
Ask about thisFertility assessment sits alongside our wider sexual health work, because erection and ejaculation problems frequently form part of the picture. The pillar page below sets out everything offered in this area.
Men's Sexual HealthStraight answers about this concern, written for men in Surat.
Ask a QuestionYou provide a sample after two to five days without ejaculation, and it is examined within an hour for volume, count, movement and shape. Because results vary naturally, an abnormal first sample is always repeated several weeks later before any conclusion is reached.
Often yes. Correcting a varicocele, treating a hormone imbalance, clearing an infection, losing weight, stopping smoking and reducing heat exposure can all raise the numbers. Improvement takes about three months to appear because of how long sperm take to mature.
No. Many are found incidentally and cause no problem at all. Correction is considered when it is large enough to feel, when the semen analysis is abnormal, and when there is a genuine reason to improve the numbers. Small silent ones are usually left alone.
Temperature does matter, because the testicles sit outside the body precisely to stay cooler. Frequent hot baths, saunas, prolonged heat at work and a laptop resting directly on the lap can all reduce production, and the effect reverses once the exposure stops.
Very much so. External hormones suppress the body's own production and can reduce sperm output for months or longer after stopping. Recovery is common but not universal, and it is important information to share at the first visit even if it feels awkward.
Sometimes. An absent count may mean production has failed, or it may mean a blockage is preventing delivery. Hormone tests and examination usually separate the two. Where a blockage is present, sperm can often be retrieved surgically for assisted conception.
Yes, and it saves months. Testing the male side is quicker, cheaper and less invasive than the female investigation, so running both together gives a complete picture early rather than discovering a male factor after a year of one sided testing.
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