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4 Common Causes of Male Infertility
April 10, 2025
Male infertility is more common than you might realize — and it’s also misunderstood. In fact, about 1 in 6 couples struggle to conceive, with male infertility playing a role in nearly half of cases.
The good news? Understanding the causes, from lifestyle factors to underlying health conditions, can help couples take proactive steps towards growing their families.
The first step is evaluation.
When you’re having trouble becoming pregnant, it’s important that both partners are evaluated. For men, this process starts with a simple medical history and physical exam.
“A history may reveal childhood conditions such as undescended testicles or past exposures like chemotherapy or radiation, all of which can affect the sperm-producing cells in the testicles,” explains Jared Bieniek, MD, medical director of Tallwood Men’s Health.
After the initial visit, you may go through testing including a semen analysis to assess sperm count and quality, along with reproductive blood work.
4 common causes of infertility in men
Male infertility can stem from a variety of factors, including:
1. Medications
When you’re trying to conceive, it’s important to review all your medications with a provider. Certain medications, such as testosterone, can play a major role in male infertility.
“Testosterone replacement therapy (TRT) shuts down the natural feedback loop between the brain and the testicles. When you lose that signaling, your innate testosterone production decreases and sperm production shuts down,” explains Dr. Bieniek.
Other medications, including some blood pressure drugs, psychiatric medications or other hormonal treatments, can also impact sperm production or function. Medications used to treat chronic conditions like cancer or autoimmune diseases can also impact sperm health.
2. Medical conditions
Certain health conditions can interfere with sperm.
Hormonal imbalances, autoimmune diseases and genetic conditions can all play a role. Even common chronic conditions like diabetes can impact fertility by affecting hormone levels and erections.
But the good news is that treating these underlying conditions may help improve fertility.
3. Previous surgeries
Surgeries on the reproductive system, pelvis or spine can sometimes lead to infertility.
A vasectomy is an obvious example, but even hernia repairs, prostate surgery or spinal cord procedures can affect the flow of sperm or ejaculation.
> Related: 5 Things to Know About Vasectomy Reversals
4. Anatomical issues
Some men are born with or develop structural issues that affect fertility.
One of the most common is a varicocele – an abnormal dilation of the veins in the scrotum which can lower sperm production or quality. Usually found during a physical examination, it often has no symptoms.
Most men with a varicocele are not infertile. But if the sperm count or motility is low, surgical repair may be recommended.
What you can do about male infertility.
Based on your exam findings and testing, your provider can recommend medications or even surgical options. There are also many lifestyle changes you can adopt to improve fertility.
“The simplest things a man can do is eat a healthy diet, exercise and watch his weight,” said Dr. Bieniek. “Excess weight can lead men to have hormonal imbalance affecting fertility and overall health.”
Dr. Bieniek also suggests:
- Considering a daily men’s multivitamin
- Avoiding excessive heat to the scrotum, such as from hot tubs and hot baths
- Reducing substance use, including marijuana
If you are struggling to conceive, your family doctor can help start the evaluation and refer to a reproductive urologist if appropriate.