Male Infertility: The Complete Guide

Why Male Infertility Is Under-Diagnosed

The typical fertility journey starts with a woman visiting her OB-GYN. She gets blood work, an ultrasound, maybe an HSG. Her male partner? He might get asked to do a semen analysis — if he's lucky. But a semen analysis is a screening test, not a diagnosis. It tells you what the sperm looks like, not why it looks that way. A comprehensive male evaluation requires a reproductive urologist, not just a lab order.

Common Causes

Structural/Physical

• Varicocele (40% of infertile men): Enlarged veins in the scrotum that raise testicular temperature and increase oxidative stress. The #1 correctable cause of male infertility.
• Obstructive azoospermia: Blockages in the reproductive tract preventing sperm from reaching the ejaculate. Sometimes caused by prior vasectomy, infection, or congenital absence of the vas deferens.
• Undescended testicle (history): Even if corrected in childhood, a history of cryptorchidism increases infertility risk.

Hormonal

• Low testosterone (hypogonadism): Affects sperm production. But critically, exogenous testosterone (TRT) makes it worse — it shuts down the brain signals needed for sperm production.
• Elevated prolactin: Can suppress GnRH, LH, and FSH. Usually caused by a benign pituitary adenoma.
• Thyroid dysfunction: Both hypo- and hyperthyroidism can affect semen parameters.

Lifestyle and Environmental

• Heat exposure: Hot tubs, saunas, tight underwear, laptops on laps.
• Medications: Testosterone, anabolic steroids, certain antidepressants, some blood pressure medications.
• Cannabis and alcohol: Regular use impairs multiple sperm parameters.
• Environmental toxins: Pesticides, heavy metals, BPA, phthalates.

Diagnosis: Beyond the Semen Analysis

A complete male fertility evaluation includes: semen analysis (2+ samples), hormone panel (testosterone, FSH, LH, prolactin, estradiol), physical exam (checking for varicocele), genetic testing (karyotype, Y-chromosome microdeletions) if severe oligospermia, and potentially a scrotal ultrasound. DNA fragmentation testing is increasingly recognized as important, especially in cases of unexplained infertility or recurrent miscarriage.

Treatment Options

Supplements That Support Male Fertility