About one in six Australian couples experience difficulty conceiving, and in roughly a third of those cases, male infertility is a contributing factor. Many men still assume fertility testing is something only their partner needs. Understanding what causes male infertility, recognising the signs, and knowing what a male infertility test involves can shorten the path to answers, and to treatment, if it’s needed.
Male infertility usually comes down to problems with sperm: how it’s made, how it moves, or whether it reaches the egg at all. In some men no clear cause is found (known as unexplained infertility), but for most, testing identifies one or more infertility causes.
Low sperm count is one of the most common findings. Sperm production can be reduced by infections, genetic conditions, undescended testicles in childhood, or a varicocele (enlarged veins in the scrotum that raise its temperature and affect sperm quality). In rare cases, no sperm is present at all, a condition called azoospermia. Low sperm count signs aren’t always obvious, which is one reason testing matters more than symptoms alone.
Sperm production relies on a chain of male hormones that starts in the brain and ends in the testicles. Low testosterone, or imbalances in FSH (follicle-stimulating hormone) and LH (luteinising hormone), can interrupt this process and lower fertility even when the testicles themselves are otherwise healthy.
Several medical conditions can affect male fertility, including diabetes, autoimmune disorders, and previous surgery or injury to the groin. Sexually transmitted infections left untreated can also cause blockages in the tubes that carry sperm.
Smoking lowers sperm count and motility and increases oxidative stress, which fragments sperm DNA. Heavy alcohol use disrupts the hormonal signalling between the brain and testicles, lowering testosterone and altering LH and FSH levels. Anabolic steroids can shut down the body’s own hormone production, suppressing sperm production for months after stopping. Heat is more mechanical: the testicles sit outside the body to stay cooler than core temperature, so frequent saunas, tight underwear or a laptop on the lap can reduce sperm quality over time.
Carrying significant excess weight affects fertility too, largely because fat tissue converts testosterone into oestrogen. The encouraging part is that these effects are among the most reversible causes of male infertility. Since sperm takes roughly 70 to 90 days to mature, quality can improve within a few months of quitting smoking, cutting back on alcohol, avoiding excess heat or losing weight.
If you and your partner haven’t conceived after 12 months of trying, or sooner if there’s a known risk factor, it’s worth booking a male infertility test. Testing usually starts simple and becomes more targeted based on the results.
Your fertility specialist will ask about past illnesses, surgeries, medications and lifestyle, then examine the testicles for size, lumps or signs of a varicocele.
A semen analysis, also called a sperm analysis, is usually the first and most useful fertility test for men. It measures sperm count, movement (motility) and shape, and can flag issues such as low sperm count or poor sperm quality that might not otherwise cause symptoms.
Hormone testing checks testosterone, FSH and LH levels to see whether a hormonal cause is behind reduced fertility. Genetic testing may also be recommended if results suggest a chromosomal or inherited cause.
Depending on your results, your specialist may order a scrotal ultrasound to check for a varicocele, or further tests such as a post-ejaculation urine test if retrograde ejaculation is suspected.
A semen analysis reports on sperm count, motility and morphology (shape), alongside semen volume and pH. Results outside the normal range don’t always mean you’re infertile. Many men with a lower than average count still achieve conception naturally or with support such as IVF or ICSI (intracytoplasmic sperm injection). Because sperm quality can vary from sample to sample, your specialist will usually ask for more than one test before drawing conclusions.
Treatment depends on the cause. A varicocele can sometimes be corrected surgically, and hormonal problems may respond to hormone therapy. Blockages can occasionally be treated with surgery, and where the aim is simply to help you and your partner conceive, assisted reproductive technology, including IVF and ICSI, is often the most direct path. Improving general health, such as quitting smoking or reducing alcohol, can also support healthy sperm production, even though it won’t reverse every cause of infertility.
See a fertility specialist if you haven’t conceived after 12 months of trying (or six months if your partner is over 35), or sooner if you notice signs of infertility in men such as pain or swelling in the testicles, changes in sexual function, or a history of undescended testicles or previous groin surgery. A male fertility check early on means any issues can be identified, and where possible addressed, before they affect your plans to grow your family.
Dr Joseph Sgroi provides male infertility testing and treatment as part of his fertility and IVF care in Melbourne, working with couples to understand the reproductive system as a whole rather than in isolation. To discuss your fertility diagnosis or arrange a semen analysis, book an appointment with Dr Joseph Sgroi.
Problems with sperm production, particularly low sperm count, are the most common cause of male infertility. This can result from hormonal imbalances, a varicocele, infection or genetic factors.
Male infertility is diagnosed through a physical examination, semen analysis and hormone testing. Further imaging or genetic testing may be used if the initial results point to a specific underlying cause.
Yes. Treatment depends on the cause and can include surgery for a varicocele, hormone therapy, or assisted reproductive technology such as IVF or ICSI.
Not always. Some causes, such as certain infections or lifestyle factors, can improve with treatment. Others, such as azoospermia linked to genetic factors, may need assisted reproductive technology to achieve conception.
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