What are the signs of male infertility? Symptoms, causes and risk factors to know

There is no single sign that means a man is infertile. However, certain symptoms and health problems can affect sperm production, ejaculation or the ability to have sex, all of which can make conception more difficult.

Here are some signs and conditions that may be worth paying attention to when trying to conceive.

Erectile dysfunction

Erectile dysfunction, or ED, means having difficulty getting or keeping an erection firm enough for sex. It does not automatically mean a person is infertile, but it can make conception more difficult if intercourse cannot take place.

ED can also sometimes be linked to health conditions or hormonal problems that may affect fertility. Diabetes, certain medications, cardiovascular problems and hormonal disorders are among the factors that can contribute to sexual or reproductive problems.

Trying to conceive can add another layer of pressure. Timed intercourse around ovulation may create anxiety for some couples, which can make sexual difficulties more noticeable.

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The good news is that ED can often be treated. Depending on its cause, treatment may include medication, counselling or other approaches. If intercourse is difficult but sperm can be collected, assisted reproductive techniques may also be considered by a fertility specialist.

Problems with ejaculation

Ejaculation problems can also interfere with conception. Some men may have difficulty ejaculating, while others may experience retrograde ejaculation, where semen travels into the bladder instead of leaving through the penis.

Certain medical conditions, surgeries and medicines can contribute to ejaculation problems. Diabetes, for example, can affect the nerves involved in ejaculation, while some medications can also interfere with normal sexual function.

Antidepressants, including some selective serotonin reuptake inhibitors (SSRIs), can also cause sexual side effects in some people.

If ejaculation becomes difficult, painful or noticeably different, it is worth discussing it with a doctor rather than assuming it is simply part of the stress of trying to conceive.

Swollen or painful testicles

Pain, swelling or a noticeable change in the testicles should not be ignored. These symptoms can have several causes, including infections, inflammation, injury or a varicocele.

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A varicocele is an enlargement of the veins around a testicle. It may cause a dull ache or heaviness, although many people have no symptoms at all. Varicoceles can affect sperm production and quality and are a recognised cause of male infertility.

Infections affecting the testicles or the epididymis, the tube behind each testicle, can also interfere with sperm production or sperm transport. A doctor may recommend a physical examination, semen analysis or ultrasound depending on the symptoms.

A history of sexually transmitted infections

Some sexually transmitted infections (STIs) can affect male fertility, particularly when they are untreated or lead to inflammation and scarring in the reproductive tract.

Infections such as chlamydia and gonorrhoea can affect the reproductive system and may interfere with the movement of sperm. Other infections, including HIV, have also been linked with fertility problems.

The important point is that an STI does not automatically mean infertility. Early testing and appropriate treatment can help reduce the risk of complications.

Anyone who has had a possible STI exposure should get tested rather than waiting for symptoms, as some infections may cause few or no obvious symptoms.

Exposure to chemicals and high heat

Work and environmental exposures can also affect sperm health. Regular exposure to pesticides, industrial chemicals, solvents, heavy metals and radiation has been associated with reduced sperm production or poorer sperm function.

Heat is another factor worth considering. The testicles need a temperature slightly below the body's core temperature for normal sperm production. Frequent exposure to high temperatures, including hot tubs and saunas, may temporarily affect sperm production in some men.

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People who work in jobs involving chemicals or prolonged heat exposure should speak to a healthcare professional about ways to reduce their exposure.

Weight and metabolic health

Body weight can also play a role in male fertility. Obesity has been associated with hormonal changes and poorer sperm production or quality. Being significantly underweight can also affect reproductive health.

This does not mean that being overweight or underweight automatically causes infertility. Rather, weight can be one factor among several that affect reproductive function.

A balanced diet, regular physical activity and treatment of underlying metabolic problems can support overall health as well as reproductive health.

Medical conditions can affect fertility

Several medical conditions can interfere with sperm production, hormones or the reproductive system. These include diabetes, hormonal disorders, thyroid problems, pituitary disorders, genetic conditions and certain autoimmune diseases.

Some men are born with conditions that affect fertility, such as undescended testicles or certain genetic disorders. Previous injuries, testicular surgery and some cancers can also affect sperm production.

Cancer treatment deserves particular attention. Chemotherapy, radiation and some surgeries can reduce sperm production or affect the ability of sperm to reach the semen. Men who are planning cancer treatment and may want children in the future can discuss fertility preservation with their healthcare team beforehand.

Certain medicines and steroids may matter too

Some medicines can affect sperm production or sexual function. Testosterone replacement therapy and anabolic steroids are particularly important because taking external testosterone can suppress the body's natural sperm production.

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Other medicines, including some treatments for depression, high blood pressure, arthritis and cancer, may also affect fertility in some people.

This does not mean you should stop a prescribed medicine on your own. If you are trying to conceive, speak to your doctor about any medication or supplement you take.

When should you get checked?

Male infertility may have no obvious warning signs, so difficulty conceiving itself is reason enough to seek medical advice.

A fertility evaluation commonly includes a medical and sexual history, physical examination and semen analysis, which checks sperm count, movement and shape. Depending on the results, doctors may recommend hormone tests, ultrasound or genetic testing.

If a couple has been having regular unprotected sex for a year without achieving pregnancy, an evaluation is generally recommended. Earlier assessment may be appropriate when there is a known testicular, sexual or reproductive problem, previous cancer treatment or another fertility risk factor.

Most importantly, a fertility problem is not necessarily permanent. The cause, when identified, can help doctors decide whether treatment, lifestyle changes or assisted reproductive options may help.

(Disclaimer: This article is for general information only and is not a substitute for medical advice. Always consult a doctor before making new changes to your routine)