A Comprehensive Guide for Couples Understanding Male Infertility
When pregnancy doesn’t happen as quickly as hoped, the first questions often focus on female factors. Yet male infertility contributes to roughly half of all cases. Feeling anxious or discouraged is normal, but the good news is that help and success are possible.
How common is male infertility?
About one in ten men worldwide has a fertility issue. Risk rises with age, smoking, excess weight, high alcohol intake, untreated medical problems (such as diabetes) and genetic factors. Early testing gives you clearer options.
The first step: semen analysis
A semen analysis looks at:
- Count – how many sperm are present
- Motility – how well they swim
- Morphology – how normal they look
Because numbers can vary day-to-day, a repeat test a month later is often required.
Today, additional tests are often performed alongside a basic semen analysis:
- Sperm DNA fragmentation – looking at DNA damage which has implications for fertility and pregnancy loss risks
- Anti-sperm antibody testing – assessing antibodies in semen which may impact sperm function
Follow-up tests that refine the plan
| Test | Why it’s done |
|---|---|
| Hormone profile (testosterone, FSH, LH, oestradiol) | Checks whether the testes are getting the right hormonal signals, and producing hormones appropriately |
| Scrotal ultrasound | Detects varicocele (swollen veins) or testicular masses. |
| Genetic testing | Considered when the sperm count is extremely low or no sperm are seen. |
| Trans-rectal ultrasound or testicular biopsy | In cases of azoospermia, where no sperm cells are evident in a semen sample |
These results help decide whether lifestyle change, medical therapy, a minor procedure, or assisted reproduction offers the best path forward.
Treatment options at a glance
- Lifestyle optimisation – weight management, balanced diet, moderate exercise, reducing alcohol, quitting smoking, vaping and other drugs.
- Medication – hormone therapy may be appropriate; antibiotics for infection.
- Day-surgery procedures – e.g. varicocoele repair, testicular sperm retrieval.
- Assisted reproductive technologies (ART) – intra-uterine insemination (IUI) or IVF with intracytoplasmic sperm injection (ICSI) when counts or motility stay low.
Your treatment plan is personalised, factoring in your partner’s fertility profile and family goals.
Why lifestyle matters
Healthy habits improve general well-being and sperm production. Research shows that within three months of:
- Stopping cigarettes or vaping
- Limiting alcohol to ≤ two standard drinks a day
- Losing 5–10 % of excess body weight
…many men see measurable gains in sperm count and motility. Regular aerobic activity also boosts testosterone and reduces stress, both of which are beneficial for fertility.
Partner support & emotional wellbeing
Infertility affects mental health for both partners. Sharing appointments, setting joint lifestyle goals, and talking openly with a counsellor or peer support group reduces isolation and keeps you moving forward together.
Timeline: when to seek help
| Time trying to conceive | Next step |
|---|---|
| < 6 months and both partners < 35 yrs | Keep trying but adopt healthy habits |
| 6 months | Book a fertility assessment for both partners if female partner is 35 years or over |
| 12 months | Book a fertility assessment for both partners if female partner is under age 35 |
| Immediately | Seek advice sooner if there’s a known risk factor such as undescended testis, chemotherapy, irregular periods in the female partner, or significant medical background for either partner. |
Frequently Asked Questions
Can lifestyle change sperm quality?
Yes—improvements may appear within three months of quitting nicotine, moderating alcohol, exercising and eating well.
Does age matter?
Male fertility declines slowly after 40; DNA damage in sperm increases with age. Earlier assessment is usually better.
Are over-the-counter supplements helpful?
Some antioxidant blends show modest benefit, but talk to your specialist before starting anything new.
How soon can we repeat the test after making lifestyle changes?
Schedule a new semen analysis about 10–12 weeks after making changes; that’s one full cycle of sperm production.
What if no sperm are found?
Sperm can often be retrieved directly from the testes for IVF-ICSI. Donor sperm is another option some couples consider.
What does a semen analysis cost?
Medicare usually covers part of the fee; typical out-of-pocket costs are modest. My preference is to perform the testing through Genea’s andrology lab for consistency and reliable results. Their fees are listed here.
Taking the next step
If you’re concerned about your fertility—or simply want peace of mind—Dr Simon Nothman offers compassionate, confidential assessments in Bondi Junction, the Sydney CBD and via telehealth.
Book a consultation or call (02) 8357 1747 to start your journey toward fatherhood.
This article provides general information and is not a substitute for medical advice. Always consult a qualified healthcare professional for personalised care.
Published 24 April 2025 • Dr Simon Nothman