A Fertility Perspective Understanding the Male Reproductive System

Male fertility is often the overlooked half of the fertility equation. Despite affecting approximately 1 in 10 men, men’s reproductive health continues to be shrouded in silence and misconception. In my practice, I regularly encounter men who are surprised to learn how significantly their lifestyle, health, and age can impact their fertility, and their partner’s chances of conception.

Understanding your reproductive system isn’t just beneficial for those actively trying to conceive; it’s essential knowledge that can influence your long-term health and family planning decisions.

The Key Components of Male Reproductive Anatomy

Testicles: The Production Powerhouse

Your testicles are oval-shaped organs housed within the scrotum, positioned outside the body for optimal temperature regulation. These remarkable organs serve two critical functions:

Sperm production: Unlike women who are born with all their eggs, men continuously produce new sperm throughout their lives. The process, called spermatogenesis, takes approximately 74 days from start to finish. This means that lifestyle changes you make today will affect sperm quality in about 2 – 3 months.

Hormone production: Testicles produce testosterone, the primary male sex hormone responsible for sperm production, libido, muscle mass, bone density, and overall male characteristics. Testosterone levels naturally decline with age, typically by 1 – 2% per year after age 30.

Epididymis: The Maturation Station

The epididymis is a coiled tube attached to each testicle where sperm complete their maturation process. This 20-foot-long (when uncoiled) structure serves crucial functions:

• Sperm spend 2 – 12 days here developing the ability to swim and fertilise an egg
• Damaged or infected epididymis can significantly impact sperm quality and transport
• Blockages here account for approximately 10 – 15% of male infertility cases

Vas Deferens: The Highway System

These muscular tubes transport mature sperm from the epididymis to the urethra during ejaculation. The vas deferens are the structures that are cut or blocked during a vasectomy. Blockages or damage to these tubes can prevent sperm from mixing with seminal fluid, resulting in azoospermia (absence of sperm in ejaculate).

Accessory Glands: The Support System

Several glands contribute to seminal fluid, which nourishes and transports sperm:

Seminal vesicles: Produce about 60% of semen volume, contributing fructose (energy for sperm), proteins, and enzymes.

Prostate gland: Produces about 30% of semen volume, including enzymes that help sperm mobility and substances that protect sperm from the acidic vaginal environment.

Bulbourethral glands: Produce pre-ejaculatory fluid that neutralises urethral acidity and provides lubrication.

Problems with any of these glands can affect sperm concentration, motility, and survival rates.

Factors That Impact Male Fertility

Age Matters More Than You Think

While men can father children well into their later years, sperm quality and quantity decline with age:

• Sperm concentration decreases by approximately 1 – 2% per year after age 35.
• DNA fragmentation in sperm increases with age, potentially affecting embryo development.
• Risk of genetic abnormalities and pregnancy complications increases.
• Partners of men over 40 have higher miscarriage rates.

Lifestyle Factors

Heat exposure: Testicles need to be 2 – 3°C cooler than body temperature. Regular hot baths, saunas, tight clothing, or occupational heat exposure can impair sperm production.

Smoking and substances: Tobacco, marijuana, and excessive alcohol can all reduce sperm concentration, motility, and increase abnormal sperm forms.

Nutrition and weight: Obesity can disrupt hormone balance and increase testicular temperature. Diets high in processed foods and low in antioxidants may increase sperm DNA damage.

Exercise: Regular moderate exercise supports healthy testosterone levels, but excessive endurance training or anabolic steroid use can suppress sperm production.

Stress: Chronic stress elevates cortisol levels, which can suppress testosterone and impair sperm production.

Medical Conditions

Several conditions can impact male fertility:

Varicocele: Enlarged veins in the scrotum affect up to 15% of men and 40% of men with infertility. These can increase testicular temperature and oxidative stress.

Hormonal imbalances: Low testosterone, thyroid disorders, or pituitary problems can affect sperm production.

Infections: Past or present infections of the reproductive tract can cause scarring or ongoing inflammation.

Genetic conditions: Conditions like Klinefelter syndrome or Y-chromosome deletions can severely impact sperm production.

When to Seek Professional Guidance

Consider consulting a fertility specialist if:

• You’ve been trying to conceive for 6 – 12 months without success
• You have a history of testicular injury, surgery, or cancer treatment
• You’ve experienced chronic illnesses, infections, or take medications regularly
• You have noticeable changes in sexual function or ejaculation
• Your partner is over 35 and you want to optimise your fertility potential
• You’re considering fertility preservation before medical treatments

Early evaluation can identify treatable conditions and provide guidance on optimising natural fertility before considering assisted reproductive technologies.

Optimising Male Fertility: Practical Steps

Maintain a healthy weight: Aim for a BMI between 18.5 – 25 kg/m².

Eat a fertility-friendly diet: Focus on antioxidant-rich foods like berries, nuts, leafy greens, and fish high in omega-3 fatty acids.

Take targeted supplements: Folic acid, zinc, selenium, and Coenzyme Q10 have shown benefits for sperm quality.
Manage heat exposure: Avoid hot baths, saunas, and tight clothing. Keep laptops off your lap.

Limit alcohol and eliminate smoking: Even moderate alcohol consumption can affect sperm quality.

Exercise regularly but moderately: Aim for 150 minutes of moderate exercise per week.

Manage stress: Consider meditation, yoga, or counselling to address chronic stress.

Get adequate sleep: Poor sleep quality can affect hormone production and sperm quality.

The Role of Advanced Treatments

When natural conception isn’t successful, several advanced options exist:

Intrauterine Insemination (IUI): Places prepared sperm directly into the uterus during ovulation.

In Vitro Fertilisation (IVF): Combines sperm and eggs in the laboratory, with resulting embryos transferred to the uterus.

Intracytoplasmic Sperm Injection (ICSI): A single sperm is injected directly into an egg, useful for severe male factor infertility.

Surgical sperm retrieval: For men with no sperm in their ejaculate, sperm can often be retrieved directly from the testicles or epididymis.

Knowledge Empowers Your Fertility Journey

Understanding male fertility isn’t just about biology—it’s about taking control of your reproductive health. When you comprehend how your body works, you can:

• Make informed lifestyle choices that support fertility
• Recognise when to seek professional help
• Have meaningful conversations with healthcare providers
• Support your partner more effectively through the fertility journey
• Make confident decisions about treatment options

Male fertility is a crucial component of the conception equation, yet it remains undervalued and under-discussed. By understanding your reproductive system and taking proactive steps to optimise your fertility, you’re not just improving your chances of conception, you’re investing in your overall health and wellbeing.

Moving Forward Together

Every man’s fertility journey is unique, influenced by genetics, lifestyle, health history, and age. What matters most is understanding your individual situation and taking appropriate action. Whether you’re actively trying to conceive, planning for the future, or concerned about your fertility, knowledge is the first step toward empowerment.

Remember, fertility challenges affect couples, not individuals. Working together with your partner and healthcare team creates the best foundation for success, whether through natural conception or assisted reproductive technologies.

If you have concerns about your fertility or want to optimise your reproductive health, I encourage you to book a consultation. Together, we can assess your unique situation and develop a personalised plan to support your family-building goals.

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Dr Simon Nothman is an experienced fertility specialist practising at Genea, a leading fertility clinic in Bondi Junction and Sydney CBD. He has supported many couples through their fertility journey, helping them optimise their fertility through natural means and offering assisted fertility treatments where appropriate. Dr Nothman takes a comprehensive approach to male fertility, recognising its critical importance in successful conception and family building.