Male Infertility
About 1 in 6 couples have trouble conceiving, and a male factor is involved in about half. A semen test is cheap and quick, so it should happen early, not after months of tests on the woman.
When to get checked
- No pregnancy after 12 months of regular unprotected sex, or 6 months if your partner is 35 or older
- Sooner with a known issue: undescended testes, testicular surgery, cancer treatment, low libido or erection problems, or steroid use
Common causes
- Unknown in many men
- Varicocele: enlarged veins around the testicle, found in about 1 in 7 men
- Testosterone or anabolic steroids: they switch off sperm production, sometimes for months to years
- Past infections, injury, undescended testes, chemotherapy or radiotherapy
- Genetic causes: Klinefelter syndrome, Y chromosome changes, cystic fibrosis gene changes (missing tubes)
- Lifestyle: smoking, heavy drinking, cannabis, obesity, and heat (saunas, laptops on laps)
Tests
- Semen analysis after 2–7 days without ejaculating. If abnormal, it’s repeated, because results vary a lot.
- Hormone tests (testosterone, FSH, LH), and genetic tests if sperm counts are very low
- Scrotal ultrasound if a lump or varicocele is suspected
What helps
Sperm take about 3 months to make, so give changes 3 months before judging them.
- Step 1 · Self-careStop smoking, cut alcohol, reach a healthy weight, keep things coolSmall changes that add up.
- Works
- Improves semen quality for many; quitting smoking also helps the pregnancy
- Cost
- Free
- How long
- At least 3 months
- Watch for
Your sperm are a 3-month-old snapshot. Behave now, reap in spring.
- Step 2 · Stop the culpritStop testosterone or steroids, review other medicinesUsually under a specialist, who may use medicines to restart production.
- Works
- Sperm return in most men, often over 6–12 months, sometimes longer
- Cost
- Varies
- How long
- Months
- Watch for
- Low mood and low libido are common while hormones recover.
- Step 3 · SpecialistVaricocele repair or treating a hormone causeFor men with an abnormal semen test and a clear cause.
- Works
- Varicocele repair improves semen in many men with abnormal results; pregnancy benefit is less certain
- Cost
- Medicare rebate; private gap
- How long
- Months
- Watch for
- Step 4 · Fertility clinicIUI, IVF or ICSI (one sperm injected into each egg), or surgical sperm retrievalEven very low counts can work with ICSI.
- Works
- Success depends mostly on the woman’s age
- Cost
- Thousands after Medicare; public options are growing in some states
- How long
- Cycles
- Watch for
Costs are rough Australian prices and vary by pharmacy and provider. PBS co-payment: $25, or $7.70 with a concession card. Results are typical figures from trials, not promises.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Fertility supplements and antioxidantsA large US trial (FAZST) found folic acid and zinc didn’t improve live births. Evidence for most antioxidants is weak.
- Repeated home sperm tests without a lab testThey miss shape and movement. Get a proper lab analysis.
Common questions
How common is male infertility?
About 1 in 6 couples have trouble conceiving, and a male factor is involved in about half.
Does testosterone make you infertile?
Yes. Testosterone and anabolic steroids switch off sperm production. Recovery after stopping can take months to years.
How long does it take to improve sperm?
Sperm take about 3 months to develop, so lifestyle changes take about 3 months to show.
Helpful resources
- Healthy Male: Male infertilityPlain-language information. Free.
- Your FertilityAustralian Government-funded fertility information.
Evidence and more information
- WHO: Infertility prevalence estimates (2023)
- Schisterman EF et al. Folic acid and zinc for male infertility (FAZST, JAMA 2020)
maladywise.com/male-infertility/