Male Infertility Is More Common Than You Think: What to Know and How to Treat It
An infertility expert and urologist explain causes of male infertility, key factors affecting sperm quality, and the right time to get a fertility test.
Male infertility is more common than many realize: About one in five couples struggle to get pregnant, and male fertility plays a role in roughly 50% of those cases.
Yet for those trying to conceive, men are still dramatically underrepresented in the fertility conversation.
“Unfortunately, there’s a lot of stigma and shame associated with male infertility. In many cases, it is treatable, so getting checked out is very important,” says Dr. Joseph P. Alukal, a urologist and director of men's health at NewYork-Presbyterian/Columbia University Irving Medical Center.
“The time to talk about male infertility is at the very beginning, and the evaluation should include both partners from the start,” says Dr. Zev Williams, chief of the Division of Reproductive Endocrinology and Infertility at NewYork-Presbyterian/Columbia University Irving Medical Center and director of the Columbia University Fertility Center. “The good news is that there is more hope in treatment today than at any point in history.”
Dr. Williams and Dr. Alukal break down what to know about men’s reproductive health with Health Matters.
What causes male infertility?
Dr. Alukal: Many factors such as illnesses, chronic health problems or sperm function can contribute to male infertility.
Common causes include:
- Varicocele, or varicose veins around the testicle that lower sperm quality
- Hormonal abnormalities, such as too much or too little testosterone
- Genetic conditions, including genetic issues that impact sperm production
- Lifestyle factors, such as obesity and smoking
What is considered a normal sperm count? And do sperm speed and shape matter?
Dr. Williams: Sperm count is a spectrum, not a pass/fail. The current threshold is 16 million sperm per milliliter.
Sperm motility and morphology are also very important. They need to swim well to reach the egg, and their shape matters too. What’s most telling is the overall picture — when multiple factors are off at the same time, the impact on fertility is much greater than any single abnormal number.
Does sperm quality decrease with age?
Dr. Alukal: Studies have found an association between advanced age and a decline in sperm’s DNA quality, which may slightly raise the risk of neurodevelopmental and psychiatric disorders in children, but the overall risk is still low.
A common misconception is that testosterone supplements will help a patient. It’s actually the opposite effect, where taking supplemental testosterone can lower sperm count numbers.
Does lifestyle affect sperm health?
Dr. Alukal: There are connections between sperm health and habits like regular exercise, stress reduction, and better sleep.
Sperm production is like a remarkable assembly line. You're making tens to hundreds of millions of sperm on a regular basis, so it’s not surprising that if you put the wrong stuff into the factory, the process doesn’t go smoothly.
Lifestyle factors that can negatively impact sperm health and production include:
- Excess alcohol use
- Smoking, including marijuana
Patients often ask about heat exposure to the testicles, like laptop use, or a hot bath or sauna. Most people don’t have enough exposure to create a problem unless it’s occupational for multiple hours a day and several days a week.
If you’re struggling to conceive, how is male fertility checked and what tests are involved?
Dr. Williams: It starts with a semen analysis — a simple test that looks at sperm count, how well they swim, and their shape.
At Columbia University Fertility Center, we’ve made this as easy as possible. We’ve developed a specialized transport kit and media so that patients can produce a sample in the privacy and comfort of their home and then drop it off at any of our three locations for analysis. Results are back within 24 hours.
A physical exam is also important because some diagnoses can be made just by examination. If needed, we’ll check hormone levels and, in more severe cases, genetic testing. It’s straightforward and non-invasive.
In addition, newer tools like sperm DNA fragmentation testing can catch what the standard semen analysis misses. There can be sperm that look completely normal under the microscope but carry significant DNA damage. Those sperm can fertilize an egg and an embryo can start to develop, but with fragmented DNA it may not survive—leading to failed embryo development, failed transfers, or pregnancy losses.
Using AI to Expand Care for Male Fertility
Columbia University Fertility Center’s STAR system—Sperm Tracking and Recovery—combines artificial intelligence, robotics, and microfluidics to locate and gently recover individual sperm in men who had been told they had none at all.
“The inspiration for the STAR system came from astronomy,” Dr. Williams says. “Astronomers use AI to discover stars hidden among billions of other stars; we asked whether the same approach could find rare sperm cells hidden among millions of other cells and debris. The answer was yes.”
“We perform STAR cases daily now, and no other center has this. The system detects and recovers 40 times more sperm than technicians could by hand. We are able to find and recover sperm in almost 30% of men previously given the diagnosis of azoospermia and told that they had no sperm. For men who had lost all hope, it has changed everything, and it has been unbelievably moving and inspiring.”
And HELIOS, an ongoing clinical trial only at Columbia, is exploring whether a light-based therapy we designed and developed can improve egg and embryo quality.
“Ideas that start at the bedside get built in the lab, and discoveries in the lab flow directly into patient care,” Dr. Williams says. “Innovation is part of our culture—we’re always working to make every step of the fertility journey an easier and more successful one.”
What treatment options are available for male infertility?
Dr. Alukal: Treatment options are tailored to each patient based on a comprehensive overview. What are the patient's prior known medical issues? Does the partner have any medical conditions? How long have they been trying?
Some treatment options include:
- Surgery: An example of a surgical treatment is a varicocelectomy to repair a varicocele, where the blood vessels are clipped, and blood flow is redirected.
- Assisted Reproductive Technology (ART): These include fertility treatments such as in vitro fertilization, where eggs and sperm, or resulting embryos, are handled outside the body to help achieve pregnancy.
- Hormone medications: Your clinician may recommend hormone treatment depending on the causes. Pituitary abnormalities that disrupt sperm production can be addressed by hormone therapies.
Can supplements improve sperm health?
Dr. Alukal: A common misconception is that testosterone supplements will help a patient. It’s actually the opposite effect, where taking supplemental testosterone can lower sperm count numbers.
Additionally, supplements are not regulated in the same way as prescription medications, and you don't know what other ingredients are included.
Many people also bring up zinc and Coenzyme Q10 (CoQ10), which can help with prostate health and sperm function, respectively. But unless you have confirmed deficiency—which most people don’t— and have discussed supplementation with your doctor, I encourage patients to instead stick to a balanced diet, where they’re likely getting the nutrients they need.
When should you see a fertility specialist?
Dr. Williams: Both partners should be evaluated if:
- A couple has been trying for a year without success, and the woman is under 35.
- A couple has been trying for six months without success, and the woman is over 35.
However, those timelines assume everything else is functioning normally, such as regular cycles and no known risk factors.
If there’s a history of testicular issues, prior surgery, chemotherapy, testosterone use, or anything that raises a red flag, don’t wait. Get evaluated right away.
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