When couples struggle to conceive, the conversation almost always turns to the woman first. Tests are booked, questions are asked, and the emotional weight tends to fall heavily on her shoulders. But here is something that often surprises people: male infertility accounts for approximately 40 to 50 percent of all infertility cases worldwide.
It is time to change the conversation. Male fertility matters just as much, and understanding the facts is the first step toward finding the right answers together.
The Myths and The Truth
Myth 1: If a Man Can Have Sex, He Must Be Fertile
This is one of the most common and most damaging misconceptions about male fertility. Sexual performance and fertility are two completely separate things. A man can have a perfectly normal sex drive, achieve and maintain an erection, and ejaculate normally, and still have a very low sperm count, poor sperm motility, or abnormally shaped sperm that cannot fertilise an egg. The only way to know for certain is through a semen analysis, which remains the single most important first test in any fertility evaluation.
Myth 2: Infertility Is a Woman’s Problem
The science is clear on this. In roughly one third of infertility cases, the primary factor is male. In another third, both male and female factors are present together. This means that in the majority of infertility cases, male fertility plays a role. Yet men are often the last to be tested. If you and your partner have been trying to conceive without success, a semen analysis for your partner should happen at the same time as your own fertility evaluation, not as an afterthought.
Myth 3: Sperm Count Is the Only Thing That Matters
Many people assume that as long as a man has sperm, fertility is not an issue. In reality, sperm health is about much more than quantity. Fertility specialists look at several key factors when evaluating sperm:
Sperm count refers to the number of sperm present in a sample. A low sperm count is called oligospermia, while a complete absence of sperm is called azoospermia.
Sperm motility refers to how well sperm move. Sperm need to swim strongly and in the right direction to reach and fertilise an egg. Poor motility is known as asthenospermia.
Sperm morphology refers to the size and shape of sperm. Abnormally shaped sperm may struggle to penetrate and fertilise an egg. This is called teratospermia.
A man can have a normal sperm count but poor motility or morphology, and this alone can significantly affect fertility.
Myth 4: Male Infertility Cannot Be Treated
This is simply not true. Many causes of male infertility are very treatable. Hormonal imbalances can be corrected with medication. Varicoceles, which are enlarged veins in the scrotum that affect sperm production, can be treated surgically. Infections can be cleared with antibiotics. Lifestyle changes including improved diet, reduced alcohol intake, stopping smoking, maintaining a healthy weight, and managing stress can all lead to meaningful improvements in sperm health.
Even in cases of severe male infertility, assisted reproductive technologies offer real solutions. ICSI (Intracytoplasmic Sperm Injection), a procedure where a single healthy sperm is injected directly into an egg, has revolutionised treatment for male infertility and has helped countless couples achieve pregnancy even with very low or abnormal sperm counts.
Myth 5: Age Does Not Affect Male Fertility
While it is true that men can father children later in life than women can conceive, age is not irrelevant to male fertility. Research shows that as men age, sperm quality gradually declines. Older sperm are more likely to carry DNA damage, which can affect fertilisation rates, embryo quality, and even the health of the child. This does not mean older men cannot have healthy children, but it does mean that age is a factor worth taking seriously for both partners.
Myth 6: Tight Underwear Is Just a Myth
Actually, this one has some truth to it. Sperm production requires a temperature slightly lower than the rest of the body, which is why the testes are located outside the body. Prolonged exposure to heat, whether from tight underwear, hot baths, saunas, laptops placed on the lap, or occupational heat exposure, can negatively affect sperm production and quality. It is a small change, but for men looking to optimise their fertility, it is worth paying attention to.
Myth 7: If Tests Come Back Normal, There Is Nothing Wrong
Sometimes a semen analysis comes back within normal ranges and yet conception still does not happen. This can be due to DNA fragmentation in the sperm, a more advanced test that looks at the integrity of the genetic material inside each sperm. Standard semen analysis does not test for this. If conventional tests have not found an explanation for your fertility challenges, asking your specialist about sperm DNA fragmentation testing may be an important next step.
What Causes Male Infertility?
There are many possible causes of male infertility, including:
Varicocele, an enlargement of the veins within the scrotum, is the most common reversible cause of male infertility.
Hormonal imbalances affecting testosterone and other reproductive hormones can significantly impact sperm production.
Infections including sexually transmitted infections can damage sperm or block the tubes through which sperm travel.
Genetic conditions such as Klinefelter syndrome can affect sperm production at a chromosomal level.
Lifestyle factors including obesity, smoking, excessive alcohol, anabolic steroid use, and chronic stress all have a documented negative impact on sperm health.
Blockages in the reproductive tract can prevent sperm from being ejaculated even when they are being produced normally.
What Should You Do Next?
If you and your partner have been trying to conceive for 12 months or more without success, or 6 months if the woman is over 35, it is time to seek expert help. Both partners should be evaluated at the same time. A simple semen analysis is quick, non-invasive, and can provide invaluable information.
Male infertility is nobody’s fault. It is a medical condition, and like most medical conditions, it can be investigated, understood, and in many cases, successfully treated.