Male Fertility Challenges: Causes, Symptoms, Types and What to Do Next
Written and medically reviewed by Physician Yuan Ting
Last Updated: 27 May 2026
Reading Time: 12 Minutes
Introduction
If you or your partner have been trying to conceive for a while without success, male fertility is worth investigating early. You are not alone in reaching this point. A semen analysis is usually the first step, and in many cases, the cause is identifiable and treatable.
Research shows that male factor infertility contributes to 40 to 50 percent of cases where a couple is unable to achieve pregnancy. Yet most men experience no outward signs at all: no pain, no visible changes, nothing to suggest a problem exists. For many, the first indication is simply the absence of a pregnancy after months of trying. In some cases, physical signs do point to an underlying condition, and knowing what to look for is worth understanding.
- If you are new to the process: Start with the sections on causes and signs below. We explain the common factors and what to look out for.
- If you already have a diagnosis: Skip ahead to the treatment and complementary support sections.
What is Male Factor Infertility
Male infertility refers to reduced male reproductive function that affects a couple’s ability to achieve pregnancy. Clinically, infertility is defined as the inability to conceive after 12 months of regular unprotected intercourse. The evaluation window shortens to six months if the female partner is 35 or older because fertility declines with age in both sexes.
If tests identify the male partner as a contributing element, it is called male factor infertility. It may involve the number of sperm, their ability to move effectively, their shape, or a physical issue preventing their release.
Male infertility is categorized into two types:
- Primary Male Infertility: The diagnosis means a man has never achieved a biological pregnancy with a partner.
- Secondary Male Infertility: The diagnosis describes difficulty conceiving after a previous successful pregnancy. Sperm health changes with age, health status, hormonal shifts, and lifestyle over time.
The Prevalence of Male Infertility
Male infertility is far more prevalent than public awareness reflects. According to the World Health Organization (WHO), approximately 1 in 6 people worldwide experience infertility at some point, affecting an estimated 186 million people globally.
Research published in Human Reproduction Update found that average sperm counts among men in North America, Europe, and Australia declined by more than 51 percent between 1973 and 2018. The exact causes of this decline are still being investigated.
In Malaysia, awareness around male fertility is also gaining attention. Reports from local media indicate that national fertility initiatives are beginning to place greater focus on male reproductive health. This move helps combat the outdated stigma that fertility is only a female concern and encourages more men to seek early assessment.
Early assessment allows both partners to better understand their reproductive health and explore suitable next steps together.
Main Causes of Male Infertility
Male infertility has a range of identifiable causes. A thorough diagnosis by a medical specialist helps shape an effective treatment plan.
Sperm Quality and Production Issues
The most common causes of male infertility relate to how sperm is produced or how well it functions. A semen analysis assesses four main parameters.
- Sperm Count (Oligospermia): A low sperm count means there are fewer sperm than normal in the ejaculate.
- Sperm Motility (Asthenospermia): Even with an adequate count, sperm must swim effectively to reach the egg. Poor movement means sperm cannot travel through the female reproductive tract as needed.
- Sperm Morphology (Teratospermia): An irregular shape and structure of sperm can affect its ability to penetrate and fertilize an egg.
- Absence of Sperm (Azoospermia): In some cases, there is no sperm in the ejaculate. This can be due to a production issue in the testes or a blockage preventing its release.
Varicocele as a Common and Treatable Cause
A varicocele is an enlargement of the veins within the scrotum. According to a clinical review by Chiba and Fujisawa (2016), varicoceles are among the most common correctable causes of male infertility, found in approximately 40 percent of men with primary infertility and 80 percent of men with secondary infertility. The enlarged veins can raise the temperature in the scrotum and negatively affect sperm production.
A urologist can detect a varicocele during a physical exam. Surgical procedures can often correct the condition and support better reproductive outcomes.
Hormonal Imbalances
Sperm production is regulated by a chain of hormonal signals. The hypothalamus releases GnRH to prompt the pituitary gland to produce FSH and LH, which in turn trigger testosterone production in the testes. A disruption at any point in this chain can reduce or halt sperm production.
Low testosterone, elevated prolactin, thyroid dysfunction, and FSH or LH abnormalities are all identifiable through a blood hormone panel. In many cases, these causes are treatable with targeted medication.
Genetic Conditions
Genetic contributors are less common than lifestyle or varicocele-related causes, but they are important in selected cases, especially severe sperm production failure or azoospermia.
Examples include:
- Klinefelter syndrome
- Y-chromosome microdeletions
- CFTR-associated congenital absence of vas deferens
Genetic testing is usually recommended by reproductive specialists when initial findings indicate high relevance.
Medical History and Infections
Past health events can have a lasting impact. Infections such as mumps after puberty or certain STIs can damage testicular tissue or cause blockages. A history of undescended testicles or cancer treatments like chemotherapy can also impair sperm production.
Lifestyle and Environmental Contributors
Several lifestyle factors are known to influence sperm health.
Common contributors include:
- Smoking
- High alcohol intake
- Obesity and metabolic dysfunction
- Chronic heat exposure to the groin region
- Anabolic steroid use
- Poor sleep and persistent high stress load
Types of Male Infertility
Medical terms used to describe a sperm or fertility finding can feel unfamiliar. The table below translates the most commonly encountered terms into plain language.
| Medical Term | Plain Language | What It Means |
|---|---|---|
| Azoospermia | No sperm in semen | Either the testes are not producing sperm or a blockage is preventing its release. |
| Oligospermia | Low sperm count | Fewer than 15 million sperm per millilitre of semen. |
| Asthenospermia | Poor sperm movement | Sperm are present but unable to swim effectively. |
| Teratospermia | Abnormal sperm shape | A high proportion of sperm have structural abnormalities. |
| OAT Syndrome | Combined impairment | Low count, poor motility, and abnormal morphology occurring together. |
| Aspermia | No semen | A complete absence of ejaculate. |
| Hypospermia | Low semen volume | A semen volume consistently below 1.5ml per ejaculation. |
Common Symptoms of Male Infertility
The most direct symptom of male infertility is the inability to achieve a pregnancy after the expected timeframe. The majority of men with male factor infertility experience no other outward signs.
Certain physical signs may indicate an underlying condition, including:
- Changes in sexual function: A noticeable reduction in libido, or difficulty with erections or ejaculation, can point to a hormonal or vascular issue.
- Testicular pain or swelling: A persistent dull ache, swelling, or a feeling of heaviness in the testicular area may indicate a varicocele or an inflammatory condition.
- Gynecomastia: Enlargement of breast tissue in men is often associated with hormonal imbalances, including elevated oestrogen relative to testosterone.
- Reduced facial or body hair: A decrease in hair growth can be a signal of low testosterone.
- Visibly reduced semen volume: A consistently low ejaculate volume may warrant clinical review.
These signs are not a checklist for self-diagnosis. Their presence is a prompt to seek a professional assessment, not a confirmation of infertility. Testing remains the only reliable way to know.
How Male Infertility Is Medically Assessed
Diagnosis begins with a structured assessment to establish the cause.
1. Semen Analysis
The semen analysis is the primary investigative tool for male infertility. A sample is collected and assessed against the World Health Organization reference values.
- Sperm concentration: above 15 million per millilitre
- Total motility: above 40 percent
- Progressive motility: above 32 percent
- Normal morphology: above 4 percent (Kruger strict criteria)
- Semen volume: above 1.5ml
One abnormal result is not sufficient for a diagnosis. Sperm parameters can fluctuate due to illness, fever, stress, or a period of prolonged abstinence. A second analysis is typically recommended before drawing firm conclusions.
At-home sperm testing kits are available in pharmacies and online, but they measure count only. A clinical semen analysis captures motility, morphology, volume, and other parameters that matter significantly to both natural conception and assisted reproduction outcomes.
2. Blood Tests and Hormonal Assessment
A hormone panel assessing FSH, LH, testosterone, prolactin, and thyroid function identifies endocrine causes of impaired sperm production. These are straightforward to test and often treatable with targeted medication.
3. Physical Examination
A physical examination by a urologist or andrologist checks for varicocele, testicular size, and any structural abnormalities of the epididymis or vas deferens. The examination remains an important component of a thorough first assessment.
4. Advanced Investigations When Required
Additional testing may be recommended based on initial results. Sperm DNA fragmentation testing measures the extent of damage to the genetic material within sperm. Genetic testing is considered when results point toward a significant sperm production failure. Scrotal ultrasound is used to confirm a varicocele or identify structural abnormalities.
Male Infertility Treatment Options
Treatment for male infertility depends entirely on the underlying cause identified through investigation.
Category | Examples |
|---|---|
Surgical | Varicocelectomy (varicocele repair), vasectomy reversal, sperm retrieval procedures including PESA and TESA for azoospermia |
Medical and Hormonal | Medications used when a hormonal cause has been confirmed |
Assisted Reproduction | IUI, IVF, or ICSI are recommended when sperm parameters are below reference values or when other approaches have not achieved a pregnancy |
Lifestyle and Supplementation | Dietary improvements, weight management, reducing heat exposure, antioxidant supplementation |
One timing consideration applies to most approaches. Sperm takes approximately 72 to 74 days to complete its full development cycle.
Lifestyle changes, supplementation, and many medical interventions require at least three months before their effect on sperm parameters can be meaningfully measured. Couples preparing for IVF, IUI, or ICSI can use this timeline to set realistic expectations around what is achievable.
To learn more about each treatment pathway and how complementary care fits alongside medical treatment, read our full guide on male infertility treatment options.
Complementary Support for Male Infertility Alongside Fertility Centre Care
Couples managing male infertility in Malaysia typically work with two types of providers at different stages of their treatment.
The first is a conventional fertility clinic or hospital, such as those offering IVF, ICSI, or surgical sperm retrieval. These centres handle the clinical diagnosis and assisted reproduction procedures.
The second is a TCM fertility specialist. Unlike general TCM practice, TCM fertility specialists such as Xi Fertility focus specifically on reproductive health, supporting the body’s condition during the period leading up to and alongside medical treatment. At Xi Fertility, our KKM-registered practitioners are trained in fertility-focused TCM and offer acupuncture and herbal medicine programmes built around each couple’s situation and where they are in the treatment process.
Xi Fertility has specialised in fertility-focused TCM since 2013. For couples preparing for IVF, IUI, or ICSI, TCM fertility support can help the body stay in the best condition going into treatment. If you would like to explore complementary support, you can learn more about our male fertility support programme or speak with our team directly.
When Should You Seek Help for Male Infertility
The standard clinical guideline is to seek a fertility assessment after 12 months of regular, unprotected intercourse without a pregnancy, or after six months if the female partner is 35 or older.
Consider seeking an earlier evaluation if you have a known history of the following conditions:
- Undescended testicles in childhood
- Prior infections including mumps orchitis
- Previous cancer treatment involving chemotherapy
- A diagnosed hormonal condition
- Persistent pain or swelling
- A known genetic condition in the family
Both partners benefit from assessment at the same time. Male factor and female factor infertility frequently coexist. Approaching the investigation as a couple is the best path forward.
Xi Fertility Centre has supported couples across Kuala Lumpur and the Klang Valley since 2013. If you are ready to take the next step, our team is available for an initial consultation at our centres in Damansara Heights, Petaling Jaya, Bukit Jalil, and Setia Alam. Book an appointment here.
FAQs About Male Infertility
1. What is the first step if I suspect male infertility?
The first step is usually a semen analysis ordered by a doctor or fertility specialist. The test provides foundational data about sperm count, motility, and morphology. Both partners should undergo a fertility assessment at the same time to ensure a complete picture from the start. Once you have initial medical reports, a TCM practitioner can review them to develop a complementary support plan.
2. Can male infertility be improved with lifestyle changes?
Yes. Lifestyle adjustments play a significant supportive role in creating a healthy foundation for sperm development. Factors such as a balanced diet, regular exercise, stress management, avoiding excessive heat, and reducing alcohol and tobacco intake are beneficial for overall reproductive wellness. The changes work best alongside a primary treatment plan recommended by your medical specialist. They can be enhanced with a personalized wellness programme from a support centre such as Xi Fertility Centre.
3. How does TCM support male fertility alongside IVF?
For men, TCM approaches such as acupuncture and herbal medicine focus on supporting circulation, hormonal balance, and the body’s general condition during the period leading up to and during an IVF cycle. Because sperm takes approximately 72 to 74 days to develop, TCM support is typically most effective when started at least two to three months before the retrieval or insemination date. The goal is to support the body’s readiness alongside the clinical process, not to replace IVF procedures.
About the Author
- Free Malaysia Today. (2024). Age matters when it comes to fertility treatment. Available at: https://www.freemalaysiatoday.com/category/leisure/2024/11/02/age-matters-when-it-comes-to-fertility-treatment
- World Health Organization. (2023). 1 in 6 people globally affected by infertility: WHO. Available at: https://www.who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility
- Free Malaysia Today. (2025). Govt now shifting fertility drive’s focus to men, says minister. Available at: https://www.freemalaysiatoday.com/category/nation/2025/06/16/govt-now-shifting-fertility-drives-focus-to-men-says-minister
- Levine, H., et al. (2022). Temporal trends in sperm count: a systematic review and meta-regression analysis of samples collected globally in the 20th and 21st centuries. Available at: https://academic.oup.com/humupd/article/29/2/157/6824414
- Chiba, K., & Fujisawa, M. (2016). Clinical Outcomes of Varicocele Repair in Infertile Men: A Review. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC4999483/
- Martins da Silva, S., & Anderson, R. A. (2022). Reproductive axis ageing and fertility in men. Springer. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC9789007/