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Male Fertility

at Cadogan Clinic, London’s Leading Cosmetic Surgery Specialists. 

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Medically Reviewed January 2024, by Mr. Bryan Mayou (GMC: 1414396) - founder of the Cadogan Clinic and one of the world's leading plastic surgeons

What is Male Fertility?

Male fertility is a man’s ability to conceive a biological child. Infertility occurs when a couple cannot conceive, despite having regular unprotected sexual intercourse.

In order to conceive, a man needs to be able to achieve and maintain an erection and have enough sperm the right shape and moving the right way, along with enough semen to get the sperm to the egg for fertilisation. Problems with sperm production, low sperm quality and low sperm motility can result in difficulty conceiving.

Sometimes simple lifestyle changes, such as improving diet, quitting smoking or losing weight if you are obese, can help to resolve male fertility problems. But sometimes there may be other issues, such as ejaculation problems, a hormonal balance or a structural problem in the male reproductive system, which will require further treatment.

Just like female fertility, male fertility can be affected by age. Sperm motility tends to drop after the age of 55. However age is less of a factor in male fertility than in women.

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What causes Male Fertility problems?

There are a number of things which can potentially cause male fertility problems:

Imbalances in hormonal systems hypothalamus, pituitary, thyroid and adrenal glands, as well as disorders of the testicles, can cause male fertility issues. 

Certain medications can have an impact on male fertility. This includes certain testosterone replacement therapy, chemotherapy and long-term anabolic steroid use. Certain antibiotics, arthritis drugs and some antidepressants can also cause male fertility problems, such as interfering with sperm production. It is important that you do not stop taking medication before consulting a doctor first.

Male fertility can be impacted by a structural problem in the male reproductive system. This may include the tubes that carry the sperm being damaged, blocked or even missing altogether.

Around one in every 25 boys are born with undescended testicles. In many cases, the testicles will descend into the scrotum within the first three to six months of a baby’s life. However, one in 100 boys born with the condition will require treatment. If the surgery is not carried out before the baby is 12 months old, this can cause fertility problems later on in life.

A swelling in the veins that drain the testicles is known as varicocele. It is not known exactly what causes this swelling, but it may be linked to abnormal blood flow. Varicoceles can lead to poor sperm quality and quantity.

Prostatitis is a painful swelling of the prostate gland in men. Symptoms of chronic prostatitis include sexual problems, including pain during sex, pain when ejaculating and erectile dysfunction.

Ejaculation issues can cause male fertility problems. This includes retrograde ejaculation, a rare condition which sees semen travel backwards into the bladder at the point of ejaculation rather than through the urethra and out of the penis, and delayed ejaculation. Men suffering with delayed ejaculation may find they experience a repeated and prolonged delay before ejaculating during sex. This can be anywhere between 30 and 60 minutes. Alternatively, they may find themselves unable to ejaculate at all.

Erectile dysfunction, which is also known as impotence, is the inability to achieve and/or maintain an erection.

Chlamydia is one of the most common sexually transmitted infections (STIs) in the UK. Symptoms include the presence of unusual discharge from the penis or anus, pain when urinating, and pain and swelling in the testicles. However most people do not experience symptoms and do not realise they have the condition. Chlamydia is easily treated if caught early on, but if left untreated it can lead to complications such as infertility.

Gonorrhoea, sometimes colloquially referred to as ‘the clap’, is a bacterial infection which causes a thick yellow or green discharge from the penis as well as pain when urinating. However one in 10 infected men do not show any symptoms. If left untreated, complications may include infertility.

Certain genetic problems can cause problems with male fertility. This includes Klinefelter syndrome where boys are born with an extra X chromosome. Many boys and men do not realise that they have this condition as Klinefelter syndrome does not usually cause any obvious symptoms early in childhood, and later symptoms can also be difficult to spot.

Certain surgeries may result in little or no sperm in the ejaculate. These include vasectomy, prostate surgeries, scrotal or testicular surgeries and large abdominal surgeries, including those carried out to treat male cancers.

Extended exposure to certain pesticides, herbicides, chemicals, organic solvents and painting materials may contribute to low sperm counts. Exposure to lead or other heavy metals may also cause problems with male fertility.

Sperm cells die when exposed to too much heat.

By continuously exposing the testicles to high heat, this can interfere with sperm production, resulting in fewer sperm, or abnormally-shaped sperm, being produced.

Illegal drug use: Illegal drugs, such as cannabis and cocaine, can harm male fertility by reducing testosterone levels and libido. Cannabis can lower sperm count, decrease the amount of semen produced and have a negative impact on sperm motility.

Smoking: Smoking can cause DNA damage in sperm, which is linked to reduced fertility and increased rates of miscarriage.

Alcohol consumption: Drinking excessive amounts of alcohol can cause male fertility problems, including decreased testosterone and sperm production.

Obesity: Being overweight or obese can impact male fertility and result in lower testosterone levels and reduced sperm quality.

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Can Male Fertility be tested?

There are a number of male fertility tests that can be performed in order to spot any potential issues. These include:

  • Sperm sample: The first male fertility test is to check whether there are any issues with a man's sperm. A semen sample is collected and the doctor will check how many sperm are present, along with their speed, size and shape. If this first sample shows any potential issues, a second sample will be taken around a month later for further examination.
  • Urine sample: A urine sample will check for retrograde ejaculation, where semen is ejaculated backwards into the bladder instead of leaving the body at the point of climax.
  • Ultrasound: A doctor may order an ultrasound scan of the testes to check whether any sperm is being produced.
  • Blood test: If you are struggling to achieve or maintain an erection, a blood test will look for low hormone levels or evidence of diabetes. Erectile dysfunction can be a sign of diabetes.
  • Hormone tests: This male fertility test is used to check hormone levels and whether there are any imbalances. A hormone test may require blood, urine or saliva samples.
  • Genetic tests: Genetic testing is used to find changes in genes that can cause health problems. It's mainly used to diagnose rare and inherited health conditions, including those which can affect sperm production. This usually requires a sample of blood or saliva.
  • STI test: A urine sample will be taken to test for chlamydia and gonorrhoea.

What can I do to enhance my fertility?

There are several lifestyle factors that may affect your chances of conceiving, and these should be addressed at an early stage. In order to enhance male fertility, we recommend the following:

  • Lose weight if obese or overweight: Studies have shown that the higher a man’s body mass index (BMI), the more likely he is to have a low sperm count. Being obese can also lead to hormonal imbalances which can affect a couple’s chances of conception. By losing weight with a combination of exercise and a healthy, calorie-controlled diet, you will improve your chances of conceiving.
  • Cool down the scrotum: Overheated testicles can affect sperm quality and production, so it’s important that you take steps to address this. Avoid saunas, using your laptop on your lap and working in hot conditions if you can help it. Swapping tight underwear for loose-fitting underwear may help to lower the temperature of your scrotum.
  • Avoid toxins: Lengthy exposure to certain chemicals, heavy metals and radiation should be avoided in order to preserve male fertility.
  • Quit smoking: The chemicals in cigarette smoke can contribute to reduced fertility. Quitting smoking will also be beneficial for your overall health.
  • Cut alcohol consumption: Drinking excessive amounts of alcohol can affect testosterone levels and sperm production.
  • Stop using illegal drugs: Illegal drugs, such as cannabis and cocaine, can harm male fertility, so by stopping using them, this will help to boost your chances of conceiving naturally.
  • Keep stress levels in check: Trying to conceive can be stressful. But it is important that you do your best to keep stress levels in check. While the link between fertility and stress is still a matter of debate, stress can push you towards unhealthy habits and behaviours which may make it harder to conceive, for example smoking, binge drinking and not eating healthily. Stress can also cause a loss of libido.
  • Eat a healthy diet: A healthy diet is important for overall health, but particularly when trying to conceive. You should also aim to up your levels of selenium and zinc. Selenium is needed for normal sperm production and development and can be found in fish, meat, poultry, eggs and Brazil nuts. Low levels of zinc have been linked to a low sperm count, but eating meat, dairy products, wholegrain cereals and nuts can help with this.  Avoid trans fats, such as margarine and vegetable oils, which are commonly found in processed snack foods, frozen dinners and fast food as they have been shown to affect fertility.

What treatment is available to help improve Male Fertility?

There are several treatments available to help improve male fertility. The appropriate treatment depends on the diagnosis.

  • Medication:  Low testosterone levels can be treated with gonadotrophin injections which will enhance sperm production. Men diagnosed with retrograde ejaculation can take medicine to close the opening to the bladder.
  • Surgery: Surgery can help to treat a number of male fertility issues, including removing blockages from the tubes that take sperm from the testicles to the penis, correcting swollen veins in the scrotum and reversing a vasectomy. If no sperm are present in the ejaculate, surgery can retrieve sperm directly from the testicles.
  • Assisted conception: If lifestyle changes, medication and/or surgery has not worked, or if the issue cannot be treated, then you may need to undergo assisted conception. This may include intrauterine insemination (IUI), also known as artificial insemination, or in vitro fertilisation (IVF) where an egg is taken from the body, fertilised and placed back in the uterus.

Where male infertility is a factor, a process called intracytoplasmic sperm injection (ICSI) may be used in IVF. This involves taking an individual sperm and injecting it straight into the egg. It is commonly used in cases of low sperm motility.

Sometimes assisted conception may include using a donor egg, donor sperm or donor embryo.

The Patient Journey. A breakdown of what you can expect on your journey with us

We are deeply invested in ensuring that every step of your surgical journey with us is as informative and reassuring to you as it can be. This article outlines what you can expect at each stage of the journey

The Patient Journey

Frequently Asked Questions

It is a common myth that male fertility does not deteriorate with age. Sperm motility declines once a man has reached the age of 55. In comparison with a 30 year old, sperm motility had decreased by 54% by the age of 55.

Male fertility supplements may help to improve fertility. You should be getting enough zinc, selenium, vitamin C and vitamin E to help with conception. However supplements should always be taken as part of, not as a substitute for, a healthy, balanced diet.

A combination of sperm, blood and urine tests and ultrasound scans are used to test male fertility and diagnose male fertility problems. The doctor will also ask questions about your sex life, medical history and overall health in order to help make an accurate diagnosis.

What are the risks?

Complications are rare although, as with all surgery, possible. Your surgeon will discuss each of these risks comprehensively at your consultation. 


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My Face My Body

Best Clinic Winner

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My Face My Body


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