Male fertility

Emma Cronin, nurse and midwife

Answering common questions about male fertility

24 March 2023

Fertility may not be something you worry about, or even consider, until it’s time to start a family. But, with around one in seven couples experiencing difficulties when they try and conceive,1 it’s worth knowing the possible risks and causes. As with many areas of our health, there are measures you can take now to help avoid issues in the future.

Emma Cronin, a nurse and midwife for AXA Health’s 24/7 health support line for members, explores all there is to know about fertility. From hormones to lifestyle choices, there are many different causes, reasons and issues that can make it difficult to conceive.

We’ve put together an overview of some of the factors and issues to be aware of.

What causes male fertility?

Infertility is clinically defined as when a male and female have been unable to conceive after having intercourse for a year without using forms of contraception. Studies have shown that after a year of trying for a baby 15% of couples are unable to conceive and after 2 years, this decreases to 10% of couples.2

There are many different issues that can cause infertility. In women, the cause can often be related to problems with ovulation or issues within the womb, while for around one in four couples, the cause can’t be identified.3

It’s thought that male issues – problems with sperm and semen – account for around a third of infertility cases.

We’ve put together a list of some of the more common problems men can encounter.

Low sperm count

Your sperm count is considered to be low if you have fewer than 15 million sperm per milliliter of semen. This is something that would need to be determined through a sperm analysis via a doctor, which would typically only happen after at least a year of trying to conceive.

A low sperm count doesn’t always mean that it’ll be impossible to conceive naturally, but it does make it more difficult.

Poor or irregular sperm motility

Healthy sperm is motile. This means it’s able to move or ‘swim’ in such a way that enables it to travel to the egg and fertilise it.

If your sperm do not move correctly or fast enough for any reason, it’ll make it more difficult for them to reach the egg.

Abnormal sperm

Sometimes sperm cells can develop abnormally so they are the wrong shape. This can also make it more difficult for them to move towards the egg and / or fertilise it.

Problems with the testicles

The testicles are where sperm is stored, so if they are damaged or impaired in any way, this can affect your ability to conceive. Issues can be caused by injury, infection, surgery or testicular cancer, as well as congenital defects.

Low testosterone

Testosterone is the male sex hormone that plays an important part in producing sperm cells. If testosterone levels are unusually low, a condition known as hypogonadism4, it can impact the amount or quality of the sperm that’s produced.

Certain medications and illegal drugs can impact testosterone levels, as well as a number of health conditions, from cancer to depression.

Unfortunately, many cases of abnormal semen and sperm can’t be explained.5 There are, however, a number of risk factors that are known to play a part.

So, even if you’re not yet trying for a family, it’s worth knowing what adjustments you can make now to help give your future self the best possible chance of being able to start a family naturally and without complications.

And, if you’ve been trying for over a year without success, it’s worth making an appointment with a GP to ask any questions, arrange the necessary assessments and better understand your situation.

How can lifestyle affect fertility?

As with so many health issues, our fertility declines with age. This is an unavoidable reality, but there are several other risk factors connected to lifestyle and health that we are able to address.

Some common causes of a low sperm count, poor quality semen and low motility include:

  • being overweight or obese
  • using recreational drugs
  • smoking
  • drinking too much alcohol
  • some medications exposure to certain solvents, pesticides and metals
  • depression or high levels of stress
  • sexually transmitted infections.

By remaining active, cutting out smoking and other toxins, moderating alcohol intake and exercising, you stand a better chance of maintaining a good sperm count, whether it’s a concern now or in the future.

Many of these issues tie-in with one another. For example, excess alcohol is one of the leading causes of obesity, and obesity can cause depression.

So, aside from improving or maintaining your fertility, there are many other benefits to adopting healthy habits.

How do I find out if I’m infertile?

We’re all different. Some couples get pregnant quickly while, for others, it can take a long time. If you’ve been trying to conceive for more than 12 months without success, it’s worth going to see your GP. Particularly if you feel that any of the above lifestyle factors might apply to you.

Your doctor will be able to carry out certain checks and assessments and provide guidance that may help you. They can also refer you for further testing if they feel it appropriate to make a formal infertility diagnosis.

There are two types of infertility that can be diagnosed:

  • primary infertility – if you’ve never conceived before and when a couple have not been able to conceive together
  • secondary infertility – if previous children have been conceived together but a couple are now unable to conceive.

Upon testing and diagnosis, there are a number of courses of treatment that may be recommended. For hormone imbalances or infections, medication can be prescribed. However, the majority of male-related infertility is as a result of poor-quality semen, low motility and low sperm count.

This means that in the aforementioned lifestyle adjustments are the most common course of action.

As with everything, the treatment prescribed will depend on your specific situation. There are also assisted conception options available such as intrauterine insemination (IUI), where sperm is inserted directly into a woman's womb, or in vitro fertilisation (IVF), where ovaries are fertilised with sperm in a laboratory.

So, if you and your partner have been struggling to conceive for over a year, be assured that there are many possible reasons and plenty of courses of action.

The important thing now is to understand the situation so it’s worth visiting your GP to have the initial tests and discuss available options.


  1. Infertility overview - NHS
  2. How common is infertility? - National Institutes of Health 
  3. Infertility causes - NHS
  4. Male hypogonadism – Mayo Clinic
  5. Low sperm count - NHS