Most men with fertility problems have no obvious symptoms, and the first sign is often that a partner has not become pregnant. When signs do appear, they can include problems with erection or ejaculation, low sex drive, pain or swelling in the testicles, reduced facial or body hair, and breast enlargement. A semen analysis is the only reliable way to check male fertility.
Fertility is often seen as a women’s health topic, yet male factors play a part in a large share of couples who find it hard to conceive. Many men put off testing because they feel healthy and have no symptoms. This guide explains the few signs that can point to a problem, the risk factors worth knowing, and why testing early saves time for both partners.
Can a man be infertile without any symptoms?
Yes. In most men with reduced fertility, everyday health, sexual function and appearance are completely normal. Sperm count, movement and shape cannot be judged by how a man feels, how often he has sex or how much semen he produces. A man can have a healthy sex life and still have a low sperm count or no sperm in the semen at all.
This is why doctors recommend that both partners are tested at the start, rather than testing the woman first and the man only later. A semen analysis is simple, quick and gives an answer within a day or two.
Signs that may point to a fertility problem
The signs below do not mean a man is infertile. They mean a check-up is a good idea, especially if you are trying to conceive.
Problems with sexual function
- Difficulty getting or keeping an erection
- Low sex drive
- Very little semen at ejaculation
- Ejaculation that is delayed, painful or does not happen
- Cloudy urine after orgasm, which can be a sign that semen is going backwards into the bladder (retrograde ejaculation)
These can have many causes, including stress, diabetes, hormone problems, nerve conditions and some medicines. They are worth discussing with a doctor whether or not you are planning a pregnancy.
Changes in the testicles
- Pain, ache or swelling in the scrotum
- A lump in the testicle
- Testicles that feel unusually small or firm
- A soft swelling above the testicle that feels like a “bag of worms”, which may be a varicocele, a group of enlarged veins. Read about varicocele.
Any new lump in a testicle should be checked by a doctor promptly, whatever your fertility plans.
Hormonal signs
Low testosterone or other hormone problems can sometimes show as:
- Reduced facial or body hair
- Breast enlargement (gynaecomastia)
- Low energy, low mood or reduced muscle mass
- Rarely, a reduced sense of smell together with delayed puberty, which can point to an uncommon hormonal condition
Your medical history
Some past conditions and treatments raise the chance of a fertility problem even when you feel well today:
- Undescended testicles in childhood, even if corrected by surgery
- Mumps that affected the testicles after puberty
- Surgery in the groin, scrotum or pelvis, including hernia repair
- Sexually transmitted infections
- Cancer treatment with chemotherapy or radiotherapy
- Use of testosterone or anabolic steroids for body building
- Long-term conditions such as diabetes or kidney disease
- A previous semen analysis that was abnormal
If any of these apply to you, consider getting tested early rather than waiting a full year.
Risk factors that can affect sperm
These do not cause symptoms, but they can lower sperm quality. Many are within your control.
| Risk factor | How it may affect fertility |
|---|---|
| Smoking | Linked with lower sperm count and movement |
| Alcohol | Heavy drinking can lower testosterone and sperm quality |
| Excess weight | Can change hormone levels and sperm production |
| Heat | Hot baths, saunas, tight clothing and long hours with a laptop on the lap can raise testicular temperature |
| Age | Sperm quality tends to decline gradually after about 40 |
| Stress and poor sleep | Can affect hormones and sexual function |
| Some medicines | Certain treatments for other conditions can affect sperm; never stop a medicine without advice |
| Workplace exposures | Pesticides, solvents, heavy metals and radiation |
| Recreational drugs | Some, including cannabis, are linked with lower sperm quality |
Sperm take about two to three months to develop, so changes you make today show up in a semen analysis a few months later. Our guides on how to improve sperm health naturally and increasing sperm count through lifestyle changes explain practical steps.
When should a man get a fertility test?
The usual advice is that a couple should see a fertility specialist after 12 months of regular unprotected intercourse without pregnancy, or after 6 months if the woman is 35 or older. Both partners should be tested at the same time.
A man should get tested sooner if:
- He has any of the signs or history listed above
- He has had a previous abnormal semen analysis
- He has had cancer treatment, or is about to start it (sperm freezing may be possible)
- His partner has a known fertility problem and the couple wants a full picture
How male infertility is diagnosed
Semen analysis
This is the main test. A sample is collected at the clinic in a private room after a short period of abstinence, usually two to five days. The laboratory checks semen volume, sperm count, movement (motility), shape (morphology) and signs of infection. Because results vary from day to day, an abnormal result is usually repeated. Read decoding a semen analysis report.
Further tests if needed
- Hormone blood tests: testosterone, FSH, LH and prolactin
- Scrotal ultrasound: to check for a varicocele or other changes
- Genetic tests: sometimes advised when sperm counts are very low or absent
- Sperm DNA fragmentation test: in selected cases
Your doctor decides which tests are needed based on the first results. See our male fertility assessment.
How to prepare for a semen analysis
A few simple steps help make sure the result reflects your usual sperm health:
- Abstinence: avoid ejaculation for the number of days the clinic advises, usually two to five. Too short or too long a gap can affect the result.
- Timing after illness: a fever in the past two to three months can lower sperm count temporarily. Tell the doctor, as the test may be timed later or repeated.
- Medicines: bring a list of everything you take, including supplements, hair loss treatments and any testosterone or muscle-building products.
- Collection: the sample is usually collected at the clinic, so it reaches the laboratory quickly at the right temperature. Use only the sterile container provided. Do not use lubricants or condoms unless the clinic gives you a special one.
- Complete sample: try to collect the whole sample. If any is lost, tell the laboratory staff.
If the first result is abnormal, do not panic. Sperm counts naturally vary, and a single result is never the final word. Your doctor will usually repeat the test after a few weeks before drawing conclusions.
Why both partners should be tested together
When a couple has difficulty conceiving, the cause can lie with the woman, the man, both, or neither clear cause can be found. Testing only one partner can lead to months of treatment that does not address the real problem. For example, a woman may be given ovulation medicines for several cycles while an untested male factor goes unnoticed.
Testing together usually means the man’s semen analysis and the woman’s hormone tests and scan are done in the same few weeks. The doctor then reviews all results at one appointment and suggests a single plan for the couple. Our fertility test for couples is built around this approach.
Signs that need prompt medical attention
Some symptoms should be checked by a doctor soon, regardless of fertility plans:
- A new lump or hard area in a testicle
- Sudden, severe pain in the scrotum, which can be a medical emergency
- Blood in the semen that keeps returning
- Breast enlargement with a lump or nipple discharge
These are uncommon, but early assessment matters for your overall health.
Common causes of male infertility
- Problems with sperm production in the testes
- Blockage in the tubes that carry sperm
- Hormone imbalance
- Varicocele
- Infection or inflammation
- Ejaculation problems
- Genetic causes
- Lifestyle and environmental factors
In some men no cause is found, even after full testing. Treatment can still help.
Treatment options for male infertility
Treatment depends on the cause and on the results of both partners’ tests.
- Lifestyle changes for a few months, with a repeat semen analysis
- Treating a specific cause, such as an infection, a hormone problem or, in some men, a varicocele
- IUI, when sperm changes are mild. See IUI treatment.
- IVF with ICSI, when sperm count or movement is significantly reduced. See ICSI.
- Surgical sperm retrieval, when there are no sperm in the ejaculate but sperm may be present in the testis. See sperm retrieval procedures and TESA.
- Donor sperm, when no sperm can be retrieved. See donor sperm programme.
For an overview of every option, read types of fertility treatment.
Talking about male fertility
Many men find fertility testing awkward or worry about what a result might mean. It helps to remember that a semen analysis is a routine medical test, that results are kept confidential, and that a low result does not reflect masculinity or personal worth. Couples who are tested together usually reach the right treatment sooner. If stress is affecting either of you, counselling and emotional support can help.
Common myths about male fertility
- “If I can have sex normally, my sperm must be fine.” Sexual function and sperm quality are separate. Many men with low sperm counts have no sexual problems.
- “A large amount of semen means high fertility.” Semen volume says little about the number or health of sperm in it.
- “Fertility problems are usually the woman’s.” Male factors are common, alone or alongside female factors, which is why both partners are tested.
- “Men stay fertile for life.” Many men father children later in life, but sperm quality does decline gradually with age.
- “Supplements can fix any sperm problem.” Some lifestyle changes help, but supplements cannot treat blockages, hormone disorders or genetic causes. Ask your doctor before taking any.
Frequently asked questions
What is the most common sign of male infertility?
The most common sign is simply that a couple has not conceived after a year of trying. Most men with fertility problems have no other symptoms, which is why a semen analysis is important.
Can a man tell if he is infertile by looking at his semen?
No. The colour, thickness or amount of semen cannot show sperm count, movement or shape. Only a laboratory semen analysis can.
Can male infertility be treated?
Often, yes. Many causes respond to treatment, and when they do not, IUI, ICSI or surgical sperm retrieval can help couples conceive.
Does how often you ejaculate affect fertility?
Very long gaps between ejaculations can lower sperm movement, and very frequent ejaculation can lower count slightly. For couples trying to conceive, intercourse every two to three days through the cycle is usually advised.
Does age affect male fertility?
Yes, gradually. Sperm quality tends to decline with age, particularly after about 40, although many older men remain fertile.
Is a semen analysis painful or embarrassing?
It is not painful. The sample is collected privately at the clinic, and staff handle every sample confidentially and respectfully.
Book a male fertility assessment
Kanaa Fertility Centre offers semen analysis, male hormone testing, ICSI and sperm retrieval at our centres in KK Nagar and Mylapore, Chennai. If you have any of the signs above, or you and your partner have been trying for a while, book a male fertility assessment or contact us.
This article is for general information. Every couple is different, and your doctor will recommend tests and treatment based on your individual evaluation.