Male Infertility
Male infertility contributes to roughly half of all couple infertility cases, which affect about 15% of couples overall, per the AUA/ASRM Diagnosis and Treatment of Infertility in Men Guideline (2020, amended 2024).
Symptoms
Often none -- infertility itself is usually the only sign, though some underlying causes also produce low libido, erectile dysfunction, or testicular changes.
Causes and risk
Varicocele, hormonal imbalance, genetic conditions, prior infections, and lifestyle factors (heat exposure, smoking, certain medications) all contribute; many cases have more than one factor.
How it is evaluated
Two semen analyses, taken about a month apart, assess volume, concentration, count, motility, and morphology against WHO reference limits. Hormonal testing (FSH, testosterone) is added for men with impaired libido, ED, very low counts, or exam findings suggesting a hormonal cause.
Treatment
Varicocele repair helps select men with an abnormal semen analysis. Nonobstructive azoospermia may require microTESE (surgical sperm extraction). Exogenous testosterone is avoided when fertility matters, since it suppresses natural sperm production -- clomiphene, hCG, or an aromatase inhibitor are the alternatives when hormone support is needed. Assisted reproductive technology is an option when other treatment doesn't restore fertility.
When to seek care
Sudden, severe testicular pain is a possible testicular torsion -- a time-sensitive surgical emergency -- and needs immediate emergency care, not a routine fertility workup.