If you are worried about male infertility, make an online video appointment with one of our NHS-trained GPs to discuss your concerns.
Claudia Jackson (RN)
Dr Adam Abbs
Next Review: Sep 1, 2025
Male infertility is the inability to father a child naturally (through normal sexual intercourse). Infertility in men has a variety of causes and any signs and symptoms will depend on the cause. In many cases, there may be no signs and symptoms and most men are unaware they have problems with fertility until they start trying to conceive a child.
Male infertility may be suspected if you have been trying to conceive through regular, unprotected sexual intercourse for one year without a resulting pregnancy. Further tests such as a sperm count are needed for male infertility to be diagnosed.
What are the signs of infertility in males?
We often talk about signs and symptoms as if they are the same thing, but signs are outward indicators of a disease or condition that can be seen by a doctor, and symptoms are what the patient experiences.
Some outward signs of male infertility include:
- Inability to conceive a child after one year of regular, unprotected sexual intercourse
- Pain, swelling, or a lump in the testicle
- Growth of breast tissue (gynecomastia)
- Loss of facial or body hair
- Frequent respiratory infections
- Being unable to get or keep an erection long enough to have sex (erectile dysfunction)
- Small, firm testicles
Symptoms of low fertility in males
Male infertility itself doesn’t usually have any symptoms, in other words, you may feel well even if you have problems with your fertility. Male infertility is often caused by other medical conditions such as genetic or hormonal problems, or previous illness or surgery.
Some symptoms you may experience include:
- Low sex drive
- Inability to smell
- Erectile dysfunction. (Being unable to get or keep an erection long enough to have sex)
- Problems ejaculating
Azoospermia is a common cause of male infertility and occurs when your semen (the fluid that comes out of your penis when you ejaculate) contains very little or no sperm.
There are 2 types of azoospermia, obstructive azoospermia (OA) and non-obstructive azoospermia (NOA).
Obstructive azoospermia (OA)
In obstructive azoospermia healthy sperm are produced in the testes, but there is a structural problem preventing the transportation of sperm out of the body. Causes include:
- Cystic fibrosis. A congenital condition (one that you are born with) that affects the lungs and digestive system. Around 95% of men with cystic fibrosis do not develop the tubes necessary to transport sperm out of the testicles.
- Surgery such as hernia surgery can damage the tubes that transport sperm out of the testicles. If you have surgery to remove the prostate gland (radical prostatectomy) you will be unable to ejaculate and father children naturally.
- Blockages of the ejaculatory ducts can occur as a result of scarring or inflammation. This may be caused by sexually transmitted infections (STIs), or congenital cysts in the testes.
- Phimosis (narrowing of the foreskin) can block semen from being ejaculated from the penis.
- Vasectomy is an operation where the tubes that transport sperm are cut as a form of birth control
Non-obstructive azoospermia (NOA)
In Non-obstructive azoospermia, the problem is that not enough sperm is produced, or the sperm are abnormal. Non-obstructive azoospermia can be pretesticular, meaning there is a hormonal problem that prevents the production of healthy sperm, or testicular, which means the problem is within the testicles themselves.
Some causes of pretesticular non-obstructive azoospermia include:
- Hypothyroidism. If left untreated, hypothyroidism can lead to low sperm count, misshapen sperm, poor sperm motility (how well sperm move) and erectile dysfunction
- Kallmann syndrome. A condition where a lack of hormones results in puberty being delayed or not happening at all
- High levels of the female hormone estradiol can cause reduced sperm count and poor quality of sperm. Causes of high estradiol levels in men include obesity, some medications, and some health conditions such as hypothyroidism, liver, or kidney failure
- Some medications such as those used to treat cancer, depression, arthritis, or high blood pressure may reduce the production or quality of sperm. If you are worried about your medication causing infertility, speak to your GP or pharmacist, but do stop taking your medication without medical advice
- Hypogonadotropic hypogonadism. Hypogonadism is a condition where little or no sex hormones are produced by the testes (or ovaries in females). In hypogonadotropic hypogonadism, this is because of a problem with the pituitary gland or hypothalamus in the brain. This can be genetic or may be caused by surgery, illness, or infection.
- Rare tumours of the pituitary gland
Some causes of testicular non-obstructive azoospermia include:
- Testicular cancer
- Cryptorchidism (where the testes are undescended at birth)
- Exposure to toxic chemicals or treatments such as radiation therapy or chemotherapy
- Varicoceles ( swollen veins in the scrotum)
- Genetic conditions such as Klinefelter syndrome or Sertoli-cell-only syndrome
- Infections like mumps which can lead to inflammation of the testicles (orchitis)
Signs and symptoms of male infertility are often missed as they can be vague and attributable to other factors. Male infertility as a complication of another health issue is usually diagnosed in childhood, but in other cases, it often remains undiagnosed until trying to conceive a child. Treatments for male infertility are most effective when started early, so it`s important to get diagnosed and treated as soon as possible.
If you are experiencing any of the above symptoms, have been trying to conceive a child for a year without success, or are worried about male infertility, a simple test called a sperm count can tell you if you are producing enough sperm.
You can arrange to have a male fertility test at your local GP or health centre, or alternatively, you can do a test yourself at home.
At Medicspot we now offer an at-home male fertility test. The test is delivered free of charge for you to carry out in the privacy of your own home and the results are ready in minutes.
We recommend booking an online video consultation with one of our GPs to interpret the results of your test and discuss any necessary further investigations or treatments.
Urology Care Foundation: What is Male Infertility? (Accessed August 17th, 2022) (Accessed August 17th, 2022)
Mayo Clinic: Male infertility April 13th, 2021 (Accessed August 17th, 2022)
Health University of Utah: AZOOSPERMIA (SPERM PRODUCTION) 2022 (Accessed August 17th, 2022 (Accessed August 17th 2022))
Stanford Medicine Healthcare: What Is Azoospermia? 2022 (Accessed August 17th, 2022)
PubMed: The role of hypothyroidism in male infertility and erectile dysfunction 2012 (Accessed August 17th 2022 (Accessed August 17th, 2022)
MedlinePlus: Kallmann syndrome December 1st, 2016 (Accessed August 17th, 2022)
MedlinePlus: Hypogonadotropic hypogonadism (Accessed August 17th, 2022)