The ultimate guide to male infertility – and 5 ways to boost your chances of being a dad

ONCE upon a time, couples settled down with three babies by the age of 30.

But the picture today is drastically different.

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Fertility rates are at their lowest levels for decades, new figures published this week revealed.

Women are having fewer babies than ever — an average of 1.44 between 2022 and 2023.

This means the fertility rate is the lowest recorded since 1938, according to the Office for National Statistics.

It reflects the fact more women are in education, focusing on their careers and delaying motherhood, statisticians say.

Plus, once a woman hits her mid-30s, her fertility declines at a faster rate so that by the time she reaches 40, she has a five per cent chance of getting pregnant each month.

But what about men?

It takes two to make a baby, and choices aside, it is thought one in seven couples will have trouble conceiving.

Dr Amit Shah, leading fertility expert and co-founder of Fertility Plus, tells Sun on Sunday Health: “Male fertility issues account for around a third of cases, so out of ten couples who come to see me, I would expect at least three of them would be due to male fertility.”

However, there is relatively little conversation about the issues affecting men.

Dr Shah says: “Men can be very closed creatures.

“Typically, they don’t like to go to the doctor and talk about their problems because it goes against this ethos that you are a man and everything will be fine.”

Generally, couples should seek advice if they cannot conceive within a year.

Tests for men start with a semen analysis, looking at the number, motility and shape of the sperm, and men will also be asked about their lifestyle habits and medical history.

Dr Shah says: “The more detailed it is, the easier it will be to understand what the problem(s) might be.”

Here are some potential causes of male infertility.

POOR SWIMMERS

AN estimated one in 20 cases of male infertility is due to low sperm, or oligozoospermia, which means there are fewer than 15 million sperm per millimetre of semen.

Dr Shah says: “Being overweight, smoking, hormone imbalances and previous surgeries or injuries to the testicular area can impact sperm production, as can taking steroids and medications for hair loss and alopecia.

“Infections can affect the quality of sperm too, while chemo-therapies and radiotherapies can knock testicular function.

“One per cent of men carry certain genetic abnormalities and some people are born with a condition called undescended testicles, which means one or neither of the testicles are in the correct position.”

Thankfully, men can do a lot for themselves, such as eating a good diet and exercising for a healthy BMI.

Dr Shah says: “If needed, there are options for assisted conception through forms of in vitro fertilisation, such as IVF.”

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NO SPERM

AN estimated one per cent of men ejaculate but produce no sperm, a condition called azoospermia.

Dr Shah says: “If a man is not producing sperm, it will either be a production or obstruction issue.

“Either testicular function has ceased, so the testes are not producing any sperm, or there are blockages along the tubular pathways that transport the sperm. This might be caused by a genetic abnormality, vasectomy, or an infection.”

A vasectomy, which 11,000 men in England have via the NHS each year, can be reversed.

Surgical sperm retrieval can retrieve sperm from the testes and use them to create embryos in a laboratory.

But Dr Shah says: “If sperm is not being produced at all in the testes, retrieval is obviously impossible.

“In these circumstances, donor sperm would be an option.”

ERECTILE DYSFUNCTION

MORE common than men realise, erectile dysfunction, also known as impotence, prevents penetrative intercourse.

It affects half of all men to varying degrees between the ages of 40 and 70, but can impact younger men, too.

Dr Shah says: “Obesity is a very common reason, as is excessive alcohol intake.

“Diabetes can affect erectile function by narrowing blood vessels to the penis.

“While some men experience erectile dysfunction due to spinal injuries.”

In some instances, however, the cause may be psychological, such as depression and anxiety.

Dr Shah says: “Treatment is dictated by the cause.

“It might mean re-evaluating lifestyle factors [which can help conditions like diabetes].

“There are also medications, such as Viagra to help achieve erections so you can ejaculate normally.”

If it is psychological, cognitive behavioural therapy (CBT) or sex therapy might be helpful.

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TESTOSTERONE

LOW testosterone isn’t just a side-effect of ageing, as referred to as the “male menopause”.

Men looking to start a family could have hypogonadism — a rare condition in which the testes do not produce sufficient testosterone either because of a problem in the testicles (primary) or the pituitary gland in the brain (secondary).

Dr Shah says: “The testes are dependent on the pituitary area in the brain, which fires all the hormonal signals to drive sperm production.

“In some men, the pituitary glands have benign tumours or are not well-developed.”

Men can be born with hypogonadism or first show signs during puberty, or it can develop later in life, often from injury or infection.

The signs of hypogonadism in adulthood include a decreased sex drive, energy, hair growth and muscle mass, potential depression, erectile dysfunction and breast tissue.

Dr Shah says: “In some cases, men can be given hormonal treatments to start testicular sperm production.”

However, this wouldn’t work for men with primary hypogonadism.

“Other options need to be considered, such as donor sperm,” says Dr Shah.