This is the most common cause of male infertility — and the best ways to treat it

It’s a growing problem in relationships.

About 1 in 10 couples struggles to get pregnant within a year, which is the clinical definition of infertility.

The issue is becoming more common due to delayed parenthood, increased obesity, environmental toxin exposure and underlying health conditions like endometriosis and sexually transmitted infections.

Infertility is divided roughly into thirds — one-third due to male factors, one-third to female factors and one-third to both partners’ troubles or unknown causes.

The good news is that there are more ways than ever to combat male infertility. These are the major and lesser-known causes of fertility adversity and the wide range of treatment options.

What causes male infertility?

For women, fertility tends to drop off after the age of 35.

There’s no comparable age for men, though men will experience changes in their fertility as they age.

These changes include reduced semen volume, less sperm movement, weaker ejaculation force and significantly increased sperm DNA damage, which can hinder fertilization of the egg and implantation of the embryo in the uterus.

The most common cause of male infertility is a varicocele, swollen veins in the scrotum that are similar to varicose veins in the legs.

About 1 in 5 men has a varicocele, which is often diagnosed in adolescent years.

Among couples struggling to get pregnant, 2 out of 5 of these men have a varicocele.

These abnormal veins can lower sperm production and reduce movement, so it’s important to inform your fertility specialist early about this issue.

How is male infertility diagnosed?

The first infertility test is a semen analysis.

Even if you’re not trying to get pregnant for a while, there’s no harm in doing a semen analysis and finding out if there is a problem.

Your primary care doctor, a urologist or an infertility specialist can order one for you — or you can obtain one online.

The analysis assesses sperm count, movement and shape. We’ll also evaluate hormones like testosterone and follicle-stimulating hormone, which signals the testes to produce sperm.

We tend to define normal sperm count as at least 15 million sperm per milliliter, normal motility at 40% or more swimming and normal morphology at 4% or more perfectly shaped.

It’s important to understand that just because you’re in the normal range doesn’t guarantee that you’ll be able to get someone pregnant.

On the flip side, someone can get their partner pregnant with a sperm concentration that’s a little bit lower than the threshold.

You should definitely see a male infertility specialist if abnormalities are detected on the semen analysis or the hormone profile.

What are the treatment options for male infertility?

Male infertility can often be addressed with surgery, medications or lifestyle changes.

Obesity is a major cause of abnormal reproductive hormones in men. Excess fat tissue converts the hormone testosterone into estrogen, which can suppress fertility.

That’s why it’s important to eat a healthy diet, engage in cardio exercise at least three times a week and strength train at least twice a week.

There are less-obvious things you can also do to improve fertility. For example, sperm production is very sensitive to temperature, so you should minimize time spent in saunas and avoid putting a laptop that’s running hot in your lap.

You should also try to limit your exposure to microplastics, forever chemicals and other potential environmental toxins.

As for medications, certain drugs stimulate natural testosterone production, while others inhibit the conversion of testosterone into estrogen. Both types raise sperm count as well as testosterone levels.

In terms of supplements, there isn’t great evidence that they can improve fertility potential. If you’re eating a healthy diet, you should be getting all the nutrients you need.

If all else fails, surgery may be the answer. We can treat varicoceles by surgically removing the veins. We can also clear any blockages in the reproductive tract or retrieve sperm from the testicles.

Sperm that’s retrieved from testicles can be banked for later use in techniques like in vitro fertilization.

Should you consider sperm banking?

There’s no age at which we recommend a man freeze his sperm.

However, around the age of 45, men are more likely to produce children who develop neurocognitive conditions like autism spectrum disorder and schizophrenia.

In general, the older the father, the greater the risk of these challenges.

It’s no wonder that with all these considerations, infertility can cause an incredible amount of stress for a couple.

To reduce stress and align on expectations, you should discuss fertility issues early in the process with your partner.

It’s important to understand that infertility is a common problem — and it’s not just a female problem.

So don’t hesitate to get tested. Here at the NYU Langone Fertility Center, we can provide a full evaluation, fertility-enhancing treatments and support from mental health professionals to help guide you through this journey.

Bobby B. Najari, MD, is the associate chief, urology service at Tisch Hospital and director of the Male Infertility Program at NYU Langone Health. He provides advanced treatments tailored to each patient’s specific needs for reproductive care, gender-affirming surgeries, vasectomies and more.