Quick Answer
Male fertility is an important part of the fertility picture, and both partners should generally be evaluated together when a couple is having difficulty conceiving. Male factors can contribute to infertility alone or alongside female factors. A semen analysis is usually one of the first investigations for the male partner, while medical history, physical examination and additional testing may be considered depending on the findings. 1 2
The two halves
When a couple has been trying to conceive for months without success, the conversation often starts with the woman.
Her periods.
Her ovulation.
Her hormones.
Her AMH.
Her uterus.
Her “stress.”
But there is another half of the fertility story sitting right beside her.
The male partner.
Male factors can contribute to infertility on their own or alongside female factors. Current fertility guidance therefore recommends evaluating both partners rather than putting the entire investigative burden on the woman.1 2
And this isn’t about finding someone to blame.
It is about finding the right answer sooner.
From the Doctor’s Desk
Fertility should never be approached as a problem that automatically belongs to the woman.
When a couple is trying to conceive and pregnancy is not happening, both partners deserve a thoughtful and respectful evaluation. A semen analysis is a relatively straightforward early investigation, and it can provide valuable information without placing the entire emotional and medical burden on the woman.
It is also important to remember that an abnormal semen analysis is not the same as a diagnosis of permanent infertility. Results can vary, and the next step depends on the overall clinical picture.
Fertility care works best when we move away from blame and towards understanding. The goal is not to ask, “Whose problem is this?” The goal is to understand what may be affecting conception and identify the most appropriate path forward for the couple.
— Dr. Sowmya Sampurna M
Infertility is a couple’s issue—not a woman’s issue
Infertility can arise from female factors, male factors, a combination of both, or sometimes no clearly identifiable cause.
A review of Indian literature has estimated that male factors contribute to approximately 40–50% of infertility cases, although the exact proportion varies between populations and study settings. 3
More recently, a 2026 multicentre Indian study of 2,414 infertile couples found male-factor subfertility in 27.3%, female factors in 36.9%, combined factors in 9.7%, and unexplained infertility in 26.1%. 4
The numbers differ because infertility populations and definitions differ. But the message is consistent: Male fertility deserves a seat at the table.
What can affect male fertility?
Making sperm is a remarkably complex process. Sperm production can be affected by conditions involving the testes, hormones, genetics, infections, previous surgery, medications and lifestyle or environmental exposures. 2 3
Some examples include:
- Varicocele, or enlarged veins around the testicle
- Previous testicular injury or surgery
- Undescended testes
- Certain infections
- Hormonal disorders
- Genetic conditions
- Some medications
- Testosterone or anabolic-steroid use
- Smoking and recreational drug use
- Excessive alcohol consumption
- Obesity and metabolic health problems
- Significant heat or occupational exposures 2 4
And sometimes, despite a thorough evaluation, no obvious cause is found. That doesn’t mean the problem isn’t real. It means reproductive biology is complicated.
The first test is often surprisingly simple
For women, fertility evaluation can involve multiple investigations. For men, one of the most important initial tests is often a semen analysis.
It assesses characteristics such as:
A semen analysis is not a “test of masculinity.” It is simply a laboratory assessment of sperm and semen. And one abnormal report does not automatically mean infertility.
Semen parameters can vary between samples. If the first analysis is abnormal, the AUA/ASRM guideline notes that repeat testing—often at least a month apart—is important, particularly because semen results can vary substantially from one ejaculate to another. 2
So please don’t let one report become a diagnosis in your head.
What happens if the semen analysis is abnormal?
The next step depends on what is abnormal and why. A doctor may take a detailed reproductive and medical history and perform a physical examination. Depending on the findings, further testing may include hormone assessment, ultrasound or genetic testing. 2
For example, hormonal testing may be particularly relevant when sperm production is severely reduced or when symptoms suggest an endocrine problem. A man with a significant abnormality may be referred to a urologist or male reproductive specialist/andrologist.
And sometimes the cause is treatable. For example, certain hormonal disorders, infections or clinically significant varicoceles may have specific treatment options. In other situations, assisted reproductive techniques may help a couple achieve pregnancy. 2
But what about lifestyle?
This is where men sometimes hear vague advice like: “Just eat healthy and take some supplements.” It’s not that simple.
Lifestyle and environmental factors can affect sperm production and reproductive health, but sperm development takes time. Changes aren’t necessarily reflected in a semen analysis immediately. 4 5
Useful basics include:
- Don’t smoke. Tobacco exposure is associated with poorer reproductive outcomes and is worth addressing before conception. 2 3
- Avoid anabolic steroids and non-prescribed testosterone. Exogenous testosterone can suppress the body’s own hormone signalling and dramatically reduce or even stop sperm production. 2
- Look after metabolic health: Healthy weight, regular physical activity and good management of conditions such as diabetes are sensible parts of preconception health.
- Review medications: Some medicines can affect fertility. Never stop a prescribed medication without speaking to your doctor.
- Consider occupational and heat exposures.: The 2026 Indian IM-FaST study found associations between abnormal semen parameters and factors including heat exposure and certain occupational and environmental exposures. 4
- This doesn’t mean every man who works outdoors or spends time in a warm environment will have infertility. It means relevant exposures are worth discussing rather than ignoring.
Should both partners be evaluated at the same time?
Yes, when a male partner is contributing sperm.
ASRM specifically recommends concurrent assessment of both partners during an infertility evaluation. At least one semen analysis is generally obtained early in the evaluation because male factors are common contributors. 1
This makes practical sense. Imagine spending months investigating ovulation, doing repeated scans and undergoing multiple blood tests—only to discover later that a semen analysis should have been done at the beginning.
A couple-centred approach can save time, money, emotional energy and unnecessary testing. And that matters enormously in fertility care.
When should a couple seek help?
The timeline depends partly on the woman’s age and the couple’s medical history.
Generally:
- Woman under 35: evaluation after 12 months of regular unprotected intercourse without conception
- Woman 35 or older: evaluation after 6 months
- Woman over 40: earlier evaluation may be appropriate 1
But don’t wait if either partner already has a known condition that could affect fertility.
Examples include:
- Previous testicular surgery or injury
- Undescended testes
- Known or suspected varicocele
- Previous chemotherapy or radiation
- Erectile or ejaculatory difficulties
- Very irregular or absent periods
- Suspected endometriosis
- Previous pelvic or reproductive surgery
- Recurrent pregnancy loss
- Previous fertility treatment 1 2
In these situations, earlier assessment can make sense.
And please don’t turn this into a blame game
A fertility diagnosis can be emotionally heavy for both partners. A man may feel embarrassed by an abnormal semen analysis. A woman may feel responsible because her age, periods or PCOS are being discussed. Neither response is helpful.
Fertility is not a test of worth, masculinity or femininity.
The question isn’t: “Whose fault is this?”
The better question is: “What is happening, and what can we do about it?”
Sometimes the answer is straightforward. Sometimes both partners have contributing factors. Sometimes everything looks normal and the couple is diagnosed with unexplained infertility. And sometimes treatment isn’t needed at all because pregnancy happens naturally after a little more time.
The better fertility conversation
If you’re trying for a baby, don’t think: Her fertility + his fertility = two separate problems.
Think: One couple → two reproductive systems → one shared goal. She deserves appropriate evaluation. He does too.
And when both partners are assessed early and respectfully, the couple has a much better chance of understanding the road ahead without unnecessary blame or delay.
Key Takeaways
- Male factors can contribute substantially to infertility, either alone or together with female factors. 1 3 4
- Both partners should generally be evaluated concurrently when infertility is being investigated. 1 2
- Semen analysis is a key initial test for the male partner. 2 5
- One abnormal semen analysis does not automatically mean permanent infertility; results can vary and repeat testing may be needed. 2
- Male fertility can be affected by medical conditions, medications, hormones, genetics, infections, lifestyle and environmental exposures. 2 4
- Testosterone and anabolic steroids can significantly suppress sperm production. 2
- Earlier evaluation may be appropriate when either partner already has a known fertility risk factor. 1 2
- Fertility is a couple’s health issue—not a woman’s responsibility alone.
References
[1] American Society for Reproductive Medicine. Fertility evaluation of infertile women: a committee opinion. Fertility and Sterility. 2021. Read the source
[2] American Urological Association & American Society for Reproductive Medicine. Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline. Read the guideline
[3] Kumar N, Singh AK. Trends of male factor infertility, an important cause of infertility: A review of literature. Journal of Human Reproductive Sciences. 2015;8(4):191–196. Read the article
[4] Kumar N, et al. Environmental and Lifestyle Exposures and Male Factor Subfertility Proportion Among Infertile Couples: A Clinic-Based Multicenter Cross-Sectional Analysis from Indian Male Factor Subfertility Evaluation (IM-FaST) Study. Environmental Science and Pollution Research. 2026. Read the study
[5] World Health Organization. WHO Laboratory Manual for the Examination and Processing of Human Semen. 6th edition. 2021. Read the WHO manual