Male Factor Infertility: Understanding Causes, Treatment, and How to Move Forward
Infertility discussions are often focused on women, but the fact is that it takes two to tango (or, at least, to make an embryo). Male factor infertility accounts for a significant portion of infertility cases, and it deserves the same attention, care, and compassion we give to any fertility challenge.
If you or a partner has received a male factor infertility diagnosis, we’re here to help you understand what it means, learn about treatment options, and plan for how to take care of yourself emotionally as you move forward.
Background: What Is Male Factor Infertility?
Male factor infertility refers to problems in the male reproductive system that affect the ability to conceive. According to the World Health Organization, male factor infertility is most commonly caused by issues with semen ejection, sperm production, or sperm quality. The good news? These issues are diagnosable and usually treatable.
Common Causes of MFI
Understanding what's happening in your body is the first step toward empowerment. Here are the most common causes of male factor infertility:
Low Sperm Count or Absence of Sperm
This can be an issue with production or obstruction. Sometimes the body produces too few sperm, or in some cases, no sperm at all, and sometimes the sperm just can’t make their way out. This can happen because of hormonal imbalances, testicular injury, infection, genetic anomalies, or certain medical treatments like chemotherapy or surgery. Varicoceles, which are enlarged veins in the scrotum, can also reduce sperm production.
Abnormal Sperm Shape and Movement
Even when sperm count is normal, problems with the shape (morphology) or movement (motility) of sperm can occur. Think of it this way: sperm need to be effective swimmers to reach and fertilize an egg. If they're misshapen or slow, conception is harder—or sometimes not possible at all. Exposure to certain environmental toxins, excessive heat, and certain medications can cause sperm to look or move abnormally.
Hormonal Imbalances
The pituitary gland, hypothalamus, and testicles all work together to regulate hormone production, including testosterone. When these hormones are out of balance, sperm production suffers. Conditions like pituitary or testicular cancers can disrupt this delicate system, as can certain medications or supplements.
Lifestyle and Environmental Factors
Some causes of male factor infertility are influenced or even caused by lifestyle factors. Smoking, excessive alcohol consumption, marijuana use, excessive heat exposure, and obesity can all negatively affect sperm production and quality. Some medications or supplements can also damage sperm.
If you’re worried a medication might impact sperm production or quality, check with your doctor.
Getting a Diagnosis: What to Expect
If you have been trying to conceive and have been unsuccessful, getting a semen analysis is very important. It is easy to do, noninvasive, and inexpensive. The semen analysis will check sperm count, motility, and morphology. It can be done at a clinic or a fertility center—or a test kit can even be sent to your home.
Your health care team may also order blood tests to check hormone levels, ultrasound imaging to look for structural issues, or other tests depending on your situation. You’ll also give a detailed medical history and discuss lifestyle factors.
Treatment Options
There are many pathways to treat male factor infertility. Your best option will depend on the underlying cause and your personal circumstances. Dr. Barrett Cowan, Chief Medical Officer at Posterity Health, encourages men having fertility challenges to be evaluated and treated by a reproductive urologist, a physician who specializes in male factor infertility.
Lifestyle Changes
Too much laptopping or hottubbing? While the research is inconclusive, if you have an abnormal semen analysis, you may be advised to do less of both.
Quitting smoking, reducing alcohol intake, maintaining a healthy weight, and managing stress can all contribute to better fertility outcomes. Your doctor can provide guidance on how to approach behavioral changes like smoking cessation or stress management. Just ask.
It takes about 74 days for new sperm to develop, so these changes can sometimes be seen after 4-6 months.
Medical Treatment
If hormonal imbalances are causing your issues, hormone replacement therapy or other medications can help restore balance and improve sperm production. Your doctor will monitor your progress with follow-up blood tests and semen analyses.
Surgical Intervention
Blockages can sometimes be corrected through surgery. Varicoceles may also be surgically repaired to restore proper blood flow and temperature regulation. Success rates depend on the specific condition and your individual health factors.
Assisted Reproductive Technologies (ART)
If male factor infertility is unresolved with medication or lifestyle changes, assisted reproduction can sometimes offer a pathway to parenthood. Intrauterine insemination (IUI) concentrates healthy sperm and places it closer to where it needs to be. In vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) can work even with very low sperm counts or poor motility. ICSI involves injecting a single sperm directly into an egg, bypassing many of the challenges sperm might otherwise face.
In some cases, sperm may even need to be directly extracted from the testicle by a reproductive urologist via a surgical procedure.
Your fertility specialist will help you understand which option makes the most sense for your specific diagnosis and goals.
Understanding the Costs
The cost of male factor infertility treatment varies widely depending on what's needed. Semen analysis and initial diagnostic testing typically range from a few hundred to a couple of thousand dollars. Lifestyle modifications are generally less costly, though they may require ongoing monitoring.
Surgical interventions for blockages or varicoceles might run several thousand dollars depending on complexity and whether they're covered by insurance.
Assisted reproduction is also an option. A single IVF cycle, with ICSI, can range from $15,000 to $20,000 or more. Many people pursue multiple cycles, which increases the total investment.
The good news? Fertility loans, health benefits, grants, and flexible payment plans can help make treatment more accessible. At Sunfish, we help people understand their financial options clearly in order to find pathways that work for their unique situations.
The Emotional Impact: You're Not Alone
“It’s important to remember that fertility challenges are a couple’s issue. It is important to work together and support each other through the process,” says Dr. Cowan.
A male factor infertility diagnosis can be emotionally challenging. Hearing that there's a problem with sperm production or function can trigger complex feelings, including shame, grief, inadequacy, or loss of control. Male factor infertility is not an issue of virility or masculinity. Rather, it is a medical issue.
These feelings are completely valid. Infertility is hard! It's okay to feel angry, sad, or even scared.
For the person with the diagnosis:
Give yourself permission to feel what you're feeling. Talking about it—whether with a partner, a therapist, a trusted friend, or a support group—can help you process these emotions or connect with others having a similar experience. Many fertility clinics now offer mental health screening and counseling as part of their standard care. Take advantage of these resources!
For partners:
If you're supporting someone through a male factor infertility diagnosis, your role matters tremendously. Listen without judgment. Acknowledge your partner’s feelings and let him know you're in this together.
Be aware that the emotional burden of infertility can strain a relationship. Couples counseling or fertility-focused therapy can help you communicate about the diagnosis or treatment decisions, so you can navigate this challenge together.
Self-Care Strategies During Treatment
Taking care of yourself mentally and physically is essential as you move through diagnosis and treatment.
Physical self-care: If lifestyle changes are part of your treatment plan, approach them as a form of self-care. Exercise, eat nourishing foods, get enough sleep, and manage stress through activities you enjoy. You’ll be supporting both your fertility and your wellbeing.
Emotional self-care: Talking about fertility a lot? Set boundaries, especially if it's causing stress. Give yourself permission to have days where you're not thinking about treatment. Engage in activities that bring you joy and remind you that your life and identity are more than your diagnosis.
Relationship care: Make time for your partner that isn't about treatment planning or discussing fertility. Maintain intimacy and connection in ways that feel right for both of you. Try not to let emotional demands of infertility crowd out other aspects of your relationship.
Professional support: Whether you find a therapist, support group, or fertility coach, professional guidance can be invaluable. There's no need to navigate this alone.
Moving Forward
A male factor infertility diagnosis is not the end of the story—it's a plot twist. Many cases of male factor infertility are treatable, and there are multiple pathways to parenthood available today.
“Male factor infertility can feel isolating, but it's one of the most treatable forms of infertility we see. With proper diagnosis and the right treatment plan, we have multiple pathways to help our patients achieve parenthood. The key is getting a clear picture of what's happening and then working together as a team," Dr. Cowan says.
At Sunfish, we focus on making fertility care accessible and understandable, so you can focus on your journey to parenthood. Reach out to our team for more information.
