Understanding Fertility and Infertility: What You Need to Know

If you've been trying to get pregnant for over a year without success, it's time to speak with your doctor. Most medical experts agree that this is the point when your fertility should be assessed.

According to the NHS, infertility is defined as a couple being unable to conceive despite having regular, unprotected sex.

Fertility in the UK: Key Facts

• Around 1 in 7 couples in the UK may experience difficulty conceiving.
• If the woman is under 40, over 80% of couples will conceive naturally within a year when having unprotected sex every 2 to 3 days.
• After 3 years of trying, the chances of conceiving naturally within the next year drop to just 1 in 4 or less.

Infertility is typically only diagnosed after a couple has been trying to conceive for 12 months or more without success.

Types of Infertility

There are two main types:

• Primary infertility – when someone has never been able to conceive.
• Secondary infertility – when someone has conceived before but is now having difficulty doing so again.

What Causes Infertility?

Infertility can affect both men and women, and in about 25% of cases, no clear cause can be found. Common causes include:

• Irregular or absent ovulation
• Low-quality semen
• Blocked or damaged fallopian tubes
• Endometriosis – a condition where tissue similar to the womb lining grows outside the womb

Risk Factors That May Affect Fertility

Several lifestyle and health factors can also play a role:

• Age – fertility naturally declines as you get older
• Weight – being overweight or underweight can affect ovulation and sperm quality
• STIs – infections like chlamydia can lead to fertility issues
• Smoking – reduces fertility in both men and women, even through passive smoking
• Alcohol – drinking too much can impact sperm quality; the safest option during conception is to avoid alcohol altogether
• Environmental exposures – such as certain pesticides, solvents, or heavy metals
• Stress – chronic stress can affect hormone levels, ovulation, and sperm production

Treatment Options for Infertility

Depending on the cause, there are several treatment options available:

• Medications to help with ovulation
• Surgical procedures, such as treatment for endometriosis or repairing blocked fallopian tubes
• Assisted conception techniques, including intrauterine insemination (IUI) and in vitro fertilisation (IVF)

Understanding Male Infertility: Signs, Causes, and What to Look Out For

When it comes to fertility, the conversation often focuses on women. But male infertility plays a role in around half of all cases where couples have trouble conceiving. So, what are the signs of infertility in men—and what could be causing it?

Let’s break it down in a simple, straightforward way.

Sperm Health: A Key Factor in Male Fertility

One of the most common causes of male infertility is poor-quality semen—the fluid that carries sperm during ejaculation.

Here are a few possible reasons why semen may not be doing its job:

• Low sperm count – You may have very few sperm, or none at all.
• Poor sperm movement (motility) – If sperm can’t swim well, they may not reach the egg.
• Abnormal sperm shape (morphology) – Misshapen sperm may struggle to move or penetrate the egg.

In many cases, there’s no clear reason for abnormal semen—it just happens. However, there is some evidence that higher temperatures in the scrotum may affect sperm quality. While some believe wearing loose underwear might help, the science is still unclear.

Testicle Health Matters

Your testicles produce and store sperm, so any damage to them can significantly impact fertility.

Potential causes of testicular damage include:

• Infections in the testicles
• Testicular cancer
• Surgery involving the testicles
• Birth defects affecting testicular development
• Undescended testicles – where one or both testicles don’t move into the scrotum as they should
• Physical injury

Vasectomy and Male Sterilisation

Some men choose to have a vasectomy if they don’t want children (or more children). This procedure involves cutting and sealing the tubes (vas deferens) that carry sperm. Afterward, semen no longer contains sperm.

While vasectomy reversals are possible, they’re not always successful. So it’s important to consider the decision carefully.

Ejaculation Problems

Some men have conditions that affect ejaculation, making it difficult to release semen during sex. These ejaculation disorders can directly impact fertility and may need medical evaluation and treatment.

Low Testosterone (Hypogonadism)

Hypogonadism occurs when testosterone levels—the hormone responsible for sperm production—are unusually low.

Causes include:

• Certain tumours
• Illegal drug use
• Klinefelter syndrome – a rare genetic condition involving an extra X chromosome

Medications, Drugs, and Fertility

Some medications and substances can impact fertility, either temporarily or long-term.

Here’s what to watch out for:

• Sulfasalazine – An anti-inflammatory drug that can reduce sperm count. Effects are reversible once you stop taking it.
• Anabolic steroids – Often misused for muscle gain; these can lower sperm count and reduce sperm movement.
• Chemotherapy – Cancer treatments may severely affect sperm production.
• Herbal remedies – Certain herbs, like Tripterygium wilfordii (a Chinese root extract), can shrink testicles or disrupt sperm production.
• Illegal drugs – Substances like marijuana and cocaine are known to harm semen quality.

Unexplained infertility

·         In the UK, unexplained infertility accounts for around 1 in 4 cases of infertility. This is when no cause can be identified in either partner.

How Male Fertility is Tested: What to Expect

In most cases, fertility specialists prefer to evaluate both partners when a couple is struggling to conceive. So, even if a woman’s fertility tests show no issues, the male partner will also be assessed.

The good news? Fertility testing for men is often simpler and less invasive than it is for women. This is partly because the male reproductive system is mostly external, and male hormones tend to remain steady (unlike women’s, which change throughout the month).

Here’s a breakdown of the typical tests and procedures you might encounter during a male fertility evaluation:

The First Appointment: What It Covers

Your fertility specialist will start by reviewing both partners’ medical history, lifestyle habits, medications, and family background. They’ll also look for risk factors such as:

• History of mumps
• Undescended testicles
• STIs or urological surgeries
• Exposure to toxins or harmful chemicals

From there, a few basic tests help to build a clearer picture of male fertility.

Common Male Fertility Tests

1. Blood Tests

A blood sample helps doctors check key hormones and rule out other underlying conditions.

• Testosterone – The main male hormone, essential for sperm production and sexual function
• FSH and LH (Follicle-Stimulating and Luteinizing Hormones) – Vital for healthy sperm development
• Prolactin – High levels may suggest a pituitary gland issue or thyroid imbalance
• Infectious disease screening – For conditions like HIV, hepatitis, and syphilis

2. Infection Tests on Semen

Certain infections can directly impact fertility. Semen is checked for:

• White blood cells – A high count may indicate infection
• Specific bacteria or viruses, including:
• Chlamydia
• Gonorrhoea
• Ureaplasma urealyticum

3. Urine Analysis

A simple urine test can reveal signs of:

• Bacterial infections or prostate issues
• Retrograde ejaculation – When sperm flows backward into the bladder instead of out through the penis. This is a treatable condition if detected.

4. Semen Analysis: The Core Test for Male Fertility

The most important test in a male fertility checkup is the semen analysis. This evaluates both the quantity and quality of sperm.

To do this, the male partner provides a semen sample—either at home or in a clinic—typically after three days of abstinence from sex for the most accurate result.

Because sperm counts and quality can vary over time, this test may be repeated over several months.

What Do Specialists Look For in Semen?

Volume

A typical semen volume per ejaculation is about ½ to 1 teaspoon (2 to 6.5 milliliters). Too little or too much can signal an issue, but volume doesn’t always reflect sperm count.

Low volume could be caused by:

• Hormonal imbalances
• Retrograde ejaculation
• Blockages
• Infections

Thickness (Viscosity)

Normal semen starts off thick and liquefies within 20 minutes. If it takes over an hour to liquefy, it may point to an infection or issues with the prostate or seminal vesicles.

Clumpy semen? This might suggest a prostate gland issue.

Runny semen? It could indicate problems with the seminal vesicles.

Sperm Quantity (Concentration)

Sperm count is crucial. A healthy range is generally 20 to 150 million sperm per milliliter. Some men may occasionally register a zero count—further tests will be needed to determine whether there’s a blockage or if the testicles aren’t producing sperm.

For example, testing for fructose in the semen can help pinpoint the issue:

• No fructose? Possibly a blockage.
• Fructose present? The testicles might not be producing sperm.

Sperm Shape (Morphology)

The shape of sperm matters for fertility. Ideally, at least 60% of the sperm should be normally shaped. Abnormally shaped sperm (e.g., with two heads, short tails, or pinheads) usually can’t swim properly or penetrate the egg.

It’s normal to have some abnormal sperm—only a high percentage becomes a concern.

Sperm Movement (Motility)

Sperm must move well to reach and fertilize an egg. Healthy sperm swim at about two inches per hour through the female reproductive tract.

At least 50% of sperm in a sample should show normal forward movement. If many of them don’t move well, it may be harder to conceive naturally.

What Happens Next?

Depending on the results of these tests, your doctor may recommend lifestyle changes, medication, further tests, or referrals to a urologist (a specialist in male reproductive health and the urinary tract).

If a cause is found, many cases of male infertility are treatable—sometimes with simple changes, other times with medical intervention or assisted fertility methods like IVF.

Additional Tests for Sperm Quality

While a standard semen analysis covers most of the basics, there are cases where more detailed testing is needed to get a clearer picture of sperm health and function.

Here are some of the additional sperm tests that may be recommended:

• Sperm Chromatin Structure Assay (SCSA) – This test checks the integrity of sperm DNA. Damaged DNA can reduce the chances of fertilization and may affect embryo development.
• Computerized Analysis of Sperm Motion – Offers a detailed look at how sperm move, beyond what’s visible under a microscope. It can measure speed, direction, and strength of movement.
• Hamster Penetration Test – An unusual but insightful test where human sperm is observed to see if it can penetrate a hamster egg (which has had its outer layer removed). This helps determine the sperm’s fertilization potential.
• Antisperm Antibody (ASA) Test – Sometimes, the body can mistakenly identify sperm as invaders and produce antibodies that attack them. This test checks for those antibodies, which can impair sperm movement and function.
• Vasogram – An imaging test used to examine the vas deferens (the tubes that carry sperm from the testicles). This test is often done if there’s concern about a blockage.

These extra tests aren’t always necessary, but they can be very helpful in diagnosing unexplained infertility or confirming specific conditions.

Next Steps

If you're going through fertility testing as a couple, remember: it's a shared journey. Male testing is quick, relatively easy, and could be the key to understanding what's going on.

Curious about what female fertility testing involves or want to know more about fertility treatment options? Stay tuned for our next post!

Can Male Fertility Supplements Help?

Yes—in many cases, they can.

Male fertility supplements are designed to address something called oxidative stress, which can seriously affect sperm quality. This stress is caused by reactive oxygen species (ROS)—molecules naturally produced during metabolism that have unpaired electrons, making them highly reactive. Common types include the superoxide anion and hydroxyl radical.

When ROS levels get too high, they can damage sperm by interfering with their development and reducing their ability to function properly.

How Fertility Supplements Help:

Most male fertility supplements are either:

• Antioxidants – Help neutralize ROS and reduce cellular damage
• Micronutrients – Support healthy sperm development by boosting essential nutrient levels

Supplements Backed by Research:

There’s solid evidence that the following nutrients may improve sperm quality—and even pregnancy rates:

• Vitamin C and E
• Carnitines (especially L-carnitine and acetyl-L-carnitine)
• Selenium
• Vitamin A
• Zinc
• Coenzyme Q10
• Folate
• Arginine
• Omega-3 (polyunsaturated fatty acids)

These ingredients may help:

• Increase sperm count
• Improve sperm motility and shape
• Reduce DNA fragmentation
• Improve sperm’s ability to fertilize an egg

Why Antioxidants Matter

Sperm are uniquely vulnerable to oxidative stress. Environmental toxins, poor diet, smoking, alcohol, and even intense exercise can raise ROS levels and damage sperm. Antioxidants help counteract these effects by supporting DNA repair, enhancing sperm quality, and protecting them from harmful molecules.

While not a miracle cure, a high-quality fertility supplement—especially when combined with a healthy lifestyle—can make a noticeable difference for many men trying to conceive.