Male Infertility is Common and Treatable: When to See a Specialist

Infertility is often talked about as a women’s health issue, but in reality, male factors play a role in roughly half of all couples who struggle to conceive. Yet men often delay getting evaluated for fertility issues.

Akanksha Mehta, MD, urologist and director of male reproductive health in the Department of Urology at Emory University School of Medicine, says that one of the most important messages she tries to convey to patients is simply this: infertility is common, it is not anyone’s fault, and getting evaluated early can make a meaningful difference.

“People don’t always realize how much the male side contributes,” Dr. Mehta says. “But fertility is a team effort, and evaluating male health upfront can save couples time, money and emotional strain.” 

For many couples, the first sign of a fertility issue is the absence of a positive pregnancy test month after month.

But when is it time to see a fertility specialist?

• Under age 35: Medical guidelines generally recommend that couples under age 35 seek an evaluation if they have been trying to conceive for a year without success.
• Over age 35: Those 35 and older should consider doing so after six months.

Dr. Mehta emphasizes that these time frames are guidelines — not rules — and there are many reasons to seek evaluation sooner.

“If a man has any known risk factors or symptoms, he shouldn’t wait the full year,” she says. “An earlier assessment is simple, noninvasive and provides valuable information.”

Some clues that it might be time to speak with a specialist include changes in sexual function — such as erectile difficulties, reduced libido or problems with ejaculation — as well as pain, swelling or heaviness in the testicles. Although many men with infertility feel perfectly healthy, others notice subtle shifts they may not immediately connect to reproductive health.

Hormonal symptoms can also sometimes hint at an underlying issue. Low energy, decreased muscle mass, mood changes or reduced shaving frequency may reflect low testosterone or other hormonal imbalances that also influence fertility.

Male infertility has a wide range of causes, from physical blockages to hormone disruptions to lifestyle factors and environmental exposures.

Some common risk factors for male infertility include:

• Varicocele
• Lifestyle factors like smoking, and alcohol or cannabis use
• Obesity
• Certain medications

Varicocele — an enlargement of veins within the scrotum — is one of the most common. Dr. Mehta describes it as “a varicose vein of the testicle” and notes that it can impair sperm production, sperm quality or both. “Varicoceles are extremely common, and the good news is they are also highly treatable,” she says.

Lifestyle factors contribute to fertility

Lifestyle factors matter as well, though they are often misunderstood. Alcohol, for example, doesn’t have to be eliminated entirely, but heavy or frequent drinking can interfere with sperm production. Cannabis use, especially when regular, has also been linked to reduced sperm count and motility. Cigarette smoking is linked to higher risk of miscarriage.

“We’re learning more and more about how social habits affect male fertility,” Dr. Mehta says. “It’s something I always ask patients about, because reducing or stopping smoking, alcohol and cannabis use can make a measurable difference.”

Obesity is another contributor, and one that is increasingly common. Extra adipose tissue (fat) can alter hormone levels, raise body temperature around the testicles and increase inflammation — all of which can impair fertility. Meanwhile, certain medications, from testosterone supplements to some antidepressants and prostate medications, can also interfere with sperm production or ejaculation.

But just as important, Dr. Mehta stresses, is what not to assume. “Having a risk factor does not mean fertility is impossible,” she says. “And lacking obvious risk factors doesn’t guarantee everything is normal. That’s why testing is so important — it removes guesswork.”

Infertility carries an emotional weight that is often underestimated, especially for men. Many men say they feel pressure to appear strong or unaffected, even when the experience is isolating or deeply stressful. Dr. Mehta says she encounters these emotions every day in the clinic.

“Men sometimes feel embarrassed or even ashamed when they come to see me,” she says. “But infertility is a medical condition like any other. It doesn’t say anything about someone’s masculinity, health or worth.”

She encourages open communication between partners — and with clinicians. Early evaluation isn’t only medically beneficial; it can also relieve a tremendous amount of anxiety. “Sometimes just having answers is therapeutic,” she says.

What to expect during a fertility evaluation

The good news: evaluating male fertility is straightforward. Most of the tests are quick, painless and non-invasive.

Male infertility tests may include:

• A semen analysis to look at sperm count, movement and shape.
• A blood test to assess hormone levels.
• A physical exam to detect conditions like varicocele or structural abnormalities.

If a cause is identified, treatment options range from simple lifestyle changes to medication or minor outpatient procedures. Some men improve significantly just by reducing alcohol use, stopping smoking, losing weight or adjusting medications under medical supervision. Varicocele repair, when needed, is common and often highly effective.

In more complex cases, assisted reproductive technologies such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) can help couples achieve pregnancy even when sperm counts are extremely low.

“Most causes of male infertility are treatable or manageable,” Dr. Mehta says. “We spend a lot of time reassuring patients that a diagnosis is not the end of the road — it’s the start of a plan.” 

Because male fertility issues are so often treatable, time matters — especially for couples hoping to avoid long delays or multiple rounds of assisted reproduction. Early evaluation ensures that reversible issues are identified quickly, and it prevents unnecessary stress or procedures for female partners.

“Waiting a full year isn’t always necessary, and it can sometimes delay the interventions that would help the most,” Dr. Mehta says. “My goal is to empower men to take an active role in their reproductive health.”

Fertility and family planning with Emory Healthcare

At Emory, male fertility care brings together urologists, reproductive endocrinologists and other specialists who collaborate closely. Dr. Mehta notes that the program combines advanced diagnostics with a compassionate, patient-centered approach.

“We see the whole person — not just the test results,” she says. “We know this journey can be emotional. Our goal is to support patients medically and emotionally, and to help them build the families they envision.”

To schedule a consultation, call 404-778-3774 or visit the Emory Reproductive Center.