Male Fertility: Why It's Half the Conversation

TL;DR: Male factors are the sole cause in about 20% of couples with infertility and contribute in another 30 to 40%, so men are involved in around half of cases. The first test is a simple, painless semen analysis, and both partners should be checked from the start. Heavy drinking, smoking, obesity, some medicines and anabolic steroids or testosterone can all affect sperm. Stigma keeps many men from testing, so raise it early, as a shared plan rather than a blame question.

In many homes, when a couple has not conceived, everyone looks at the woman. The aunties ask her what she is eating. The pastor prays over her. She is the one sent from clinic to clinic, scan to scan, sometimes for years, while her husband is never asked to give a single sample. It is unfair, and it is also bad medicine. Fertility is a couple's issue, and a man's test is one of the simplest and least invasive in the whole process. This post is for women who want to understand the male side, and for the men in their lives too.

How often is male fertility part of the problem?

Far more often than most people assume. The American Urological Association and the American Society for Reproductive Medicine estimate that about 15% of couples experience infertility. Within that group, the male partner is solely responsible in about 20% of cases and contributes in another 30 to 40%. Put together, men are involved in roughly half of couples' fertility problems.

The World Health Organization explains that male infertility is most commonly caused by problems ejecting semen, low or absent sperm, or sperm with an abnormal shape or movement. None of these show on the outside. A man can feel completely healthy, have a strong sex drive and ejaculate normally, and still have a low sperm count. That is exactly why testing matters.

What is a semen analysis?

A semen analysis is a lab test of a sample produced by masturbation, usually into a sterile pot at the clinic or at home and delivered quickly. It is painless and involves no needles. The lab looks at volume, how many sperm there are, how well they move, and their shape. NICE asks clinicians to compare results with the World Health Organization reference values, which include:

• Semen volume of 1.4 ml or more.
• Sperm concentration of 16 million per ml or more.
• Total sperm count of 39 million or more per ejaculate.
• At least 42% of sperm moving, and at least 30% moving forward.
• At least 4% of sperm with a typical shape.

These are lower reference limits, not pass or fail scores, and the lab or doctor will explain your results in context. One abnormal result does not mean infertility. Sperm counts vary from sample to sample, which is why NICE recommends a repeat test, ideally about three months later, to allow a full cycle of sperm production. If there are no sperm at all or very few, the repeat is done sooner.

The doctor will usually also ask about general health, medicines and past problems. According to the NHS, testicle damage from infection, injury, surgery, testicular cancer or undescended testicles can affect semen quality, as can low testosterone levels.

What affects sperm?

Some things are out of a man's control, but several are not. NICE's 2026 fertility guideline gives clear advice:

• Alcohol. Excessive drinking harms semen quality. Staying within the UK low-risk limit of 14 units a week, spread over several days, is unlikely to affect it.
• Smoking. Smoking is associated with reduced semen quality, and stopping improves general health.
• Weight. Men with a BMI of 30 or over have an increased risk of reduced fertility.
• Heat. Higher scrotal temperature is linked to poorer semen quality, though it is uncertain whether loose underwear improves fertility.
• Work. Some jobs involve exposure to hazards that can reduce fertility, so mention your occupation to your doctor.
• Medicines and drugs. Doctors should ask about testosterone-replacement therapy, finasteride, anabolic steroids and cannabis, among others.

That last point deserves extra attention. Testosterone therapy and anabolic steroids, which some men take to build muscle, can suppress sperm production. The AUA and ASRM guideline is clear that men who want to have children now or later should not be prescribed testosterone therapy. If your partner uses any body-building or "manpower" products, it is worth bringing them to the doctor.

Because sperm take around three months to develop, changes made today show up in the sperm of a few months from now. It is a good reason to start early, alongside the steps in our preconception checklist.

A test that can reveal more than fertility

Semen quality can also be a window into a man's general health. The AUA and ASRM guideline notes that infertile men have higher rates of other medical conditions than fertile men, and that 1% to 6% of men have an undiagnosed medical condition at the time of their fertility evaluation. For a man who has not seen a doctor in years, this check could be the start of better care overall.

Why do so many men avoid testing?

In many African communities, a man's fertility is tied to his sense of manhood, status and respect. Admitting a problem can feel like losing face. A study at a teaching hospital in rural south-east Nigeria found that while most men agreed to a semen test, 12% only agreed after much persuasion and 18% refused. The most common reasons were believing they were healthy and not responsible for the infertility. Some also feared their sample could be used for witchcraft or rituals.

The cost of that silence falls heavily on women. A 2025 review of studies across Africa found infertility stigma to be widespread and deeply embedded in cultural norms. The WHO notes that women in relationships with men are often perceived to be the infertile partner, whether they are or not. Meanwhile, years can pass with a woman undergoing tests and treatments she may never have needed.

How can you raise it with your partner?

There is no perfect script, but a few approaches tend to land better than others:

• Make it "us", not "you". Try: "The doctor wants to check both of us, so we can find out faster."
• Lead with how simple it is. It is a single sample, with no needles involved.
• Pick a calm moment. Not straight after a period arrives or in front of family.
• Address privacy. Reassure him the result stays between the two of you and the doctor. Many clinics have a private room for collection.
• Separate fertility from manhood. Sperm count says nothing about strength, virility or worth, and in around 1 in 4 cases of infertility in the UK, no cause is found at all.
• Bring in a professional. Sometimes a man will hear it from a doctor more easily than from his wife.

If he still refuses, protect your own health and peace. You can continue with your own assessment and ask your doctor how to approach it. Our post on when to see a fertility specialist explains the full first round of tests for both partners, your fertile window covers timing, and Fertility 101 is a good starting point if you are new to all of this.

When should a man see a doctor?

Alongside his partner after a year of trying, or after six months if she is over 35. He should go sooner if he has had testicular injury, surgery or undescended testicles, past sexually transmitted infections, cancer treatment, difficulty with erections or ejaculation, or a lump, swelling or pain in the testicles. A new lump should always be checked promptly, whether or not you are trying for a baby.

Where Asele fits

Asele is built around women's cycles, and that history is useful for both of you. Logging your periods and symptoms helps your doctor rule things in or out on your side, and the Health Brief gives you a short summary to bring to your joint appointment. If you want help finding the words for a hard conversation, Amara can talk it through in Yoruba, Hausa, Igbo, Swahili, French or English. You can find us at Asele.

This post is education, not medical advice. Fertility is a shared journey, and both partners deserve care and answers.

References

1. American Urological Association and American Society for Reproductive Medicine. Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline. auanet.org
2. World Health Organization. Infertility fact sheet. who.int
3. NICE. Fertility problems: assessment and treatment (NG257), 2026. Advice about factors that can affect fertility; Investigation of fertility problems
4. NHS. Infertility: causes. nhs.uk
5. Umeora OU, Ejikeme BN, Sunday-Adeoye I, Umeora MC. Sociocultural impediments to male factor infertility evaluation in rural South-east Nigeria. Journal of Obstetrics and Gynaecology, 2008. pubmed.ncbi.nlm.nih.gov
6. Ekpor E, Brobbey SS, Kumah CY, Akyirem S. Experience of infertility-related stigma in Africa: a systematic review and mixed methods meta-synthesis. International Health, 2025. pubmed.ncbi.nlm.nih.gov