What causes male infertility? Dr Sanjay Prakash J shares common factors and when to get tested

Fertility issues are common in men and are influenced by a number of factors, explains Dr Sanjay Prakash J, while also sharing the importance of getting tested.

For decades, infertility has largely been perceived as a woman’s health issue. However, contemporary evidence clearly shows that male factors contribute to nearly half of all infertile couples, shared urologist and andrologist Dr Sanjay Prakash J in an interaction with HT Lifestyle.

“One of the biggest challenges is that male infertility is often silent. A man may have normal sexual desire and performance, yet still have poor sperm production. Fertility and sexual performance are not the same,” he stated.

The common factors that play a role in male infertility, according to Dr Prakash J, are presented as follows.

1. Lifestyle factors

As per the doctor, lifestyle plays a significant role in male infertility.

Unhealthy lifestyle can lead to fertility issues in men. (Pexel)

Chronic stress, inadequate sleep, obesity, sedentary work, smoking, vaping, excessive alcohol intake, recreational drug use, and the growing misuse of anabolic steroids for bodybuilding can all impair sperm production.

“Environmental pollutants and endocrine-disrupting chemicals are also emerging concerns, making healthy lifestyle choices more important than ever,” he noted.

2. Medical conditions

Medical conditions are as important as lifestyle factors.

“Varicocele, an enlargement of the veins surrounding the testis, is one of the most common treatable causes of male infertility,” shared the doctor.

Diabetes, hormonal disorders, thyroid disease, undescended testes, previous mumps involving the testes, sexually transmitted infections, certain medications, chemotherapy, and radiation therapy can also affect fertility, he added

3. Genetic causes

According to Dr Prakash J, men are increasingly being diagnosed with severe sperm abnormalities due to genetic causes.

“Conditions such as Y-chromosome microdeletions, chromosomal abnormalities, and other inherited disorders may present as azoospermia (complete absence of sperm in the semen) or extremely low sperm counts,” he shared.

When should men get tested?

As Dr Prakash J stated, “While these diagnoses can be emotionally challenging, advances in medical technology have enabled many men to achieve biological fatherhood. Early diagnosis also provides valuable information for family planning and genetic counselling.”

When it comes to couples, those who have not conceived after one year of regular unprotected intercourse should undergo evaluation, noted the doctor. Also, those who are above the age of 35 should also get checked up.

“Men with risk factors - including undescended testes, previous genital surgery, cancer treatment, recurrent genital infections, anabolic steroid use, or a family history of infertility - should not delay assessment,” he further cautioned.

According to Dr Prakash J, the conversation around fertility also needs to begin earlier.

“Just as young adults undergo routine health screening, a premarital fertility evaluation can identify potential issues before couples start planning a family. Likewise, a basic fertility assessment should be considered alongside annual preventive health check-ups, especially in young men with unhealthy lifestyles or chronic medical conditions,” he noted.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.

Dr Sanjay Prakash J, MS(GS), DrNB(Uro), FMAS, FIAGES, FAMH, FECSM, is a Consultant Urologist and Microsurgical & Cosmetic Andrologist specialising in male infertility, male sexual disorders, and microsurgical procedures at the Asian Institute of Nephrology and Urology, Chennai.