Male fertility: causes, assessment and GP guidance

Male fertility plays a role in around half of couples experiencing difficulty conceiving. Fertility issues in men are common and often treatable or manageable once contributing factors are identified.

This page explains how GPs assess male fertility, which tests are useful, what results can and cannot show, and when referral to specialist care is appropriate.

These articles are intended as educational sources, not diagnostic nor taking place of a proper medical assessment. If you need help, please book an appointment with one of our GP’s.

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What male fertility depends on

Male fertility is influenced by several factors, including:

Sperm production and quality
Hormonal balance
Testicular health
General physical and mental health
Lifestyle factors

Problems may affect sperm count, movement or shape, or interfere with sperm delivery.

Common causes of male fertility problems

Sperm-related factors

These include:

Low sperm count
Reduced sperm movement
Abnormal sperm shape

Many men with abnormal semen results have no obvious symptoms.

Hormonal factors

Hormones involved in sperm production include:

Testosterone
Follicle-stimulating hormone (FSH)
Luteinising hormone (LH)

Hormonal causes are less common but important to identify.

Lifestyle and environmental factors

Fertility may be affected by:

Smoking
Excess alcohol
Obesity
Recreational drug use
Heat exposure to the testes
Stress and poor sleep

Addressing these can improve fertility over time.

Medical and structural causes

Less common causes include:

Varicocele
Previous testicular injury or infection
Surgery affecting the reproductive tract
Certain genetic conditions

How GPs assess male fertility

Initial GP assessment usually includes:

How long pregnancy has been attempted
Frequency and timing of intercourse
Medical and medication history
Lifestyle factors
Sexual function and erectile concerns

Fertility is always considered as a couple issue, even when symptoms appear to be on one side.

Semen analysis explained

Semen analysis is the key initial test for male fertility.

It assesses:

Sperm count
Sperm movement
Sperm morphology

Results can vary, so an abnormal result is often repeated before conclusions are drawn.

A single abnormal test does not always mean permanent infertility.rather than routine and should be discussed with a GP for a full assessment.

Explore convenient home sperm testing kits with GP follow up.

Hormone tests and blood tests

Blood tests may be considered if semen results are abnormal or if symptoms suggest hormonal involvement.

Tests may include:

Testosterone
FSH and LH
Prolactin
Thyroid function tests

Hormone testing is targeted, not routine.

What male fertility tests can and cannot tell you

What they can help with

Identifying sperm production problems
Detecting hormonal causes
Guiding referral decisions

What they cannot do

Predict natural conception with certainty
Replace assessment of the female partner
Guarantee success of fertility treatment

Normal tests do not always mean pregnancy will happen quickly, and abnormal tests do not always prevent conception.

Testosterone and fertility

Testosterone is important for male health, but external testosterone treatment can suppress sperm production.

Men trying to conceive should not start testosterone therapy without specialist advice.

Testosterone and male hormone balance.

When referral to specialist care is appropriate

Referral may be considered if:

Semen analysis is persistently abnormal
There is suspected hormonal or structural disease
Pregnancy has not occurred after appropriate time
There are significant risk factors or previous testicular problems

GPs aim to ensure timely and appropriate referral.

Emotional impact of fertility concerns

Fertility difficulties can affect confidence, relationships and mental wellbeing. Men may be less likely to talk about fertility concerns, but support and clear information can make a significant difference.

GPs can help address both physical and emotional aspects of fertility concerns.