Infertility impacts about one in six couples worldwide, and is often viewed as primarily a woman’s issue. Yet male-factor infertility contributes to roughly half of all cases. 

That imbalance is starting to shift.

As Men’s Health Month puts a spotlight on overlooked areas of men’s well-being, reproductive health is gaining overdue attention—prompting experts to push for a more balanced, informed approach to fertility.

“Men are often less likely to openly discuss infertility diagnoses,” says Dr. Timothy Dunn, a reproductive endocrinologist at Aspire Fertility in Houston.

“And even when male-factor infertility is identified, women typically undergo the majority of treatments. That’s why it’s important that the narrative shift to capture the realities of infertility – that it can affect men as much as it can women.”

The Foundation: Understanding Sperm Health

At the core of male fertility is sperm health, measured by three key factors, including count, motility, and morphology.

A healthy sperm count exceeds 15 million per milliliter, while

motility refers to how effectively sperm can swim, which is critical for reaching and fertilizing an egg. Morphology, or shape, also plays a role, as properly formed sperm have a higher likelihood of success.

“Sperm production can be an indicator of overall health,” Dr. Dunn explains. “When something is off, it may point to underlying medical issues that might otherwise go unnoticed.”

Factors Contributing to Male Factor Infertility

What’s raising concern among specialists is that sperm health appears to be declining globally, with lifestyle and medical factors playing a significant role, and one of the most overlooked contributors to male infertility is the growing use of testosterone therapy.

Prescriptions have surged in recent years, particularly among men under 35, many of whom are in their prime family-building years. According to Dr. Dunn, his practice is seeing a significant rise in male-factor fertility diagnoses because of testosterone use. And he explains how that works, noting, “When external testosterone is introduced, the body stops producing its own. And because testosterone and sperm production are closely linked, this can reduce or even halt sperm production.” Dr. Dunn continues, “Unfortunately, if a man has used testosterone for a significant time without other therapies, even when stopping testosterone, sperm counts do not always recover back to initial, pretreatment levels.”

He warns that while testosterone use can have benefits to improving mood, energy, and strength, it’s important for men who are trying to or planning to have children to be aware of the potential disruption to their fertility. “If a man is wanting to conceive now or in the future, my recommendation as a fertility specialist would be to not use testosterone if possible, and to consider other potential therapies that wouldn’t harm fertility,” notes Dr. Dunn. “But if testosterone is needed, I’d recommend he only use it under the care of someone with fertility experience to ensure options are explored to protect fertility health as much as he can.”

Lifestyle Matters More Than You Think

Daily habits can have a measurable impact on fertility.

Diets high in processed foods and sugars are associated with poorer sperm quality, while nutrient-rich options—think leafy greens, fish, nuts, and citrus—can help support reproductive health.

Alcohol, caffeine, and smoking also play a role. Studies suggest that higher alcohol consumption can reduce sperm production and increase abnormalities, while excessive caffeine may lower sperm concentration. And smoking can decrease sperm quality and quantity, trigger hormonal issues, and cause erectile dysfunction. All of this lowers the success of the sperm in fertilizing the egg.

Experts generally recommend no more than one to two alcoholic drinks per week, limiting caffeine intake to about 300 milligrams per day, and refraining completely from smoking.

Physical health is another critical piece of the puzzle. Excess weight has been linked to reduced sperm quality and even DNA damage, which can increase the risk of infertility and miscarriage.

But the good news is that with simple lifestyle changes, like improved diet, reduced alcohol and caffeine intake, and boosting exercise, male fertility can improve.

How to Treat Male Factor Infertility

“Luckily, medical advances are helping more patients overcome male factor infertility,” says Dr. Dunn. “Options may include surgery to correct anatomical obstructions, medications like clomid, or assisted reproductive technologies like intrauterine insemination (IUI) or in vitro fertilization (IVF). In some cases, especially if a medical condition has led to a complete lack of sperm production, donor sperm use can be very effective to help achieve a pregnancy.”

Here, Dr. Dunn breaks down the three most common reproductive technologies to help aspiring parents facing male-factor infertility:

Intrauterine insemination (IUI): IUIs are one of the most basic and least invasive forms of fertility care. In an IUI, the sperm is washed to achieve the best possible quality before being placed directly into the female patient’s uterus

In Vitro Fertilization (IVF): IVF is ideal for more severe cases of male-factor infertility. Specialists use a technique called intracytoplasmic sperm injection (ICSI), where the sperm is directly injected into an unfertilized egg to create an embryo. In some cases, embryos are frozen and undergo testing, like pregenetic implantation testing, to determine which embryo has the highest chance of resulting in a live birth. After testing, the embryo is transferred into the woman’s uterus.  

Sperm Donor: In severe cases of male factor infertility, a couple may need to explore using a sperm donor to help build their families. Donor banks, like MySpermBank, offer a wide range of profiles where patients can review a donor’s physical characteristics, medical history, familial medical history, education, career, hobbies, etc. After a sperm donor is identified, patients can work with their fertility providers to determine if the best course of treatment is an IUI or IVF.

Changing the Narrative

As awareness grows, so does the opportunity to reshape how fertility is approached.

“Fertility health is men’s health,” Dr. Dunn says. “When planning a family, it’s just as important for men to evaluate their lifestyle and health as it is for their partners.”

With more open conversations and earlier intervention, experts say couples can improve their chances—and begin to close the long-standing gap in how infertility is understood.

To schedule a consultation or learn more, please visit Aspire Fertility at aspirehfi.com.