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Signs that may be present
- Not conceiving after 12 months of regular unprotected intercourse
- Often no symptoms at all; the problem is found on a semen test
- In some men, low sexual desire or difficulty with erection or ejaculation
- Pain, swelling or a lump in the testis, or a history of undescended testis
Common causes
- Varicocele (enlarged veins around the testis), one of the commonest correctable causes
- Low or absent sperm production, including from hormonal problems
- Blockage in the tubes that carry sperm, or absence of these tubes
- Infections, past mumps, or injury to the testis
- Ejaculation problems, including semen passing back into the bladder
- Smoking, heavy alcohol, obesity, some medicines and heat exposure
How it is evaluated
- History and examination, including the testes and the veins around them
- Semen analysis, usually repeated after an interval
- Hormone blood tests when the sperm count is low
- Scrotal ultrasound, and genetic tests in selected men
- The female partner is evaluated at the same time
Management options
- Lifestyle changes, such as stopping smoking, limiting alcohol and controlling weight
- Medicines for infection or hormonal causes where suitable
- Surgery for varicocele, or to open a blockage, in selected men
- Sperm retrieval from the testis or epididymis for assisted reproduction, together with a fertility specialist
- Counselling for the couple, as in many men no single cause is found
When to see a urologist
Consider a urology review if a couple has not conceived after 12 months, or after 6 months if the woman is over 35. See a urologist sooner for a history of undescended testis, testicular surgery, infection or injury. A semen analysis is the usual first step.
This information is for education and does not replace an examination. Please consult a doctor for your own condition.
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