Male Infertility: Understanding the Causes, Risk Factors and When to Seek Help

Infertility is a reproductive health concern that can affect both men and women. Globally, about 1 in 6 people experience infertility during their lifetime, making it an important health issue that deserves proper medical attention. Infertility may be caused by male factors, female factors, a combination of both, or sometimes the cause may not be identified.
In Ghana, male infertility is also an important concern. Research conducted among Ghanaian men has identified abnormalities in sperm count, movement and shape, as well as factors such as infections, lifestyle and environmental exposures that may affect semen quality. However, available Ghanaian studies do not provide sufficient nationally representative data to establish one definitive prevalence figure for male infertility across the country.
For couples trying to have children, it is important to remember that infertility is not solely a woman's issue. Men can contribute to infertility, and appropriate evaluation of both partners is an important part of fertility care.
What Is Male Infertility?
Male infertility refers to difficulty achieving a pregnancy because of problems affecting the male reproductive system.
For pregnancy to occur, the male reproductive system must produce healthy sperm, transport the sperm effectively and release sufficient numbers of functional sperm into the semen.
Problems with sperm production, sperm quality, sperm movement, the reproductive organs, hormones or the passage of sperm can therefore affect fertility.
What Are the Signs of Male Infertility?
The most common sign of male infertility is difficulty achieving a pregnancy with a partner despite regular, unprotected sexual intercourse.
In many cases, there may be no obvious symptoms.
However, some men may experience symptoms associated with an underlying condition, including:
•    Difficulty achieving or maintaining an erection.
•    Problems with ejaculation.
•    Pain, swelling or a lump in the testicles.
•    Reduced sexual desire.
•    Recurrent infections affecting the reproductive system.
•    Changes in the size or appearance of the testicles.
•    Previous injuries or surgery involving the testicles, groin or reproductive system.
Having none of these symptoms does not necessarily mean that fertility is normal.
What Causes Male Infertility?
There are many possible causes of male infertility, and sometimes more than one factor may be involved.
1. Problems With Sperm Production
The testicles are responsible for producing sperm. Conditions that interfere with normal testicular function can reduce sperm production or affect sperm quality.
These may include:
•    Varicocele, which is an enlargement of veins around the testicle.
•    Testicular injury.
•    Undescended testicles.
•    Certain infections.
•    Hormonal disorders.
•    Genetic conditions.
•    Certain medical treatments, including chemotherapy and radiation.
2. Low Sperm Count
A man's semen may contain fewer sperm than expected. A low sperm concentration can reduce the likelihood of sperm successfully reaching and fertilising an egg.
However, sperm count is only one part of fertility. Sperm movement and shape are also important.
3. Poor Sperm Movement or Shape
For successful fertilisation, sperm need to move effectively and have appropriate structural characteristics.
Abnormal sperm movement, known as poor motility, or abnormalities in sperm shape, known as abnormal morphology, may reduce the chances of fertilisation.
Recent research among men undergoing infertility evaluation in Ghana has reported abnormalities involving sperm concentration, motility and morphology, highlighting the importance of proper semen evaluation.
4. Blockages in the Reproductive Tract
Sperm must travel through a series of tubes before being released in semen.
Previous infections, injuries, congenital conditions or surgeries can sometimes cause blockages that prevent sperm from being released normally.
5. Infections
Certain infections can affect sperm production or quality and may cause inflammation or scarring within the reproductive system.
Sexually transmitted infections and other infections affecting the testicles or reproductive tract may contribute to fertility problems.
Some Ghanaian research has also investigated the relationship between infections, environmental exposure and semen quality among Ghanaian men.
6. Hormonal Problems
The production of sperm depends on a carefully regulated hormonal system.
Problems involving the testicles, pituitary gland, thyroid or other parts of the endocrine system can affect hormone levels and interfere with sperm production.
7. Varicocele
A varicocele occurs when veins around the testicle become enlarged.
It is one of the recognised causes of male infertility and may affect sperm production and quality.
8. Erectile and Ejaculatory Problems
Infertility may sometimes be associated with difficulty achieving or maintaining an erection, problems with ejaculation or other sexual difficulties.
These conditions may have physical, hormonal, psychological or relationship-related causes and should be medically assessed.
Lifestyle and Environmental Factors
Some lifestyle and environmental factors may negatively affect male reproductive health.
These include:
•    Smoking and exposure to tobacco smoke.
•    Excessive alcohol consumption.
•    Use of anabolic steroids.
•    Certain recreational drugs.
•    Obesity and unhealthy weight.
•    Prolonged exposure to excessive heat around the testicles.
•    Exposure to certain pesticides, industrial chemicals and heavy metals.
•    Certain medications.
•    Poorly controlled chronic health conditions.
Research involving Ghanaian men has also examined environmental and lifestyle factors, including heat exposure, chemical exposure, smoking, alcohol use and prolonged sitting, in relation to semen quality.
Who Is at Risk?
A man's risk of fertility problems may be higher if he has:
•    A history of testicular injury or surgery.
•    Undescended testicles.
•    Previous reproductive or sexually transmitted infections.
•    A history of infertility.
•    Certain hormonal or genetic conditions.
•    Obesity or other long-term health conditions.
•    A history of chemotherapy or radiation treatment.
•    Regular exposure to certain chemicals or toxins.
•    Smoking, excessive alcohol use or anabolic steroid use.
•    Problems with sexual function or ejaculation.
When Should a Man See a Doctor?
If you and your partner have been having regular, unprotected sexual intercourse without achieving pregnancy for 12 months, it is advisable to seek medical evaluation.
You should consider seeking medical advice sooner if there is a known or suspected fertility problem, previous testicular or reproductive surgery, a history of testicular injury, sexual dysfunction, or other concerns affecting reproductive health.
Importantly, fertility evaluation should involve both partners. Delaying assessment of the male partner can sometimes delay the identification and treatment of a potentially manageable condition.
How Is Male Infertility Evaluated?
A healthcare professional will usually begin with a detailed medical and reproductive history and a physical examination.
Depending on the individual's circumstances, evaluation may include:
•    Semen analysis.
•    Hormonal testing.
•    Assessment for infections where clinically indicated.
•    Examination of the testicles and reproductive system.
•    Imaging or other investigations when necessary.
•    Further specialist evaluation to identify underlying conditions.
A semen analysis can provide important information about sperm concentration, movement and morphology, but it is only one part of a complete fertility assessment.
Can Male Infertility Be Treated?
In many cases, male infertility can be evaluated and managed once the underlying cause is identified.
Treatment depends on the cause and may include treatment of infections or hormonal problems, management of certain reproductive conditions, surgical treatment where appropriate, lifestyle modifications, or referral for assisted reproductive techniques when necessary.
The appropriate treatment should be determined by a qualified healthcare professional after proper evaluation.
What Can Men Do to Protect Their Fertility?
While not all causes of male infertility can be prevented, men can take steps to support their reproductive health:
•    Avoid smoking.
•    Limit excessive alcohol consumption.
•    Avoid anabolic steroids and illicit drugs.
•    Maintain a healthy weight.
•    Manage chronic health conditions properly.
•    Protect yourself from sexually transmitted infections.
•    Seek medical attention for testicular pain, swelling or injury.
•    Minimise unnecessary exposure to pesticides, chemicals and other toxins.
•    Discuss medications that may affect fertility with a healthcare professional rather than stopping prescribed medication on your own.
•    Seek medical evaluation when pregnancy does not occur after a reasonable period of trying.
Male Infertility Is a Medical Condition, Not a Cause for Shame
Infertility can be emotionally difficult for couples and may be accompanied by stress, stigma and social pressure.
Male infertility should not be viewed as a measure of a man's masculinity or worth. It is a medical condition that deserves proper evaluation, understanding and appropriate care.
If you and your partner are experiencing difficulty conceiving, do not assume that the problem is with the woman. Both partners should be appropriately assessed.
New Crystal Hospital Is Here to Help
At New Crystal Hospital, we understand that concerns about fertility can be deeply personal. Our Urology Services provide specialised medical care for men experiencing conditions affecting the urinary and reproductive systems, including concerns that may be associated with male infertility.
If you are experiencing difficulty conceiving or have concerns about your reproductive health, speak with a qualified healthcare professional and take the first step towards understanding the cause. (Call us today: 0544347239 / 0800180260)

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