Male fertility: why men need to join the conversation sooner

Fertility challenges are not just a female issue, yet men often postpone testing despite its importance. 

Specialists say early assessment can make a significant difference in understanding and addressing potential causes.

Male fertility plays a bigger role in conception than many people realise, and the data backs this up. In around half of all cases where a couple struggles to conceive, male factors are either the primary cause or a contributing factor. That means if you and your partner are trying to start a family, getting yourself tested is not optional; it's essential.

But men are far more likely to delay seeking help than women. Dr Neelan Pillay, an obstetrician and gynaecologist specialising in reproductive medicine at Mediclinic Sandton, sees this regularly. "Many men are reluctant to believe they have an issue and hesitant to do tests to check their fertility," he says.

Here's the reality: a fertility test for men is straightforward. It involves providing a semen sample, which is then analysed to assess sperm count, quality and movement. It’s quick, non-invasive, and it gives you and your partner real answers.

The longer you wait to get tested, the fewer options you may have. Getting tested isn’t a weakness; it’s taking charge, stepping up, and finding out what’s really going on, so you and your partner can move forward with clarity.

Understanding the factors that affect male fertility can help couples make informed decisions earlier and seek the right support.

Male fertility matters more than you might think

The numbers tell a clear story. Of all couples struggling to conceive, one in four cases involves:

• A male factor
• A female factor
• A combination of both
• An unexplained reason.

“There’s still a common belief that difficulties with conception are mainly caused by problems on the woman’s side,” says Dr Pillay. “But male factors contribute to a significant proportion of fertility challenges, either on their own or together with female factors."

Male fertility is largely linked to sperm quality, quantity and movement, all of which can be influenced by overall health and lifestyle. The good news is that many of these factors are within your control.

Age plays a role for men too

Most people know that female fertility changes with age. Fewer realise that the same is true for men, and the implications are significant.

“There’s a decline in male fertility as early as the ages of 35, and significantly from the ages of 45,” says Dr Pillay.

For men facing medical treatments such as chemotherapy, radiation, or certain surgeries, fertility preservation becomes even more critical. “If treatment may damage sperm, it's advisable to store and freeze sperm beforehand so there are options available in future," advises Dr Pillay. This means that even after treatment, if sperm quality is affected, previously frozen sperm can be thawed and used to fertilise eggs, giving you a way forward.

Lifestyle factors that can harm sperm health

Lifestyle plays a significant role in male fertility, and Dr Pillay is clear about the main culprits. “The biggest things we know that can affect sperm health are smoking and alcohol and when we talk about smoking, that includes cigarettes, marijuana, cigars, and vaping.”

Other contributing factors include:

• Excess weight or obesity
• Sedentary lifestyle
• General metabolic health
• Certain environmental exposures (including chemicals found in food packaging, clothing, and plastic cups and plates)
• Heat around the testes, which can result from prolonged sitting, tight underwear, and frequent hot baths or saunas.

Dr Pillay's advice to support reproductive health is straightforward:

• Start focusing on your overall health early
• Maintain a healthy weight
• Stay active
• If you drink alcohol, limit how much and how often – binge drinking is more harmful than moderate consumption
• Cut out smoking and vaping entirely.

Are there warning signs of male fertility problems?

One of the most important things to understand about male fertility is that there are seldom obvious red flags that something is wrong. “There are no specific signs that tell us a man’s fertility is declining,” says Dr Pillay. “Erectile dysfunction does not tell you that sperm quality is not going to be good either."

In most cases, concerns only become apparent once a couple starts trying to conceive. Current guidance generally recommends:

• Consulting a healthcare professional after 12 months of trying to conceive if the female partner is under 35
• Consulting a healthcare professional after six months if the female partner is 35 or older
• Earlier assessment if there are concerns such as erectile dysfunction, ejaculation difficulties, or a history of medical treatments that may affect fertility.

A fertility assessment usually involves taking a medical history, a physical examination, and a semen analysis. Consulting a specialist and getting tested are proactive and necessary steps.

Fertility treatment has come a long way

A diagnosis that shows you have an issue isn’t the end of the road. Many male fertility challenges can be treated or managed, depending on the underlying cause.

“If there are functional problems like erectile dysfunction, those may be treated medically,” says Dr Pillay. “If sperm factors are involved, we can investigate further and explore different treatment options." In cases where elevated oxidative stress in sperm is identified, antioxidant therapy may be recommended.

Advanced techniques such as intracytoplasmic sperm injection (ICSI) allow a single sperm to be injected directly into an egg during assisted reproduction – meaning even men with very low sperm counts have a viable path to fatherhood. In some cases, sperm can also be retrieved directly from the testes if there is an obstruction affecting its natural release.

"There are several options for men who cannot conceive naturally," Dr Pillay emphasises. “It all depends on where the problem lies."

Don't wait. Act now!

Fertility is a shared journey, but when men disengage early, valuable time can be lost for both partners. “The longer a couple waits to seek medical attention, the older they’re both becoming, and that decreases the chance of treatment success,” says Dr Pillay. “The more proactive men are, the quicker a couple can get help, and the higher the success rate of treatment.”

His single most important piece of advice? Don’t wait. Get tested, get informed, and take action while you still have the most options available to you.