Many couples need help to have a baby. About 1 in 7 couples struggle to get pregnant. In up to half of these couples, the man’s health plays a role. The good news: many causes can be found and treated.

When should we get checked?

• If you have tried to get pregnant for 12 months without success.

• If your partner is 35 or older, consider an evaluation after 6 months of trying.

• Seek a consultation sooner if you have testicle pain or swelling, problems with erections or ejaculation or a history of genital surgery or injury.

What can cause male infertility?

Male fertility depends on healthy sperm and clear pathways from the testicle to the urethra. Problems can include:

• Low sperm count, movement, or shape (these affect how sperm reach and enter the egg).

• Blocked tubes (for example, after infection or surgery).

• Varicocele (enlarged veins in the scrotum).

• Hormone problems (the brain and testicles must signal each other to make sperm).

• Ejaculation problems (for example - semen going backward into the bladder, called ‘retrograde ejaculation’).

• Infections or past sexually transmitted infections.

• Genetics (some men are born with changes in genes that affect sperm).

• Medicines and substances (anabolic steroids and testosterone therapy can lower or stop sperm production).

How do we make a diagnosis?

You’ll talk about your health, medicines, lifestyle, and any past surgeries. We also do a focused exam.

Key tests may include:

1) Semen analysis

This is the most common test. We usually ask for two separate semen samples because results can change from day to day. Before each sample, avoid ejaculation for 2 to 7 days. The lab looks at semen volume, sperm number, movement, and shape.

To help you understand results, here are typical lower reference values used by many labs (WHO 2021). Some men with “low” numbers still father children, and some with “normal” numbers still need help. These numbers are guides, not pass/fail grades. Your provider will review them with your full history.

• Volume: 1.4 mL

• Sperm concentration: 16 million per mL

• Total sperm per ejaculate: 39 million

• Progressive motility: 30%

• Normal forms (shape): 4%

• Vitality (live sperm): 54%

2) Blood tests

Hormone tests (such as FSH, LH, testosterone, and sometimes prolactin) can point to problems with sperm production or hormone signalling.

3) Imaging (when needed)

An ultrasound of the scrotum can look for a varicocele or other issues. If we think there is a blockage near the prostate or ejaculatory ducts, imaging such as transrectal ultrasound or, in select cases, pelvic MRI may be used. (Not every patient needs imaging.)

4) Genetic testing (in select patients)

Some men with very low sperm counts or no sperm need genetic tests. Current guidelines suggest considering Y‑chromosome microdeletions when a man has azoospermia (no sperm) or very low sperm counts. Karyotype testing (to look at chromosomes) and CFTR testing (when the vas deferens is absent) may also be advised.

5) Other tests (case by case)

• Retrograde ejaculation can be checked by looking for sperm in the urine after orgasm.

Treatment options

Your plan will match the cause(s) we find. Often, more than one step helps.

Healthy habits that help sperm

• Stop anabolic steroids and avoid testosterone therapy while you are trying to conceive; they can shut down sperm production. If you have low testosterone and want fertility, ask us about medicines that raise your own testosterone instead.

• Quit smoking.

• Limit alcohol and avoid recreational drugs.

• Aim for a healthy weight and regular exercise.

• Protect the testicles from heat (limit hot tubs and very high‑heat jobs when possible).

• Manage medical problems like diabetes and high blood pressure.
  Small changes can improve sperm over time.

Medicines

• Hormone therapy (for certain hormone problems).

• Clomiphene or aromatase inhibitors may be used to boost your own testosterone if you’re trying to keep fertility.

• Antibiotics for infections when present.

• Retrograde ejaculation: medicines that tighten the bladder neck (such as pseudoephedrine or imipramine) may help semen move forward.

Important: Do not start or continue testosterone replacement if you are trying to conceive now or soon.

Procedures

• Varicocele repair (varicocelectomy): If you have a palpable varicocele and abnormal semen, surgery can improve sperm in many men and can raise natural pregnancy chances for some couples. It’s usually recommended only when a varicocele can be felt on exam and you are trying to conceive.

• Unblocking ducts: If semen flow is blocked, surgery can sometimes open the pathway.

• Sperm retrieval: If there is no sperm in the semen, an attempt might be made to take sperm directly from the testicle or epididymis (for example, TESA/TESE/micro‑TESE). These sperm are usually used with IVF/ICSI, so you would need to see our colleagues in Moncton, Halifax or elsewhere to consider this (there is no IVF center in Saint John).

Assisted reproductive technologies (ART)

These methods work with the female partner’s care team. The IVF labs we work with most commonly are Atlantic Fertility in Halifax and Conceptia in Moncton.

• IUI (intrauterine insemination): Washed sperm are placed in the uterus around the time of ovulation.

• IVF (in vitro fertilization): The egg and sperm meet in the lab.

• ICSI (intracytoplasmic sperm injection): One sperm is injected into one egg; this helps when sperm counts, movement, or shape are very low, or after surgical sperm retrieval.

• Donor sperm may be an option.

FAQs

Can normal sperm numbers still mean trouble?
Yes. A “normal” semen test does not guarantee pregnancy, and a “low” result does not mean you can’t have a child. Your full health picture matters.

How fast will we see changes?
Changes in sperm often show over weeks to months. We’ll time re‑checks so you can see progress.

Is testing painful?
Semen testing is not painful. Most blood tests are simple draws. Imaging, when needed, is usually quick.