UNC Health Care
black and white pattern of sperm

Male Infertility: What You Need to Know

UNC urologist and male fertility specialist Matt Coward, MD, would like to start a conversation about male infertility. As the general understanding of male infertility has grown over the years, the myth that fertility issues are a female problem has been debunked. But, he says, there is still a wide gap in the number of men who are evaluated for infertility.

According to Dr. Coward, more than a million women make infertility-related office visits each year, but only 20 percent of their partners will receive an evaluation. In addition, many of these evaluations focus only on achieving one goal: conception. But focusing solely on conception can ignore the root causes of infertility.

While it may be an uncomfortable subject for men, Dr. Coward suggests you talk about it with your primary care doctor long before you end up in his office because, he says, fertility is a barometer of a man’s health.

“Many men defer this conversation because it’s uncomfortable. But it’s much easier when patients are evaluated earlier, when they suspect there might be a problem but aren’t necessarily looking to conceive right away,” Dr. Coward says.

If you have concerns about fertility, Dr. Coward recommends asking your primary care physician to order a semen analysis. A primary care physician can help begin treating any underlying issues outside of the stress of trying to conceive.

Here are a few common causes of infertility, according to Dr. Coward.

Lifestyle Issues

Certain habits, such as smoking, excessive alcohol intake, poor sleep habits and poor diet can lead to fertility issues. A visit to your primary care physician can help identify these factors and offer strategies for quitting smoking or improving your diet.

“Men who are unhealthy may have an abnormal semen analysis. That could be because they are overweight or because they smoke or have uncontrolled diabetes,” Dr. Coward says.

Dr. Coward also says many popular supplements used by fitness enthusiasts can have negative effects on fertility. He says these supplements—particularly pre-workout and testosterone boosters, but even branched-chain amino acids and others that are used to increase strength—can be laced with chemicals related to anabolic steroids that can harm users.

“Many of the products that are advertised as making your muscles big can make your testicles atrophy,” Dr. Coward says.

He recommends avoiding workout supplements and discussing any other vitamin supplements you are taking with your primary care physician.

Medical Issues

The most common medical condition Dr. Coward sees is varicocele, an enlargement of the veins above the testicles. As the testicles descend, they bring the blood supply down from near the kidneys. The length of the vein carrying blood between the kidneys and testicles makes it susceptible to becoming dilated over time. Though 15 percent of men have this condition, many don’t have symptoms. Varicocele is most often diagnosed by a physical examination.

“Of the men who come in with an abnormal semen analysis, around half will have a varicocele,” Dr. Coward says.

The condition is treated through a minor outpatient surgical procedure.

“If you are having trouble conceiving and have an abnormal semen analysis and a varicocele, getting that fixed is usually recommended,” Dr. Coward says. “It’s very safe and very effective.”

In addition, a host of rarer conditions can cause infertility, including hormonal imbalances. Finally, male infertility is associated with increased risk of a range of cancers.

Dr. Coward says that while many men experiencing infertility don’t have any other symptoms, a few things should prompt a discussion with your doctor. Those include sexual problems, erectile dysfunction, abnormal ejaculation and a history of testicular problems.

Ultimately, Dr. Coward wants men to be comfortable discussing these issues with a physician and asking about a semen analysis the way they might discuss any other routine test.

“It’s not something you should be afraid of,” Dr. Coward says. “It’s an easy test we do in the office at UNC Fertility, any physician can order it, and it provides so much information about a man’s health and fertility.”


If you have concerns about infertility, talk to your doctor. If you do not have one, find one near you.