This Is the Most Common Cause of Male Infertility (and How to Fix It)

If you’ve been trying for a baby and nothing is happening, the vibe in your house can go from hopeful to clinical and depressing pretty quickly. Ovulation strips on the bathroom counter. Group texts from friends who “weren’t even trying.” Googling every possible reason or cause. 

Sadly, a lot of couples hit this wall. Public health experts define infertility as pregnancy that hasn’t happened after a year of unprotected sex. And while our culture loves to treat fertility like a woman’s problem, male factors play a huge role. The most common identifiable cause of male infertility is also one of the least sexy words you’ll hear all week.

It’s called a varicocele. It’s basically swollen veins in the scrotum, similar to varicose veins in the legs. The short version is heat and blood flow. Sperm production hates extra warmth, and a varicocele can raise the temperature around the testicles enough to affect how well the sperm swim and even kill them. Varicoceles are common in the general male population (around 15 percent of men have one) and have higher rates among men dealing with infertility.

The good news is that this is fixable, and you don’t need to white-knuckle your way through guesswork. The first step for most guys is a semen analysis, usually paired with hormone testing if the results look off. A urologist who works with fertility can also do a physical exam and imaging when needed, which is important because a varicocele isn’t something you can diagnose yourself.

How to Treat Male Infertility if a Varicocele is to blame

If a varicocele is the culprit, treatment can be pretty simple. As Dr. Marc Goldstein at NewYork-Presbyterian and Weill Cornell put it, “early repair of varicoceles may prevent both future infertility and hormone deficiency.”

Here are the best ways doctors treat male infertility, including varicocele-related issues.

• Varicocele repair: A procedure, like a microsurgical varicocelectomy or an embolization, to reroute blood flow away from the enlarged veins.
• Medication to support hormones: Your doctor might use meds that boost the body’s own testosterone production or reduce conversion of testosterone to estrogen when that imbalance is part of the problem.
• Lifestyle changes that affect sperm: Weight management, consistent exercise, less heat exposure, and fewer toxins in your daily routine can help sperm parameters in some men.
• Fixing blockages or retrieving sperm: When sperm can’t get where it needs to go, doctors can correct obstructions or retrieve sperm directly for assisted reproduction.

If you’re stuck in the “maybe it’ll happen next month” loop, get the test. It’s not romantic, but neither is month 14 of hoping.

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