The Missing Piece: Understanding the Role of Male Fertility in the Journey to Parenthood

Male fertility accounts for up to half of all infertility cases and yet men are rarely offered the tests, the information, or the support they need. It's time that changed.

Picture this scene. A couple has been trying to conceive for over a year. The woman has had blood tests, ultrasounds, hormone panels and follow-up appointments. She's changed her diet, started supplements, downloaded the apps. Her partner has had one semen analysis perhaps told his results were 'within normal range' and has largely been left to wait on the sidelines. No one has sat down with him to explain what those results actually mean, what else could be investigated, or what he could do to genuinely improve their chances together.

This is not an unusual story. In my practice, it is an extremely common one. And it speaks to a significant gap in how we support men through the fertility journey.

Men often come to this process feeling helpless. They want to do something; they want to contribute but they're rarely told what that something is. The system simply isn't set up to investigate or support them in the same way it does women.

The numbers make a compelling case for change. Sperm count has declined by nearly 63% since 1973 a staggering shift that has been described as a public health crisis. Sperm abnormalities now account for 40 to 50% of all infertility cases. And yet the fertility conversation continues to centre almost entirely on women.

More Than Just Numbers

There's a particular kind of pressure that falls on men when a couple is struggling to conceive. Fertility is still, culturally, coded as something that belongs to women which means that when a male factor is eventually identified, it can feel like a shock, even a source of shame. Men are not always given the language or the space to process this. They are handed a result and sent on their way.

One of the first things I want men to hear is this: a finding on a semen analysis or sperm health test is not a verdict. Poor sperm quality does not mean infertility. It means there is something to work with a starting point, not a full stop. Sperm health is dynamic and responsive, and in the vast majority of cases where structural issues have been ruled out, it can be meaningfully improved. I have seen men transform their results through targeted nutrition, lifestyle changes and appropriate supplementation. The diagnosis is the beginning of the investigation, not the end of the road.

What men are rarely told is how much agency they actually have. Because sperm takes approximately 70 to 90 days to be produced, the choices a man makes today will directly shape the quality of the sperm he produces three months from now. That is a genuine and meaningful window of opportunity, not a platitude.

Sperm quality matters in ways that go beyond simply achieving conception. High levels of DNA fragmentation, damage to the genetic material carried within each sperm cell, have been linked to a 2.5 times increased risk of miscarriage. Research also suggests that paternal health may influence pregnancy complications such as preeclampsia and gestational diabetes, and potentially has longer-term implications for child health. These are reasons why male fertility deserves to be taken every bit as seriously as female fertility and why men deserve proper investigation and support, not an afterthought appointment.

Secondary Infertility: Don't Forget the Male Factor

There is another group of couples who are often overlooked in this conversation entirely: those who have already had a child and are struggling to conceive again. Secondary infertility, difficulty conceiving after a previous successful pregnancy, is far more common than many people realise, and it carries its own particular pain. The assumption is often that because it worked before, the issue must lie elsewhere. But sperm quality is not fixed. It changes over time, and the male factor is just as relevant second time around as it was the first.

Age, lifestyle shifts, new health conditions, increased stress, or simply the passage of time can all affect sperm quality between pregnancies. I regularly work with couples experiencing secondary infertility where a thorough male investigation had never been considered because of the previous successful conception. Investigating both partners fully regardless of fertility history is always the right approach.

The Testing Men Deserve

A single semen analysis, while a useful starting point, is not the full picture. And 'normal' on a standard test does not always mean 'optimal'. In my experience, many men with results that fall within reference ranges are still experiencing sperm quality issues that are simply not being detected.

A thorough investigation should include a hormonal blood panel, testosterone, FSH, LH, prolactin, alongside thyroid function, nutrient status and metabolic markers. A semen analysis should look not just at count but at motility, morphology and markers of infection. Beyond that, DNA fragmentation testing offers a much deeper look at sperm health at a cellular level. Results below 15% are considered optimal, while results above 25% are associated with poor reproductive outcomes and warrant further action. A semen culture can also identify low-grade infections within the seminal microbiome something that is rarely tested for routinely, but which can have a direct impact on both sperm quality and a partner's vaginal health.

Couples experiencing unexplained infertility, recurrent pregnancy loss, secondary infertility, or repeated IVF failure should be actively encouraged to pursue this level of investigation on the male factor. Not as an afterthought as a priority.

What Men Can Actually Do

Once a man understands that sperm health is modifiable, and that he has real tools at his disposal, the sense of helplessness often lifts. That shift — from passive bystander to active participant is one of the most rewarding things I witness in my work.

Diet is one of the most accessible places to start. A Mediterranean-style approach rich in vegetables, oily fish, nuts, seeds and healthy fats consistently supports sperm quality. Cooked tomatoes offer lycopene, a powerful antioxidant with well-documented benefits for sperm. Two handfuls of mixed nuts daily, particularly Brazil nuts, walnuts and almonds, provide selenium and zinc. Oily fish two to three times a week delivers DHA, an omega-3 essential for sperm membrane health. Refined sugars, processed foods and charred or blackened food are worth reducing.

Lifestyle adjustments matter too. Smoking and vaping are strongly associated with sperm DNA damage. Excessive heat from saunas, hot tubs or tight underwear can impair sperm production. Chronic stress, poor sleep and excessive alcohol all work against hormonal health. Supplementation can offer additional targeted support a good men's prenatal multivitamin, omega-3 fish oil and CoQ10 are commonly recommended, with personalised dosing always preferable to a one-size-fits-all approach.

Stronger Together

The fertility journey can be isolating. For men especially, it can feel like something happening around them rather than with them. They watch their partners endure appointments, procedures and emotional upheaval, while feeling unsure of their own role or whether they even have one. I want to say clearly: you do.

When both partners invest in their health ideally for at least three months before trying to conceive outcomes improve for everyone. Men who feel informed and involved, who understand what they can contribute and have been given real tools to work with, are better partners through the process. They feel less like bystanders and more like participants in something they can genuinely influence.

If the male side of the equation hasn't been fully explored in your journey so far whether you're trying for the first time or the second please know that it is never too late. The support exists. Men simply need to be pointed towards it, and given the same care and attention that we so readily offer everyone else.