By Dr Sascha Edelstein
For many years, infertility has often been thought of as a women’s issue. It’s a perception that’s still remarkably common, but it’s simply not accurate.
Infertility affects around one in six couples, and when you look at the data, male factor is involved in up to half of those cases. In around 20 to 30 per cent of couples, it is the sole cause.
Despite this, men are still often assessed later than women, or sometimes not assessed at all. Couples can spend months investigating and treating one partner while half of the picture goes unexamined.
Thankfully, that’s beginning to change.
Towards the end of 2025, Australia published its first evidence-based clinical guidelines for the assessment and management of male infertility. These are an important step forward because they reinforce something fertility specialists have known for many years. If you’re trying to understand why a couple isn’t conceiving, you need to assess both partners from the very beginning.
Why I Call Male Fertility "Half the Picture"
Conception takes two people. That’s why it has always struck me as a little odd that, historically, we’ve often investigated only one.
When a couple isn’t conceiving, the male partner contributes to the outcome about half the time, either on his own or alongside a female factor. That’s why I describe male fertility as half the picture. Not because I’m trying to shift the focus away from women, and certainly not because I’m trying to assign blame, but because it’s impossible to properly understand a couple’s fertility while only looking at one partner.
In my experience, assessing both partners together makes the journey more efficient. Instead of working through one investigation after another, we can build a complete picture from the outset, identify contributing factors earlier, and make better decisions about the next steps.
For couples, that often means fewer delays, fewer unnecessary tests and a clearer understanding of what they’re dealing with.
Why the New Australian Guidelines Matter
The publication of Australia’s new male infertility guidelines is genuinely significant.
Until now, Australian clinicians have largely relied on European and American guidelines. They’ve been excellent resources, but they don’t always reflect how fertility care is delivered in Australia or how our healthcare system works.
These new guidelines were developed by an expert Australian panel and endorsed by Healthy Male, the Fertility Society of Australia and New Zealand, and Australia’s leading urological and endocrine organisations. Together they provide more than 80 evidence-based recommendations covering everything from assessment through to treatment.
Perhaps the most important message isn’t complicated at all.
Both partners should be investigated together.
For patients, this means a more consistent standard of care across Australia and a greater expectation that male fertility will be assessed thoroughly, rather than being treated as an afterthought.
If a couple has been trying to conceive for 12 months without success, both partners should be investigated.
When Should Male Fertility Be Investigated?
One of the questions patients often ask me is, “When should the man actually be tested?”
The answer is simpler than many people expect. If a couple has been trying to conceive for 12 months without success, both partners should be investigated.
If the female partner is over 35 years of age, or either partner has known risk factors, such as previous cancer treatment, undescended testes, reproductive surgery or other medical concerns, we generally recommend starting investigations after around six months instead.
What I don’t recommend is investigating one partner while waiting months before looking at the other. Assessing the male partner doesn’t slow the process down. It happens alongside the female assessment and, in many cases, shortens the journey because we’re gathering all of the important information at the same time.
One of the biggest advantages of doing this early is that we sometimes identify problems that are treatable before a couple ever needs IVF. Even when IVF ultimately becomes the right option, understanding the male partner’s fertility helps us tailor treatment appropriately rather than making assumptions based on incomplete information.
A Semen Analysis Is Only the Starting Point
Many people assume that a semen analysis tells us everything we need to know about male fertility. It doesn’t.
A semen analysis is an important first step, but it’s only one part of a much broader assessment.
When we assess a male patient, we want to understand far more than the numbers on a pathology report. We start with a detailed medical and reproductive history, including previous pregnancies, medications, illnesses, surgery and lifestyle factors. A physical examination is equally important because conditions such as a varicocele, which is an enlargement of the veins around the testes, or differences in testicular size can only be detected by examining the patient.
Part of that history also means asking about sexual function. It isn’t always an easy subject to raise, but difficulties such as erectile dysfunction or problems with ejaculation are more common than many men expect, can directly affect a couple’s chances of conceiving, and are very often treatable. They can occasionally be an early sign of other health concerns too, such as cardiovascular or hormonal issues, which is one more reason it’s worth discussing openly rather than leaving unspoken.
Depending on what we find, we may also recommend hormone testing, genetic testing or imaging.
I often explain it like this. A semen analysis tells us about the sample. The rest of the assessment tells us about the man and often explains why the semen analysis looks the way it does.
A Normal Semen Analysis Doesn't Always Mean Everything Is Normal
This is one of the biggest misconceptions. A normal semen analysis is reassuring, but it doesn’t rule out male fertility problems. The reference ranges we use are based on men who have successfully conceived. They are not a simple pass or fail test.
That means a man with results that fall within the normal range can still have fertility issues. Equally, a man whose results fall below the reference values may still conceive naturally.
A standard semen analysis also has limitations. It doesn’t tell us everything about how sperm function, nor does it assess the integrity of sperm DNA.
That’s why we don’t interpret a semen analysis in isolation. It needs to be considered alongside the couple’s history, examination findings and, where appropriate, further investigations.
What Causes Male Factor Infertility?
One of the questions couples often ask is whether we’ll be able to identify the exact cause.
Sometimes we can. Sometimes we can’t.
In fact, in around three quarters of men, we don’t identify one single cause. That doesn’t mean the assessment hasn’t been worthwhile. Quite the opposite. A thorough work-up helps us identify the men with conditions that are potentially treatable, while also ruling out more serious underlying problems.
Among the causes we can identify, a varicocele is one of the most common. Hormonal disorders, genetic conditions, previous undescended testes, genital tract blockages, previous injury or surgery, certain medications, age and lifestyle factors can also contribute.
The important thing is not simply finding a diagnosis. It’s understanding whether there’s something we can treat, whether we can improve sperm health, or whether assisted reproductive treatment is likely to offer the best chance of success.
Looking after your fertility isn't just about trying to conceive. It's also an opportunity to improve your long-term health.
Does Lifestyle Really Make a Difference?
Patients often ask whether changing their lifestyle will improve their fertility.
The honest answer is yes, but it’s important not to oversimplify it.
Smoking, carrying excess weight, heavy alcohol consumption and repeated heat exposure, such as frequent hot tubs, saunas or even regularly resting a laptop on your lap for long periods, can all affect sperm production. These are all recognised in the new Australian guidelines and are worth addressing.
At the same time, I don’t want patients to think there’s one magic change that will suddenly solve everything. Male fertility is rarely that simple.
What I encourage men to focus on is improving their overall health. In many cases, what’s good for your general health is also good for your fertility. That’s important for another reason too. We now know that male infertility can be an early marker of a man’s broader health. Men with fertility problems have a higher risk of conditions such as cardiovascular disease and metabolic disease later in life. This was one of the strongest themes at this year’s Fertility Society of Australia and New Zealand annual conference, where Professor Michael Eisenberg of Stanford University, one of the world’s leading researchers in this field, described a man’s fertility as a window into his overall health. Large studies following men over decades back this up, showing that semen quality tracks long-term health in a measurable way.
Some of the most exciting research in this area is happening close to home. At the University of Melbourne, Dr Liz Bromfield and her team are studying the biology that connects sperm health with the health of the rest of the body, working towards a future where a semen analysis could double as an early health check for men. That work is still at the research stage rather than something any clinic can offer today, but it reinforces a simple, practical message: looking after your general health is one of the best things you can do for your fertility, and vice versa.
Looking after your fertility isn’t just about trying to conceive. It’s also an opportunity to improve your long-term health.
What About the Headlines That Sperm Counts Are Falling?
This is a question we frequently hear, and it’s a fair one to ask. You may have seen headlines warning that sperm counts have declined over the past few decades, or even predictions that men could effectively run out of sperm within a generation. It’s an alarming message, and it understandably worries a lot of the men and couples that we see.
The picture is far less certain than the headlines suggest. The research most often quoted does report a downward trend in sperm counts over time, but the studies behind it have real limitations. They pool men who were tested in very different ways, in different parts of the world, across more than fifty years, using laboratory methods and reference standards that have changed enormously in that time. When you look closely, the differences between regions are often larger than the change over time, and some more recent studies haven’t found a decline at all. Healthy Male, the national men’s health organisation behind Australia’s new guidelines, has reviewed this evidence and reached a similar conclusion, noting that geography appears to matter more than generation when it comes to sperm quality.
A similar caution applies to the worry about environmental chemicals, sometimes called endocrine disruptors, such as those found in some plastics. It’s a reasonable thing to be concerned about, and it’s biologically plausible that these chemicals could affect reproduction. But as Healthy Male points out, causation in humans is far from established, and the more familiar and better-evidenced factors, such as weight, smoking and general health, are often left out of the conversation.
None of this means there’s nothing you can do. Some people understandably want to take a more proactive approach to their environment, and there are sensible, low-risk steps for those who wish to: filtering drinking water, storing and heating food in glass rather than plastic to limit contact with microplastics, choosing fresh wholefoods and organic produce where it’s practical and affordable, and, for some, a carefully targeted course of supplements.
The direct evidence these measures improve fertility is mixed rather than definitive, so they are best seen as part of a broader healthy-lifestyle approach rather than a guaranteed fix. Antioxidant supplements are a good example. They are heavily marketed to men trying to conceive, and a large Cochrane review suggested they may modestly improve the chances of pregnancy and live birth, but only on low-certainty evidence, while a more recent randomised trial, the SUMMER trial, found no clear benefit. They may still have a role for some men, but they should never replace the fundamentals. For anyone who wants to explore this properly, my advice is to do so with guidance, ideally as a coordinated plan involving your fertility team and, where appropriate, a qualified practitioner in nutritional or environmental medicine. That way any supplements are genuinely targeted rather than a scattergun, and the effort stays on the changes most likely to make a difference.
Put into perspective, while it is easy to feel powerless when the message is that something invisible in the environment is quietly harming your fertility. The more useful truth is that the factors with the strongest evidence behind them are largely the ones within your control, and that is where I’d encourage any man to focus his energy.
Can Sperm Health Be Improved?
One of the encouraging things about male fertility is that, in many cases, it can.
Sperm are constantly being produced, but they take around three months to develop. That means the changes you make today are unlikely to be reflected in your semen analysis for around three months.
This is why we encourage patients to think about consistency rather than quick fixes.
The changes most likely to make a meaningful difference include achieving a healthier weight, stopping smoking, moderating alcohol intake, staying physically active and avoiding unnecessary heat exposure to the testes.
Where there’s a specific medical problem, such as a hormonal disorder or a significant varicocele, treating that condition may improve sperm parameters even further.
Does Male Factor Infertility Always Mean IVF?
One of the most reassuring conversations I have with couples is explaining that a diagnosis of male factor infertility does not automatically mean IVF.
The right treatment depends entirely on the underlying cause. For some men, improving lifestyle factors or treating an underlying medical condition may be enough to improve fertility. Others may benefit from hormone treatment or surgery to correct a varicocele or a blockage.
Even in situations where there are very few sperm, or no sperm in the ejaculate at all, modern surgical techniques can often retrieve sperm directly from the testes for use in fertility treatment.
IVF, particularly IVF with ICSI, has transformed what’s possible for many couples and remains an incredibly valuable treatment. However, I always see it as one option within a much broader spectrum of care, rather than the default answer.
There is one important exception that surprises many men.
Testosterone therapy is sometimes promoted as a way to improve male health and vitality, but men who are trying to conceive should not be prescribed testosterone. Although it may increase testosterone levels in the bloodstream, it actually suppresses sperm production and can significantly reduce fertility.
Every couple's situation is different, which is why our approach is always individualised.
How We Approach Male Fertility at Thrive
At Thrive, we treat the couple. That means assessing the male partner at the outset, rather than after every possible female factor has been investigated first. Focusing only on the female partner risks two things. First, it can miss a cause that’s sitting in plain sight. Second, it can mean putting a woman through investigations or treatment for a problem that may not be hers alone to solve.
We also look at male fertility as part of a man’s overall health, rather than simply focusing on a semen analysis result. In many ways, a fertility check is also a health check.
If we identify something that’s treatable, we’ll discuss the available options. If assisted reproductive treatment is the best path forward, we’ll explain why. Most importantly, we want couples to understand what’s happening and make decisions based on good evidence rather than assumptions.
Every couple’s situation is different, which is why our approach is always individualised.
If there’s one message I’d like couples to take away, it’s that male fertility really is half the picture.
Getting the male partner assessed early isn’t about assigning blame or pointing fingers. It’s about understanding what’s happening as quickly and as accurately as possible.
The encouraging news is that while male fertility problems are more common than many people realise, they’re often modifiable, and in some cases they’re treatable. A proper assessment can also provide valuable insights into a man’s broader health.
If you and your partner have been trying to conceive without success, don’t assume the investigation should begin with only one of you.
Assessing both partners from the beginning gives us the best opportunity to identify the cause, choose the most appropriate treatment, and give you a clear understanding of your options for moving forward.
If you’d like to learn more about your fertility, or you’re ready to take the next step, our team is here to help. We’ll talk through where you’re both at and help you decide on the right next step, at a pace that suits you.
Contact us to get started.