Dispelling Common Myths About Men’s Reproductive Health & Fertility

*We recognize that the use of gendered language may be triggering for some individuals. In this article, when we refer to “males” or “men,” please know we are referring to individuals who were born with testes.

About 50% of all infertility cases are male factor, which disproves a major misconception that infertility is solely an issue for individuals with ovaries. When it comes to the health of men and individuals who were assigned males at birth*, we know that fertility needs to be part of the conversation, so that members of our community can make fully informed decisions about their reproductive health — even independent of where they are on their path to parenthood.

When it comes to evaluating fertility and finding treatment options for underlying issues, as well as deciding what lifestyle choices should (and should not!) be made to optimize fertility wherever possible, there are several myths and misconceptions surrounding men's reproductive health that need to be addressed:

Diagnosing & Addressing Male-Factor Infertility

MYTH: Infertility is a female issue.

FACT: Male infertility is responsible for about half of all infertility cases, making it essential to consider both partners when addressing fertility issues and to include semen analysis among your tests and fertility evaluations.

Dr. Chen, a urologist at Stanford, says “Men and individuals assigned male at birth come in to see me for fertility evaluations for a variety of reasons: they and their partners may not have had a successful pregnancy within 12 months of purposeful, timed intercourse and are undergoing a fertility workup together; they may have known infertility risk factors such as a varicocele, history of cancer treatment, hormone, genetic, or congenital comorbidities; the female partner is over the age of 35, or if the individual is simply curious or anxious about his fertility potential.”

MYTH: Men's fertility remains constant throughout their lives.

FACT: Male fertility declines with age, just like in women. While men can continue to produce sperm throughout their lives, the quality and quantity of sperm tend to decrease with age, affecting fertility. You are considered to be of advanced paternal age at around 45–47 years old. 

MYTH: Abnormal semen parameters are not treatable.

FACT: If your semen analysis finds that you have abnormal semen parameters that might be impacting your ability to conceive (including quantity, morphology, and motility), there are treatment options available so that you can achieve your dream of parenthood. While your urologist may be able to recommend lifestyle changes or prescribe medications to improve your outcome in some cases, it is also possible that seeing a fertility specialist is the next step toward understanding your treatment options - which may include intrauterine insemination (IUI) or in vitro fertilization (IVF). 

Dr. Chen advises “For patients being seen in our Urology clinic for concerns of male factor infertility, we typically recommend that they see a reproductive endocrinologist if the female partner hasn't been evaluated yet (since fertility is a team sport), if there's a history of recurrent miscarriages, or other female infertility risk factors like advanced age, PCOS, etc. We also recommend a visit to the reproductive endocrinologist if our own evaluation of the male/AMAB patient reveals any uncorrectable sperm deficiencies that would likely require intrauterine insemination or in-vitro fertilization for next steps in treatment.”

MYTH: Virility and fertility are the same .

FACT: Healthy sexual function and high sex drive, unfortunately, are not indicators that you have healthy, functional sperm and will have an easier time conceiving — and, as Posterity Health points out, possessing physical traits associated with traditional “masculinity” does not mean you are less likely to have sperm issues. 

Urologist Dr. Turek points out, however, that there is a meaningful link between male fertility and overall health and wellness: “Think of sperm production as an engine that really wants to run as hard as possible. If maintained well and left on its own, it will perform at its peak. The responsibility of the owner of the engine (i.e. the man) is to optimally support its performance, and the way to do that is to take great care of yourself. East well, sleep well, stay lean, exercise and reduce stress. A healthy body supports optimal fertility. It also makes you the most productive person you can be and adds to longevity.”

Lifestyle Choices & Fertility

MYTH: Smoking and alcohol have no impact on male fertility.

FACT: Both smoking and excessive alcohol consumption can impair male fertility. Smoking can lead to DNA damage in sperm, while excessive alcohol intake can reduce testosterone levels and sperm quality. Since sperm regenerates in the testes every 90 days, consider making any necessary lifestyle changes 3 months before you start trying to conceive.

Dr. Turek adds, “One thing to note here is that lifestyle issues or choices such as tobacco, pot, hot tubs, saunas, diet and obesity, matter greatly for male fertility potential and can be fixed without medications or surgery. In other words, there are often practical, health-related fixes to male infertility issues.”

MYTH: Tight underwear can lead to infertility.

FACT: Wearing tight underwear, such as briefs, has been falsely linked to male infertility. While it can slightly increase scrotal temperature, this is unlikely to have a significant impact on fertility. Nonetheless, it's advisable to opt for comfortable, breathable underwear to promote overall reproductive health.

MYTH: Masturbation decreases likelihood of natural conception.

FACT: Masturbation is a normal and healthy activity. It does not lead to infertility or any adverse effects on male fertility. In fact, regular ejaculation can help maintain healthy sperm production.

Even if you are not actively trying to start or grow your family, Dr. Chen emphasizes the importance of being educated on male reproductive health, and its potential impact on men’s health overall: “The most important takeaway for male/AMAB patients is that their reproductive health is intimately tied to their general health. Poor sperm quality found on our evaluation could be the canary in the coal mine for a more serious medical condition. Research has shown that infertile men are more likely to have metabolic, cardiovascular, hormonal, and genetic comorbidities. Male infertility has been linked to higher risks of certain cancers, and even mortality.”