Signs that may point to infertility in men

Ejaculation disorders

Absent ejaculation, a very low volume, retrograde ejaculation (semen entering the bladder) or painful ejaculation can interfere with sperm delivery. These problems may be linked to prostate surgery, diabetes, certain medications or an obstruction of the genital tract.

Erectile dysfunction

Persistent difficulty obtaining or maintaining an erection mechanically reduces the chances of conception. It is also a general health signal: it is frequently associated with diabetes, high blood pressure, smoking or a hormonal disorder, and deserves an assessment in its own right.

Testicular abnormalities

Small testicular volume, marked asymmetry, pain, a lump, or the sensation of dilated veins (varicocele) are reasons to consult. An undescended testicle in childhood, even if operated on, is an important part of the history to mention.

A history of genital infection or surgery

Orchitis (notably after mumps in adulthood), epididymitis, a sexually transmitted infection, inguinal hernia repair or testicular surgery may have affected sperm production or transport.

Only a semen analysis documents an abnormality

None of these signs allows a conclusion. Conversely, their absence guarantees nothing: a man with no symptoms at all can have a markedly abnormal semen analysis. The reference test is the semen analysis, carried out in a specialised laboratory and usually repeated a few weeks apart, because results vary from one sample to the next.

It assesses sperm concentration, motility and morphology, among other parameters, against World Health Organization reference values.