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11 Myths About Male-Factor Infertility

Dr. Barry Witt, Medical Director with WINFertility | July 2, 2021

Male infertility is a male-factor health issue that lowers the chances of a female partner getting pregnant. Unfortunately, because less is known and reported on about male-factor infertility, men are left out of the conversation around reproduction, as society labels infertility as a woman’s issue.

There are many myths surrounding male-factor infertility – here are the most common.

Myth 1: Male fertility is not related to overall health

There are many underlying health problems that can result in male-factor infertility, such as cancer and cardiovascular disease. It is important for men to start with an assessment of their overall health when male infertility is identified.

Myth 2: Infertility is a female-only issue

Infertility is commonly thought of as primarily a female disorder.  However, studies reveal that up to 50% of infertility has a significant male component and about 20% of infertility is purely male-related.  Although women typically initiate the evaluation of their infertility with their gynecologist or reproductive endocrinologist, it is critical to test the male with a semen analysis to see whether there are any male-related fertility issues that need to be addressed.

Myth 3: Men are fertile forever

Beginning at age 35, men experience a significant decline in semen characteristics, including ejaculate volume, sperm motility, and sperm morphology. These characteristics decline further over time, which are reflected in decreased pregnancy rates (25-35% lower in partners of older men) and a longer time to conceive.  The risk of miscarriage is higher if the man is over 45. There has also been a direct link found between a man’s age and an increased risk for autism, schizophrenia, and some genetic mutations in their offspring.

Myth 4:  The “missionary position” is most likely to result in a pregnancy

There is no science-backed evidence that coital position (woman on bottom, man on top) affects the chances of conception. Sperm ejaculated into the vagina reaches the fallopian tubes within minutes regardless of position during intercourse.

Myth 5: Frequent ejaculations decrease male fertility

In men with normal semen quality, sperm concentrations and motility remain normal, even with daily ejaculations. In fact, in men with significantly reduced sperm counts, the sperm concentrations and motility may be highest with daily ejaculations. Longer intervals of abstinence are actually associated with poorer semen characteristics.

Myth 6: Taking supplemental testosterone can enhance a man’s fertility

Men who are planning on creating a pregnancy should not take testosterone. Taking testosterone reduces male fertility; testosterone has been studied as a male contraceptive.   In men who are symptomatic with low testosterone levels, and who are not planning on creating a pregnancy with their partner, taking supplemental testosterone can be helpful by improving libido and energy levels. But it suppresses the pituitary gland and shuts down sperm production often resulting in very low or absent sperm in the ejaculate, which can last for many months after discontinuing the testosterone supplementation.  There are alternative medications that can be used for men that want to increase their testosterone level without suppressing sperm production.

Myth 7: Alcohol must be completely avoided by men who are trying to procreate

Chronic alcohol dependence has been associated with lower sperm counts and sperm motility, and heavy alcohol use has been associated with a longer time to pregnancy.  However, the occasional moderate consumption of alcohol has not been proven to result in decreased male fertility.

Myth 8: Smoking doesn’t affect fertility in the male

Smoking increases chances of male infertility by 30 percent. While most men know that quitting smoking has obvious health advantages, many don’t realize how harmful cigarettes can be to fertility.   Smokers have a significantly lower chance of creating a pregnancy each month and smoking as few as five cigarettes per day has been associated with lower fertility rates. It has been shown that there are toxic substances in cigarette smoke that result in lower sperm concentrations and decreased sperm motility.  Cigarettes are the major source of human cadmium exposure (a heavy metal) and cadmium is a proven reproductive toxicant that results in poorer sperm characteristics.

Myth 9: Weight does not affect fertility

Being overweight or obese presents many health issues, but its effect on male fertility may not be obvious.   Obesity causes elevated estrogen and low testosterone levels, which can result in lower sperm counts. Overweight males may also experience a decreased libido and morbidly obese men may have difficulty having effective intercourse.  Diet and exercise are important in trying to bring down the BMI (body mass index) to a more normal level which will improve the semen parameters and the libido.

Myth 10: Drinking coffee causes infertility in males

Caffeine consumption has no demonstrated effect on semen volume, sperm count, sperm concentration or sperm motility in men drinking moderate amounts of coffee per day (up to three cups).

Myth 11: Wearing brief underwear causes a decrease in sperm quality

Some studies suggest that wearing brief underwear may decrease sperm quality by raising the temperature around the scrotum. However, these studies are inconclusive. Things that avoid raising a man’s scrotal temperature, for example, boxers, avoiding hot tubs, and using laptops directly on your lap, may improve sperm quality.

Dr. Barry Witt is a Medical Director with WINFertility. He is board-certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility and has been offering reproductive care for more than 25 years.


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