Male infertility is contributing to a large share of fertility struggles among Australian couples, with specialists warning that stigma and delayed testing continue to place emotional and medical strain on families.
Melbourne urologist Associate Professor Darren Katz says male factor infertility is present in half of all couples who experience difficulty conceiving and is the sole factor in around 30 per cent of cases.
The issue remains sensitive in many close-knit communities where fertility struggles are still commonly associated with women, despite growing medical evidence pointing to shared reproductive health challenges between partners.
Associate Professor Katz said misconceptions around male fertility remained widespread, particularly the assumption that physical appearance reflected reproductive health.
“A man can appear perfectly healthy externally but still produce zero sperm,” he said. “You cannot judge fertility by appearance, because only a tiny fraction of semen volume is actually sperm, the rest is supportive fluid.”
He also warned about the growing use of testosterone and steroids among men trying to conceive.
For instance, common gym drugs like testosterone or steroids are actually “poison for sperm and can cause complete infertility”, Associate Professor Katz says. Recovery can take six to 12 months after stopping, sometimes longer, while some men may never fully recover fertility.
Even men with naturally low testosterone should avoid testosterone treatment if they are actively trying to conceive or may wish to have children in future, he said, adding that alternative medications could help boost testosterone in a “sperm friendly” way.
Associate Professor Katz also points to varicoceles, enlarged veins in the testicles, as a common contributor to male infertility.
“They are actually the most common cause of secondary infertility, which is when a couple struggles to have a second child after successfully fathering their first,” Associate Professor Katz says.
Varicoceles affect around 15 per cent of men and are linked to IVF outcomes and recurrent miscarriages. Australia’s new male infertility guidelines devote six separate guideline statements to the condition.
Associate Professor Katz said men also faced age-related fertility decline, although the process was generally less defined than for women.
“Sperm quality undergoes a gradual decline beginning around ages 40 to 50, which brings a small but increased relative risk of genetic issues and autism spectrum disorder in offspring.”
He said many men continued to avoid testing because fertility remained closely tied to ideas around masculinity and pride.
“Fear or shame often stops men from getting tested, leaving women to undergo multiple, unnecessary treatments,” Associate Professor Katz says.
Even men with naturally low testosterone should avoid testosterone treatment if they are actively trying to conceive or may wish to have children in future
Australia’s first male infertility guidelines, which Associate Professor Katz helped develop, recommend both partners undergo testing together after six to 12 months of actively trying to conceive.
Testing is described as straightforward and non-invasive, with specialists encouraging couples to approach fertility as a shared medical issue rather than assigning blame.
“Attending appointments as a team and recognising that seeking professional counselling is a sign of strength, not weakness, can transform the entire experience.”
The pressure placed on couples by extended family and community expectations can further intensify the emotional burden, particularly for migrant families navigating cultural expectations around parenthood.
Associate Professor Katz said couples should focus on making decisions together and avoid external judgement.
“Present a united front. Make decisions based on what is best for the two of you as a couple, not what is best for parents or community expectations.”
“There should be no judgment, no blame, and no shame. When couples face this medical issue together with open hearts, it doesn’t pull them apart, it actually brings them closer than ever before.”
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