Fertility Isn’t Just a Woman’s Job: Why Both Partners Should Get Checked

When a couple has trouble getting pregnant, the testing often starts, and sometimes stops, with the woman. She gets the blood work, the ultrasounds and the cycle tracking, while her male partner waits on the sidelines. But infertility is frequently a shared issue, and checking both partners early can save months of time, money and stress.

This is general information, not medical advice. Please talk to your doctor about your own situation.

Male factor infertility is common

Male factor infertility means a problem with sperm, such as how many there are, how well they move or their shape, or with getting sperm to where it needs to go. It’s not rare. Male factors are estimated to contribute to roughly 30 to 50 percent of couples’ infertility, either on their own or alongside a female factor. In some couples, both partners have something that affects fertility.

That’s why major fertility organizations recommend evaluating both partners at the same time when a couple is having trouble conceiving. Testing only one person can miss half the picture.

When to get checked

Infertility is generally defined as not getting pregnant after 12 months of regular, unprotected sex. Doctors usually recommend starting an evaluation:

• After 12 months of trying, if the woman is under 35.
• After 6 months of trying, if the woman is 35 or older.
• Sooner, if there’s a known issue, such as irregular periods, PCOS, a history of pelvic infection or endometriosis in the female partner, or a history of testicular problems, cancer treatment, undescended testicles or erection or ejaculation problems in the male partner.

If either partner has a known condition that affects fertility, there’s no need to wait out the full year. For women with PCOS, our post on PCOS questions to ask your doctor includes fertility questions to raise.

What testing involves for men

For men, the first step is usually simple and noninvasive:

• A semen analysis. A sample is collected, typically after a few days without ejaculation, and examined in a lab for sperm count, movement and shape, along with the volume of the sample. Because results can vary from one sample to another, an abnormal result is often repeated.
• A medical history and physical exam. A doctor will ask about past illnesses, surgeries, medications, lifestyle and sexual function, and may examine the testicles.
• Further tests if needed. Depending on results, this can include hormone blood tests, genetic testing or an ultrasound. A referral to a urologist who specializes in male fertility may be suggested.

Compared with the testing many women go through, the first round for men is quick. That’s one more reason to do it at the start rather than at the end.

Common causes, and what can help

Some causes of male infertility are treatable or improve with changes. Others need fertility treatment to work around. Examples include:

• Varicocele, an enlargement of the veins in the scrotum. It’s one of the most common findings in men being evaluated for infertility, and it can sometimes be treated.
• Hormone problems, which may respond to medication.
• Blockages in the tubes that carry sperm, which can sometimes be repaired surgically or worked around.
• Testosterone use. Taking testosterone or anabolic steroids can sharply reduce sperm production. Men trying to conceive should tell their doctor if they use either.
• Lifestyle factors. Smoking, heavy drinking, recreational drug use, obesity and frequent heat exposure, such as hot tubs, are linked to poorer sperm health.

Sperm take roughly two to three months to develop, so lifestyle changes take a while to show up in test results. That’s another reason to test early.

When needed, treatments such as intrauterine insemination (IUI) or in vitro fertilization (IVF), sometimes with a technique that injects a single sperm into an egg, can help many couples with male factor infertility conceive.

Making it a shared process

Fertility struggles can strain a relationship, especially when one person feels like the “problem.” Testing both partners together reframes it as something you’re working on as a team. A few practical ideas:

• Book both evaluations at the start. Many fertility clinics can arrange the semen analysis at the first visit.
• Go to appointments together when you can, and keep a shared list of questions.
• Talk about how much you want to share with family and friends before anyone asks.
• Consider counseling or a support group. Organizations such as RESOLVE: The National Infertility Association offer support for both partners.

Check what your health insurance covers for fertility testing and treatment before you start, since coverage varies a lot by plan and by state. If your doctor only orders tests for one partner, it’s reasonable to ask about testing the other at the same time.