Male-factor infertility basics: Advice from a urologist

For one-third of different-sex couples experiencing infertility, male-factor issues are the main cause — the same rate as female-factor issues. But up to 27% of the time, the male partner does not undergo an infertility evaluation.

Aaron Spitz, MD, a urologist treating patients at Carrot partner OC Urology Associates, wants to make sure male-factor infertility is always a part of the conversation. Between seeing patients, he spreads the word about male-factor infertility through writing and regular TV appearances as an infertility expert.

We talked with Dr. Spitz about the importance of including male-factor fertility testing as part of a fertility journey. He discussed advice for those just starting their fertility journey, how people can ensure strong collaboration between doctors, and some of the lifestyle changes he recommends to his patients.

When addressing male-factor fertility challenges, what do you recommend individuals and couples look for in a clinic and doctor?

Look for a fertility specialist who is fellowship trained in male-factor infertility. For different-sex couples who are planning to go through IVF, they should look for a male-factor fertility specialist who has a strong collaborative relationship with reproductive endocrinologists that they may also be working with. Your male-factor fertility specialist should have the scheduling flexibility to accommodate planned and unplanned sperm retrieval procedures to coincide with the egg retrieval of their partner. This requires sophisticated and experienced schedulers and lab personnel that work as a team in coordination with your reproductive endocrinologist.

What advice do you have for people just starting their family-forming and fertility journey?

Don’t just assume infertility is a “female issue.” Common sperm health issues are related to volume, count, concentration, motility (how well they move), and morphology (size, shape, and appearance). Occasionally, male-factor infertility can be a sign of other health problems which may go undetected without a proper evaluation.

It's also important to understand that female age plays an important role in fertility. If a different-sex couple knows male-factor infertility will need to be addressed, it’s better to start treatment as soon as possible. If you already know there is a male-factor fertility issue, a doctor should still evaluate both partners so you don’t miss an issue that may delay successful treatment.

In the case of someone whose infertility is due to a vasectomy, there is no time limit after which a vasectomy reversal will not work. The probability of success declines with passing years, but there is no cut-off after which it cannot work. However, for some people, sperm extraction for use with IVF is a better option, for example, when female-factor fertility is also an issue.

You’re interested in the relationship between nutrition and male-factor fertility. Can you share more about that?

I recommend that my patients adopt a predominantly plant-based diet to the degree that they are able while minimizing added sugars and preservatives. Research demonstrates that this diet is associated with better semen quality.

I encourage weight loss when a person is overweight and may recommend intermittent fasting or other weight-loss approaches in addition to a plant-based diet. More research is needed, but studies suggest that obesity negatively impacts sperm health. I also recommend nutritional supplements that have been scientifically demonstrated to improve sperm quality. In addition, I advise against excessive alcohol intake, cigarette smoking, or frequent marijuana use — all of which may be detrimental to sperm health.

What advice do you have for addressing the mental and emotional side of male-factor fertility?

The stress of infertility can play on the mind of those facing it and interfere with sexual intimacy. It’s not uncommon to experience erectile dysfunction as a result, and this should be addressed, not ignored. It can usually be easily remedied temporarily with safe medication and counseling.

Is there anything else you’d like to add?

I am grateful to be able to help people faced with the challenge of male-factor infertility or sexual dysfunction. It’s gratifying to see the joy or relief they experience from successful therapy or getting answers to questions about a condition that may not always be completely fixable but can be better understood.

If you’re a Carrot member, sign in to your Carrot account to search for fertility and family-forming services near you, including OC Urology. Carrot partners offer exclusive benefits like priority booking and lower negotiated rates.

If you’re a fertility care or family-forming service provider interested in supporting Carrot members or want to learn more about working with Carrot, please contact us at

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