Male Infertility in Nigeria: Causes, Symptoms, Diagnosis and Treatment

By: Foluke Akinwalere.  Health & Wellness Writer. Medically reviewed by:  By: Azuka Ezeike, MBBS, FWACS (Obstetrics and Gynaecology), FMCOG, MSc. (Public Health). 

 

Couple having conversation in their bedroom about infertility. Image credit: Freepik

 

Highlights

• Male infertility in Nigeria contributes to nearly half of all infertility cases.
• Common causes of male infertility include low sperm count, poor sperm motility, hormonal imbalances, infections, and genetics issues.
• Lifestyles factors like smoking, alcohol, obesity, and stress can significantly affect male fertility.
• Men with infertility may show no obvious symptoms other than the inability to father a child.
• Diagnosis usually involves a physician taking a good history, performing full physical exams, and conducting tests like semen analysis, hormone level checks, and imaging.
• Treatment options range from counselling, lifestyle changes and medications to surgery and assisted reproductive techniques like IVF.
• Many Nigerian men delay seeking help due to cultural stigma, myths, and fear of judgment.
• Early diagnosis and intervention increase the chances of successful treatment.
• Male infertility is a manageable condition—with proper support, most men can still achieve fatherhood.

 

Introduction

According to the World Health Organisation, infertility is defined as failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse by a couple. [1] It is a condition that can be caused by several factors that include diseases and dysfunctions of the male or female reproductive organs.  But when the problem lies specifically with the male partner, it is referred to as male infertility.

Infertility is a deeply emotional and sensitive issue that affects many couples in Nigeria.  While it is often assumed to be a woman’s issue, male infertility accounts for nearly half of all infertility cases. [2] Unfortunately, many men in Nigeria are unaware of their fertility status or are reluctant to seek help due to cultural beliefs, stigma, and lack of information.

This article will shed light on male infertility in Nigeria—its causes, risk factors, symptoms, diagnosis, treatment, and prevention. Its goal is to help men understand that infertility is not a curse or a personal failure. It is a medical condition, and like many others, it can be managed or treated successfully with the right approach.

 

Understanding Male Infertility 

 

Fig. 1  Image of human male reproductive system. Click on image to enlarge.

 

Male Infertility is a medical condition in which a man has difficulty getting a woman pregnant due to problems with his reproductive system. It means that the man’s sperm is not able to fertilise a woman’s egg, either because of low sperm count, poor sperm quality, or other reproductive challenges.

For a man to naturally achieve fertility and successfully impregnate a female partner, several key factors must align:

 

Fig. 2  Image of sperm cells swimming towards female egg. Image credit Freepik

 

• He must produce a sufficient number of healthy sperm in his testicles. A normal sperm count ranges from 15 million sperms and above per milliliter of semen. If lower than 15 million, the man may have trouble impregnating his partner. [3]

• The sperm must also have a normal shape and structure (morphology), that is, an oval-shaped head, midpiece, and long, uncoiled, thinner tail. 

• The sperm should be able to move actively and swim effectively.

• The man must be able to achieve and maintain an erection.

• During sex, he must be capable of ejaculating semen (the fluid released during ejaculation that carries and nourishes sperm for reproduction).

• The sperm must be able to reach and fertilise the woman’s egg in her fallopian tube.

Any problem affecting one or more of these factors can result in male infertility.

In Nigeria, many people still assume that fertility issues are solely a woman’s problem.  However, study has shown that overall, male factors substantially contribute to about 50% of all infertility cases in Nigeria.[2]  This means that addressing male reproductive health is just as important when it comes to building a family.  Male infertility can be caused by a variety of physical, hormonal, genetic, or lifestyle-related factors. 

 

What Are The Common Causes of Male Infertility In Nigeria?

In Nigeria, major causes of male infertility include infections, hormonal abnormalities, and environmental factors like diet and exposure to toxins. Other contributing factors include genetic disorders, and lifestyles choices. [4]

There are many other possible causes of male infertility, and some of them are treatable—especially when detected early.These causes are generally grouped into three main categories: [5]

1. Pre-Testicular Causes
2. Testicular Causes
3. Post-Testicular Causes

1. Pre-Testicular Causes

Fig. 3:  Illustration of pre-testicular causes of male infertility. Click on image to enlarge.

 

These affect the brain and hormones that control sperm production. They happen before the sperm is even made.  The brain controls the hormones that tell the testicles (the pair of organs that form part of the male reproductive system) to produce sperm.  If these hormones are too low or not working right, sperm production may not happen at all. Examples include:

• Low hormone levels from the brain can reduce sperm output.

• Sexual dysfunctions: These are erection or ejaculation issues which can prevent sperm from being delivered properly. For example, erectile dysfunction, anejaculation (failure to ejaculate), premature ejaculation, or retrograde ejaculation (ejaculating into the bladder instead of out through penis). [5]

• Genetic conditions or chromosomal problems:  Some men are born with genetic issues that affect their ability to have children.  For example, in rare conditions like Klinefelter's syndrome, a man has an extra X chromosome (XXY instead of the usual XY), which can affect the normal growth of his reproductive organs.  Another condition, called Kallmann syndrome, happens when the body doesn’t produce a hormone needed to make sperm, which can also cause infertility.

2. Testicular Causes

Fig. 4:  Illustration of testicular location of causes of male infertility. Click on image to enlarge.

 

These are problems that happen inside the testicles, which are responsible for making sperm. If the testicles are damaged or don’t work properly, sperm production or quality can suffer. Examples includes:

• Testicular cancer or removal of a testicle (orchiectomy).

• Undescended testicles (where one or both testicles did not drop into the scrotum).

• Varicocele: This is a swelling of the veins that drain the testicles.  It is a common and reversible cause of male infertility and may affect sperm quality by increasing heat around the testes.

• Exposure to harmful chemicals or drugs, especially during pregnancy (in the womb), can affect how the testicles develop.

• Certain medications:  Testosterone replacement therapy, antiepileptic drugs, and other medications can contribute to male infertility. [6]  Also any substance that changes blood flow in the testicles or affects how the epididymis works can impact the quality of sperm. [6]

• Infections or injuries that affect the testicles (orchitis).

3. Post-Testicular Causes

Fig. 5: Illustration of post-testicular location of causes of male infertility. Click on image to enlarge.

 

These are the issues with how sperm is transported or ejaculated.  They are problems that occur after sperm is made and it’s time for the sperm to travel out of the body through the penis.  If there's a blockage, damage, or something interfering with ejaculation, the sperm cannot reach the egg. 

Examples include:

• Blocked tubes:  Blockages in the sperm’s pathway, such as in the epididymis (a coiled tube at the back of the testicle that stores and carries sperm), vas deferens (a tube that transports sperm from the epididymis to the urethra during ejaculation), or the ejaculatory duct.

• Post-Vasectomy: Infertility can occur after a vasectomy (a surgical procedure of cutting or blocking the sperm-carrying tubes, which permanently prevents a man from fathering children).

• Retrograde ejaculation:  This is ejaculation into the bladder instead of out of the urethra, which prevents the sperm from being released during intercourse.

• Infections:  Some infections can cause scars that block sperm from passing through.  These include swelling of the epididymis (epididymitis), and STI (sexually transmitted infections) like gonorrhea or Chlamydia.

4. Others (Sperm Problems)

• Azoospermia: Absence of sperm in the ejaculate.

• Oligospermia: Low sperm count

• Abnormal Sperm Morphology: Malformations or irregularities in the sperm’s shape or structure, which can hinder fertilisation.

• Poor Sperm Motility: Inability of sperm to swim efficiently can hinder their ability to reach and fertilise the egg. Even if a man produces enough sperm, they must be able to move effectively (motility) and have the right shape (morphology) to fertilise a woman’s egg.

 

What Are the Risk Factors of Male Infertility in Nigeria?

Understanding what increases the risk of male infertility can help men take preventative actions. In Nigeria, several lifestyle, environmental, and health-related factors can affect a man’s ability to father a child. The key risks that may contribute to male infertility in Nigeria include:

1. Age

Although men remain fertile longer than women, as they get older, especially from age 35 and above, the quality and number of healthy sperm they produce tend to decline. [7]  Also, their testosterone levels may decline, making it harder for them to get a woman pregnant.

2. Lifestyle Habits

Habits such as lack of exercise, smoking, excessive alcohol intake, and drug abuse (e.g. marijuana, cocaine) are harmful to sperm health.

3. Obesity and Poor Diet

Being overweight or obese affects hormone levels and sperm quality.  A poor diet lacking essential nutrients also contributes to Infertility.

4. Industrial and Environmental Toxins

Men who work in environments with pesticides, heavy metals, industrial chemicals or even overheating (like sitting for long in hot environments) may be at risk.  A study revealed evidence of associations between occupational and environmental insecticide exposure and lower sperm concentration.

5. Exposure to Radiation or Frequent Use of Heat Around the Groin Area

Such as using hot tubs, saunas, or placing laptops directly on the lap for long periods.

6. Untreated/Poorly Treated Infections 

Untreated/Poorly treated sexually transmitted infections (STIs) like gonorrhea and Chlamydia can damage the reproductive organs and block sperm pathways.

7. Use of Anabolic Steroids 

Abuse of steroids to build muscle can reduce the number of sperm a man makes and lead to infertility. [8]  

8. Medical History 

Men with a history of undescended testicles, chronic illnesses like diabetes, or testicular cancer are more likely to face infertility.

9. Stress and Mental Health Issues 

High stress levels can interfere with hormone levels and sexual performance, indirectly affecting infertility.

10. Testicular Injury or Surgery 

Trauma to the testicles or past surgeries (like hernia repair or testicular torsion) can damage sperm-producing tissues.

 

In Nigeria, limited access to early healthcare, untreated infections, environmental hazards, and myths about fertility often worsen these risk factors, and this may have emotional and psychological impacts on the man and his partner.

 

What Are the Signs and Symptoms of Male Infertility?

In many cases, male infertility does not show obvious signs or symptoms. A man may feel healthy and function normally but still have problems with his sperm that prevent pregnancy.  The main symptom is usually the inability to get a partner pregnant after a year of regular, unprotected sex.  However, some men may notice other signs that could point to a fertility problem, including:

• Problems with sexual function

This can include difficulty getting or keeping an erection (erectile dysfunction), reduced sexual desire (low libido), or issues with ejaculation, such as little to no semen release or painful ejaculation.

• Changes in the testicles

Some men may notice swelling, pain, or lumps in the testicle area.  Others may feel that the testicles are smaller or softer than usual.

• Visible signs of hormonal imbalance

Low testosterone levels may cause symptoms such as reduced facial or body hair, decreased muscle mass, or enlarged male breasts (a condition called gynecomastia).

• Inability to smell (anosmia)

In rare cases linked to Kallmann syndrome, men may have both infertility and trouble smelling.

• Lower sperm count

This can only be detected through a laboratory semen analysis, which checks the quantity and quality of sperm.

Because many symptoms can be subtle or easily missed, it is important for men to get evaluated by a doctor if pregnancy doesn’t happen within a year—or earlier if there are signs like testicular pain, swelling, or a history or injury or infection.

 

How is Male Infertility Diagnosed in Nigeria?

Diagnosis starts with a visit to a healthcare provider or fertility clinic.  The process is usually straightforward and involves:

• Medical and Sexual History 

The doctor will ask about past illnesses, surgeries, lifestyle habits, sexual function, and any previous attempts to conceive.

• Physical Examination 

The doctor performs a focused check for physical abnormalities in the penis, testicles, and scrotum, and assesses for varicocele or signs of hormonal imbalance.

• Semen Analysis 

This is the most important test.  The man provides a semen sample, which is analysed for sperm count, movement, shape, and overall quality.  Multiple tests may be needed for accuracy.

• Hormonal Testing 

Blood tests may be done to check levels of hormones like, testosterone, FSH, LH, and other hormones that regulate sperm production.

• Scrotal or Transrectal Ultrasound

Ultrasound imaging helps identify blockages or abnormalities in the reproductive organs.

• Genetic Testing 

If sperm count is extremely low or zero, genetic testing may be recommended to identify inherited conditions.

 

What Are The Treatment Options for Male Infertility?

Treatment depends on the underlying cause and may include a combination of the following

1. Lifestyle and Dietary Changes

• Quit smoking and alcohol
• Exercise regularly 
• Eat a balanced diet rich in fruits, vegetables, and antioxidants.
• Reduce stress and improve sleep quality.

These changes can boost natural fertility.

2. Treatment of Infections or Medical Conditions 

Antibiotics can clear infections, and treating conditions like diabetes or hypertension can improve reproductive health.

3. Hormonal Therapy 

If hormone levels are off, medication can help balance them. This might include drugs like clomiphene citrate or injections to stimulate sperm production.

4. Surgery

Procedures such as varicocele repair or surgery to unblock ducts can restore sperm flow. In some cases, sperm may be surgically retrieved from the testicles.

5. Assisted Reproductive Technologies (ART)

For severe infertility, techniques like:

• In Vitro Fertilization (IVF) 
• Intrauterine insemination (IUI)

These procedures are available in major Nigeria cities, including Lagos, Abuja, Port Harcourt, and Ibadan, but they are costly.

6. Counseling and Psychological Support

Dealing with infertility can be emotionally challenging. Counseling helps couples cope with stress, manage expectations, and make informed decisions.

 

Related: 13 Ways to Know Why You Are Infertile with Expert Advice on Treatment

 

How Can Male Infertility Be Prevented in Nigeria?

While not all causes of infertility are preventable, men can take steps to protect their reproductive health.

• Regular Medical Checkups

Early detection of infections, varicocele, or hormonal imbal8ances improves outcomes.

• Avoiding Harmful  Substances

Stay away from tobacco, alcohol, recreational drugs, and performance-enhancing steroids.

• Protecting Testicular Health

• Avoid tight underwear.
• Wear protective gear during contact sports or risky jobs.
• Don’t place laptops or hot items on the lap. This can significantly raise the temperature of the scrotum and decrease sperm quality. [9]

• Healthy Living

Maintain a healthy weight, eat well, stay active, and manage chronic conditions.

• Safe Sexual Practices

• Use condoms consistently and correctly during sex.
• Get tested regularly for STIs.
• Limit the number of sexual partners, preferably, be faithful to one uninfected partner in a mutually monogamous relationship.
• Communicate openly with your partner about sexual history and STI status.

• Limit Exposure to Environmental Toxins

If you work in farming, painting, or chemical industries, use protective clothing and follow safety measures.

 

Conclusion

Male infertility is a real and growing concern in Nigeria, but it is not a hopeless condition.  With increased awareness, early diagnosis, and appropriate treatment, many men can become biological fathers or explore other parenting options.

It is important to break the silence and stigma around male infertility. Talking about it openly with your partner or healthcare provider does not make a man less masculine—it shows courage, responsibility, and issues. Take that first step and see a healthcare provider.

Infertility is not the end.  It is simply a challenge—one that can be met with the right information, support, and treatment.

 

References

1. World Health Organisation, Infertility, [Internet]. 22 May 2024. [Accessed April 14, 2025] Available from here. 

2. Abarikwu SO. Causes and Risk Factors for Male-Factor Infertility in Nigeria: A Review. Afr J Reprod Health 2013; 17[4]: 150-166.  Available from here 

3. WebMD, What is Sperm? [Internet]. December 22, 2023, [Accessed April 18, 2025] Available from here.

4. Uadia PO, Emokpae AM. Male infertility in Nigeria: A neglected reproductive health issue requiring attention. Journal of Basic and Clinical Reproductive Sciences ·2015, 4(2), 45-53  Available from here.

5. Leslie SW, Soon-Sutton TL, Khan MAB. Male Infertility. [Updated 2024 Feb 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from here 

6. Semet M, Paci M, Saias-Magnan J, Metzler-Guillemain C, Boissier R, Lejeune H, Perrin J. The Impact of drugs on male fertility: a review. Andrology. 2017;5(4):640-663. doi: 10.1111/andr.12366. Available from here  

7. Demirkol MK, Barut O, Dogan NT, Hamarat MB, Resim S. At What Age Threshold does the Decline in Semen Parameters Begin? J Coll Physicians Surg Pak. 2021 Jan;31(1):4-7. doi: 10.29271/jcpsp.2021.01.4. Available from here

8. El Osta R, Almont T, Diligent C, Hubert N, Eschwège P, Hubert J. Anabolic steroids abuse and male infertility. Basic Clin Androl. 2016 Feb 6;26:2. doi: 10.1186/s12610-016-0029-4. Available from here 

9. Mortazavi SA, Taeb S, Mortazavi SM, Zarei S, Haghani M, Habibzadeh P, Shojaei-Fard MB. The Fundamental Reasons Why Laptop Computers should not be Used on Your Lap. J Biomed Phys Eng. 2016 Dec 1;6(4):279-284. Available from here

 

Related 

Infertility: Causes in African Women and Men with Prevention Tips

Testicular Cancer Awareness and Self Examination Techniques for Africans

Study Links Low Sperm Quality To Pesticide Exposure in Men

 

 

Published:  May 12, 2025

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