Leading specialists say male infertility remains critically under-researched in the UK, causing many couples to undergo IVF unnecessarily because the NHS often fails to diagnose and treat reversible causes affecting men.

Despite men accounting for about half of all infertility cases, experts warn that a lack of awareness among general practitioners, combined with limited NHS testing and a shortage of male fertility specialists, means treatable conditions frequently go undetected.

One of the most common causes, varicocele, a dilation of veins in the scrotum that raises testicular temperature and damages sperm, can often be corrected through surgery. Lifestyle interventions and supplements can also improve sperm health. However, urologists say such options are too often overlooked.

Vaibhav Modgil, honorary clinical professor at the University of Manchester and consultant urological surgeon, said male infertility affects 5–10% of men in the UK but remains largely invisible in healthcare planning.

“Women visiting a doctor after struggling to conceive are rapidly submitted to every test you can think of,” he said. “Whereas it could take years for men to receive even basic testing.” He added that changing the situation “will require a top-down approach at a much higher level,” but said there is little evidence of progress.

Most couples facing conception challenges are first seen by gynaecologists, who specialize in female reproductive health. In contrast, many regions have only one or two dedicated andrologists who focus on male fertility.

Calls for policy reform

Experts hoped the government’s first Men’s Health Strategy, published this week, would include a strong focus on male infertility, similar to approaches in Australia. Instead, they say the issue was notably absent, though the Health Department has indicated that a refresh of the Women’s Health Strategy may address the gap.

Dr. Michael Carroll of Manchester Metropolitan University said the mental health burden on infertile men is frequently underestimated and is linked to shorter life expectancy. He is writing a book aimed at closing the awareness gap, noting that many men are unaware of basic practices such as keeping testicles cool, avoiding tight underwear and hot baths, and reducing alcohol and smoking, all factors that impact sperm quality.

“Historically, fertility has been seen as a women’s health issue,” he said. “Men think they’re fertile if they’re producing semen. We should do more rigorous testing, take proper medical histories, and physically examine the testes, not just rely on semen analysis.”

Evidence and training lag behind

Raj Mathur, consultant in reproductive medicine and former chair of the British Fertility Society, said male infertility research has been neglected for decades. “We need more money to research appropriate tests for men through randomised control trials to see what actually makes a difference,” he added.

The National Institute for Health and Care Excellence (NICE) is updating guidance to recommend more investigation for men. Campaigners say the draft changes are encouraging but insufficient.

A study by Fertility Action found that 80.6% of GPs had received no training on male fertility, and 97% were unable to properly examine for varicocele.

Tim Shand, founder of Men’s Sexual and Reproductive Health Matters, said improving testing could reduce emotional and financial strain on couples and provide “significant cost benefit for the NHS” by avoiding unnecessary IVF.

A spokesperson for the Department of Health and Social Care said, “For too long, there has been a reluctance to accept that men suffer specific inequalities and hardships when it comes to their health. This includes male infertility. The Men’s Health Strategy sets up a strong foundation for improving how we think and act on men’s health.”