Red flags men ignore: 7 physical signs that may indicate fertility issues

For most people, fertility health comes into the picture only when they find it difficult to conceive. And when that happens, it’s usually the woman who is put under the spotlight. Yet, research shows that male factors are solely responsible in roughly 20% of infertility cases while they contribute alongside female factors in about 50% of the cases.
While symptoms of male infertility can often be silent, there are also times when the body sends subtle clues. Recognising these signals early can enable timely intervention and preserve future fertility potential.
Below are seven physical signs that call for attention, not just if you and your partner are planning for a family but even otherwise.

An ache, persistent swelling or a palpable lump in the testicular area should never be dismissed. Such symptoms can indicate varicocele, infections, or other structural issues, all of which may impair sperm production or function.

Sexual function is closely linked with reproductive health. Men who struggle with maintaining an erection, have a markedly reduced libido, or notice that the volume of ejaculate is unusually low may have an underlying hormonal or anatomical issue. While such problems are common, when they are persistent, they merit evaluation in the context of fertility.

When male sex-hormone levels fall, or when there is a chromosomal disorder such as Klinefelter syndrome, physical changes may start to appear. These could include less facial or body hair than typical for age, or even breast enlargement or gynaecomastia. Such signs may point to testicular dysfunction, which in turn can compromise sperm production.

A significant drop in sexual desire or drive can be one of the most overlooked signs of hormonal imbalance in men. Low levels of testosterone that are driven by stress, obesity or certain medication usage can affect both libido and sperm health in men. Men with lower testosterone levels are shown to have poorer sperm concentration and motility. While fluctuating desire can be normal, as sustained decline signal the need for assessment.

Physical examination of infertile men often reveals a varicocele around the testicle, which feels like a ‘bag of worms.’ Because such varicoceles can raise scrotal temperature and impair sperm development, their presence is a clear red-flag. In one clinical study, varicocele was found in up to 20–40 % of men evaluated for infertility.

Increasingly, lifestyle and metabolic factors are recognised contributors to male fertility. Excess weight can disturb hormonal balance, raise scrotal temperature or impair sperm parameters. While not as overt as a lump or dysfunction, weight gain is a meaningful physical signal.

It may seem indirect, but repeated respiratory infections or other health issues may hint at an endocrine or genetic disorder that also influences fertility. For example, failure of sperm production and other systemic signs can coexist. As one Oxford Academic Paper puts it, “reproduction is the sixth vital sign” of a man’s overall health.

Appearance of these symptoms doesn’t automatically mean infertility but if several appear together, they deserve medical attention. Studies show that poor semen quality isn’t just linked to difficulty conceiving, but also to higher risks of cardiovascular and metabolic diseases. In short, reproductive health is closely tied to overall health.
Fertility care shouldn’t begin only after failed attempts to conceive. If you notice any of the above-mentioned signs or simply want to understand your reproductive health better – a consultation with a fertility specialist is warranted. Physical signs often reflect deeper biological changes – altered hormones, reduced sperm production, or systemic health concerns. A complete evaluation including semen analysis, hormonal testing, and a physical examination can help detect and address underlying issues before they become barriers.
Dr Shreya Gupta, Fertility Specialist, Birla Fertility & IVF, Lucknow