For millions of couples, the journey to parenthood can feel less like an act of love and more like a high-stakes science experiment. The romance fades, replaced by ovulation charts, timed intercourse, and mounting pressure that can strain even the strongest relationships. Now, new guidelines, co-authored by a top urologist at Hackensack University Medical Center, are calling for a shift in focus, urging doctors to treat the intimate, often-ignored connection between male sexual health and a couple's fertility struggles.
These new recommendations from the 5th International Consultation on Sexual Medicine offer a vital roadmap for clinicians worldwide. They aim to move beyond a purely mechanical view of conception and address the sensitive, interconnected issues of male sexual dysfunction and infertility - improving not only a couple's chances of conceiving but also restoring intimacy and well-being.
"We've seen countless couples where the joy of sex has been replaced by the job of 'baby-making,' and it creates a vicious cycle," says Dr. David Shin, Director, Division of Sexual Health and Fertility at Hackensack University Medical Center and a primary author of the new guidelines. "A man might develop performance anxiety and erectile dysfunction because of the pressure, or an underlying sexual issue might have been the root cause of the infertility all along. For too long, these have been treated as separate problems, or worse, the man's side has been completely overlooked. These guidelines are about putting the whole picture together."
Infertility affects approximately 15% of couples, with male factors playing a role in about half the cases. The new manuscript provides a clever and much-needed re-evaluation of this two-way street: sexual problems can cause infertility, and the emotional toll of infertility can trigger sexual problems.
Dr. Shin, a fellowship-trained expert in male infertility and sexual dysfunction, emphasizes that a man's sexual function is a powerful indicator of his overall health. "It's time to start the conversation," he insists. "The initial fertility evaluation is a golden opportunity to ask simple, direct questions about a man's sexual health. It’s not just about a sperm count; it’s about desire, function, and satisfaction. Uncovering these issues is often the key to solving the entire puzzle."
The guidelines translate complex medical research into clear, compelling advice for both doctors and the public. Highlights include:
The Green Light for ED Meds: Performance anxiety around ovulation is a real and common cause of erectile dysfunction. The guidelines reassure couples that widely used oral ED medications are safe and do not harm sperm or fertility, helping to remove a significant barrier to conception.
The Red Flag on Testosterone: A crucial warning for men hoping to become fathers: do not use standard testosterone replacement therapy. It effectively acts as a male contraceptive. The guidelines steer clinicians toward alternative, fertility-sparing treatments to boost testosterone without shutting down sperm production.
Beyond the Bedroom: Lifestyle is Key: The recommendations underscore the powerful link between overall health and fertility. Quitting smoking, achieving a healthy weight, and managing stress are highlighted as actionable steps that can significantly improve both sexual function and reproductive outcomes.
Lube Matters (But Maybe Not How You Think): While many popular lubricants can be toxic to sperm in a lab, the guidelines note that for many couples, their real-world impact on fertility may be minimal. However, to be safe, couples are advised to choose "sperm-safe" options to maximize their chances.
By championing a more holistic and compassionate approach, these guidelines aim to empower both patients and their doctors. They encourage a shift in the conversation from one of failure and frustration to one of hope, health, and renewed intimacy on the path to parenthood. As National Infertility Awareness Week approaches in April 2026, this research provides a perfect opportunity to highlight this critical, often-overlooked aspect of the fertility journey.
I had a chance to learn more in this interview with Dr. Shin.
What are some things that are often overlooked in discussions about infertility?
It's not just a "female problem" — male factors contribute to roughly 40-50% of all infertility cases.
Sperm health goes beyond sperm count. Volume, morphology (shape) and motility (movement), are equally important parameters to be analyzed from a semen analysis.
Medical conditions causing male infertility are treatable — varicoceles (dilated veins in the scrotum), hormonal imbalances, and blockages within the male reproductive tract can often be corrected with either medication or surgery.
Best to be evaluated by a reproductive urologist who can fully evaluate and address these issues.
What are some things that families can do to reduce the stigma that surrounds infertility?
Stop assuming infertility is only the woman's "fault" — families should avoid directing all questions, concerns, and pressure regarding fertility solely toward the female partner, especially since male factors account for up to 50% of all infertility cases.
Normalize male fertility testing — treat a semen analysis as a routine test, just like any other health screening.
Better education - understanding that infertility is a medical condition, not a character flaw or divine punishment, helps families respond with empathy rather than judgment.
How can people support friends and loved ones that are struggling with infertility?
Listen without trying to fix — sometimes men just need someone to hear them without being offered solutions or silver linings.
Be mindful of triggering moments — Father's Day, baby showers, and family gatherings can be particularly painful. A simple acknowledgment or check-in goes a long way.
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