If you are trying for a baby and erectile dysfunction keeps getting in the way, the question on your mind is probably blunt: can you still conceive with erectile dysfunction?ED does not automatically mean infertility and many couples do conceive. But ED and fertility are separate issues that can share underlying causes, so it helps to understand the difference.
ED is highly treatable, and treating it can make intercourse possible again. However, better erections do not by themselves show that sperm production and quality are normal. This guide provides you with the necessary information about male fertility and erectile dysfunction, what your options look like and when it is worth bringing a specialist into the conversation.
Can You Still Conceive With Erectile Dysfunction?
It is possible. Erectile dysfunction can sometimes make it more difficult for a man to impregnate a woman during sexual activity but it does not automatically indicate that he is incapable of conceiving a child. Moreover, it must be pointed out that erectile dysfunction and fertility problems are two different types of issues that usually have similar causes.
How Are ED and Male Fertility Actually Connected?
They are more connected than men tend to think. ED itself does not directly change sperm quality, but it can reduce how often a couple has intercourse, especially during the fertile window, which lowers the chance of pregnancy.
The opposite situation is also possible. Some men with fertility problems also experience sexual difficulties such as ED. Male factors contribute to roughly a third of couples experiencing infertility and conditions such as diabetes, low testosterone and cardiovascular disease can affect both erections and sperm.
Conditions That Can Affect Both ED and Fertility
Underlying Cause | Effect on Erections | Effect on Fertility |
Type 2 diabetes | Damage to nerves and blood vessels decreases erection quality | Can impact the quality of sperm and hormone levels |
Decreased sex drive and difficulty achieving an erection | Can impair sperm production | |
Reduced blood flow damages erections | Associated with additional reproductive health issues | |
Obesity | Related to hormonal changes that contribute to impaired erection | Associated with lower sperm quality in research |
Smoking / heavy alcohol use | Affects blood vessels necessary for erections | Associated with decreased sperm production and motility |
Do ED Medications Affect Fertility?
If you are trying to conceive, check any ED treatment with your doctor first. The right choice depends on the medicine.
PDE5 Inhibitors (Sildenafil & Tadalafil)
These medicines improve blood flow to help achieve an erection and are widely prescribed for ED. Tadalafil is prescribed both for use as needed and as a low daily dose and the right regimen is a decision for your prescribing doctor. Tell your doctor you are trying to conceive so they can advise on the most suitable option for you.
Testosterone Therapy
Testosterone replacement is not a treatment for men who want to father a child. It suppresses the body's own signals for sperm production and can sharply reduce sperm count, sometimes to zero. It should not be started by men who are trying to conceive. If you take testosterone and want to conceive, discuss a fertility-preserving management plan with your doctor.
Alprostadil (Injections or Urethral Pellets)
Alprostadil is available in Australia as an injection into the side of the penis, used when tablets are unsuitable or ineffective. It works locally and does not rely on the PDE5 pathway. If you use alprostadil injections and are trying to conceive or your partner is pregnant, ask your doctor what precautions are needed.
How Often Should You Have Sex to Conceive?
It is optimal for couples to have sexual intercourse every one to two days during the fertile window for maximum probability of getting pregnant. This window is roughly six days long and is made up of five days before ovulation and the day of ovulation itself. The sperm can survive for up to five days whereas the egg survives only for about 12 to 24 hours, which makes pre-ovulation intercourse as important as intercourse during the ovulation day. Frequent sex is not necessary either, and it does not mean saving up. You don’t need to save up. For men with normal semen parameters, having sex every day or two does not reduce sperm quality, while long periods of abstinence may reduce sperm motility. Low sperm count does not automatically mean you should have sex less often. If there are concerns about semen quality, your doctor can give advice specific to you.
However, despite having sex at the right time, the healthy couple’s chances of pregnancy remain only at about 20-25% per cycle although about 80% to 85% of couples will get pregnant in a year.
Timing and ED
Scheduled sex may actually make it harder to achieve an erection. However, some methods may help:
- Try sex every other day or every few days within the window of fertility rather than daily sex.
- Ask your doctor whether a PDE5 inhibitor is suitable for you and how it should be taken.
- Instead of thinking of the fertile period as something that must be performed, think of it as a relaxed routine. Anxiety is a common cause of ED and can be treated.
- You may also want to use ovulation prediction kits or keep track of menstrual cycles to find the fertile day.
Practical Steps If You're Trying to Conceive With ED
- Once the root cause is identified, a physician can check for diabetes, low testosterone, cardiovascular disease or other factors instead of treating ED alone.
- Ask your doctor which ED treatment is right for you and follow their advice on how to take it. Avoid testosterone therapy if you are trying to conceive. If you take testosterone and want to conceive, discuss a fertility-preserving management plan with your doctor.
- Make lifestyle changes that help both ED and fertility; quitting smoking, drinking less alcohol, exercising regularly and being a healthy weight are all beneficial for these conditions.
- Don't wait if ED is stopping intercourse. See a doctor promptly. Otherwise, see the section below on when to seek a fertility assessment, including a semen analysis.
- Maintain an open dialogue with your doctor regarding your fertility goals.
When Should You See a Specialist?
If ED is preventing intercourse, see a doctor promptly rather than waiting. Otherwise, fertility assessment is generally recommended after 12 months of regular unprotected sex if the female partner is under 35 or after 6 months if she is 35 or older. Earlier assessment is appropriate if either partner has a known concern. Both partners should be assessed. For men, this usually starts with a GP visit and a semen analysis, with referral to a reproductive urologist or fertility specialist if needed.
Frequently Asked Questions
Can you still conceive with erectile dysfunction?
Often, yes. ED can make intercourse difficult, but it does not automatically mean a man is infertile. Because ED and fertility problems can share causes, it is worth having both looked at.
Does erectile dysfunction mean I'm infertile?
No, not necessarily. ED and infertility are different problems. While ED refers to one’s capability to achieve or keep an erection, infertility refers to issues with the production, quality or delivery of sperm. They often occur together due to the same cause such as diabetes or hormone imbalance but one does not imply the presence of the other. Treating ED also does not confirm that fertility is normal.
Does ED medication affect sperm or conception chances?
It depends on the medicine. PDE5 inhibitors such as sildenafil and tadalafil are commonly prescribed for ED, and your doctor can advise on the right regimen while you are trying to conceive. Testosterone therapy suppresses sperm production and should not be started by men trying to conceive. If you use alprostadil injections, discuss any precautions with your doctor.
What is the fastest way to address ED while trying to conceive?
See a doctor to identify the cause such as diabetes, cardiovascular disease or low testosterone. Treating the cause can improve erections, but fertility may need to be assessed separately.
How often should we have sex when trying to conceive?
Every one to two days during the fertile window gives the best chance. The window is about six days, ending on ovulation day. For men with ED, every other day is a realistic target and your doctor can advise whether a PDE5 inhibitor is suitable.
When should we see a fertility specialist?
You should see a doctor promptly if ED is preventing intercourse. Otherwise, seek assessment after 12 months of trying if the female partner is under 35, or after 6 months if she is 35 or older, or sooner if there are known concerns. A semen analysis is usually the first step in assessing male fertility.