Yes, a hernia can cause infertility, though the risk depends on the type of hernia, how long it goes untreated, and whether surgical repair causes complications. The concern applies primarily to inguinal hernias, which occur in the groin area near the reproductive structures in both men and women. The hernia itself can interfere with fertility by compressing blood vessels or reproductive organs, and the surgery to fix it carries a small but real risk of damaging the tubes that transport sperm or eggs.
How an Untreated Hernia Affects Male Fertility
An inguinal hernia sits in the groin canal, the same passageway that houses the spermatic cord, blood vessels feeding the testicle, and the vas deferens (the tube that carries sperm). When a hernia grows large or becomes trapped in place (incarcerated), it can squeeze these structures and restrict blood flow to the testicle on that side.
Research using Doppler ultrasound has shown that men with inguinal hernias have measurably higher resistance to blood flow in the testicle on the affected side compared to the healthy side. This vascular compression can reduce testosterone production and, over time, lead to testicular atrophy, where the testicle shrinks and loses function. One documented case involved a man whose hernia had been incarcerated for two decades, resulting in significant atrophy of the affected testicle. While that’s an extreme example, the mechanism is well established: chronic pressure on the testicular blood supply starves the tissue.
The encouraging finding is that this vascular compression appears to be reversible if the hernia is repaired before permanent damage sets in. Studies show that the elevated blood flow resistance returns to normal after surgical repair, which suggests that timely treatment can protect testicular function.
Fertility Risks From Hernia Surgery
Ironically, the surgery meant to fix a hernia also poses its own risks to fertility. During open inguinal hernia repair, the vas deferens can be accidentally cut, tied, or scarred. This happens in roughly 0.1% to 0.5% of open repairs. That number sounds small, but for a man who has surgery on both sides, the stakes are higher because damage to both vas deferens would completely block sperm from reaching the ejaculate.
A systematic review published in the journal Hernia found that obstructive azoospermia (a complete absence of sperm due to blockage) occurred in about 0.03% of open mesh repairs. The rate jumped to 2.5% for bilateral laparoscopic repairs using mesh placed behind the abdominal wall. That’s a significant difference. The mesh used in laparoscopic repair sits closer to the vas deferens and spermatic cord, and the inflammatory response it triggers can cause scarring that narrows or blocks the tube over time.
Animal studies confirm that mesh implantation can reduce the cross-sectional area of the vas deferens and impair testosterone production on the affected side, even without obvious inflammation or heavy scarring. The effect appears related to the body’s reaction to the foreign material rather than surgical error alone. Because of these findings, researchers have recommended that male infertility be included in the informed consent process for men who haven’t finished having children, particularly when bilateral repair with mesh is planned.
Sperm Quality After Repair
For men who undergo hernia repair without complications, the news is mostly reassuring. A randomized clinical trial tracking sperm quality for three years after laparoscopic repair found that while sperm motility dipped slightly at one year with certain lightweight mesh types, the difference was no longer statistically significant at the three-year mark. Other semen parameters and scrotal ultrasound results remained stable as well. In other words, for the majority of men, a single uncomplicated hernia repair does not meaningfully damage sperm production or quality over the long term.
Hernias and Female Infertility
Women can develop inguinal hernias too, and in girls and young women, these hernias sometimes contain reproductive organs. The fallopian tube or ovary can slip into the hernia sac, putting them at risk of damage during surgical repair. Case reports describe women who were found to be infertile as adults because childhood hernia surgery had inadvertently tied off or severed both fallopian tubes, effectively creating an accidental tubal ligation.
This complication is considered rare but likely underestimated, because the connection between a childhood surgery and adult infertility may not be recognized during a fertility workup. Surgeons repairing hernias in female infants and children are urged to use meticulous technique to identify and protect any reproductive structures within the hernia sac.
Sexual Pain After Surgery
Beyond direct damage to reproductive structures, hernia repair can affect fertility indirectly through chronic pain. A study of over 1,000 patients found that 22% reported pain during sexual activity after inguinal hernia surgery. About 12% experienced genital or ejaculatory pain specifically, and roughly 3% of younger men said the pain was severe enough to meaningfully impair their sexual activity. Chronic groin pain that makes intercourse difficult or painful can obviously reduce the frequency of attempts to conceive, creating a practical barrier to fertility even when the reproductive system itself is intact.
What This Means in Practical Terms
If you have an inguinal hernia and are planning to have children, the timing and type of repair matter. Leaving a large hernia untreated for years risks gradual damage to the testicle from compressed blood flow, but rushing into bilateral mesh repair without considering the fertility implications also carries risk. The highest concern is for men needing repair on both sides, where the 2.5% rate of complete sperm blockage after bilateral laparoscopic mesh repair is worth a serious conversation with your surgeon.
For men already experiencing infertility, a history of hernia repair on both sides should be flagged early in the evaluation. Obstructive azoospermia from surgical scarring is a treatable cause of infertility, and identifying it can change the course of a fertility workup entirely. For women with unexplained infertility who had hernia surgery as children, the same principle applies: the connection is uncommon but worth investigating.