Written by Dr. Shirisha Reddy Varna — Fertility Specialist & Gynecologist, Prana Women and Fertility Hospital, Miyapur, Hyderabad
Quick answer: Male factor infertility contributes to 40–50% of all infertility cases — meaning in nearly half of couples struggling to conceive, there’s a male-side cause that needs evaluation and often treatment. The good news: most male infertility is treatable. Lifestyle changes, medications, hormonal treatment, and assisted reproductive techniques like ICSI (Intracytoplasmic Sperm Injection) can help even men with very low sperm counts or azoospermia (zero sperm in ejaculate) become biological fathers. The first step is a simple semen analysis — a test that’s often delayed for years while the female partner undergoes extensive workup.
If you’re a couple trying to conceive without success, this guide explains what male infertility actually means, why it’s so often missed, what tests are involved, and what treatment options exist in 2026. It also explains why getting the male partner evaluated first — not last — saves time, money, and emotional cost.
Why Male Infertility Is Underdiagnosed in India
In most Indian fertility journeys, the woman is evaluated for months or even years before the male partner does a single test. This is a cultural pattern, not a medical one — and it’s responsible for enormous wasted time.
A semen analysis costs ₹500–₹1,500 and gives a result in 2 hours. There is no medical reason to delay it. Yet at our clinic in Miyapur, we routinely see couples in their third year of trying where the man has never been tested. When testing finally happens, the male factor is often the dominant cause.
The lesson: at the start of any fertility workup, both partners should be tested at the same time. Always.
What Causes Male Infertility?
Male infertility is rarely about one thing. It’s usually a combination of factors affecting sperm production, sperm quality, sperm transport, or hormonal regulation.
Sperm Production Problems
- Varicocele — enlarged veins in the scrotum that raise testicular temperature and damage sperm production. Found in roughly 40% of infertile men. Often treatable surgically.
- Hormonal disorders — testosterone deficiency, thyroid disorders, prolactin imbalance
- Genetic conditions — Klinefelter syndrome, Y-chromosome microdeletions, cystic fibrosis gene mutations
- Undescended testes (cryptorchidism) — even if corrected in childhood, can affect adult sperm production
- Mumps orchitis — childhood mumps that affected the testes
- Cancer treatments — chemotherapy and radiotherapy damage sperm production
- Infections — past infections like tuberculosis, gonorrhea, chlamydia can damage reproductive ducts
Sperm Transport Problems (Obstructive Azoospermia)
Sperm is being produced but can’t get out:
- Vasectomy (intentional)
- Congenital absence of the vas deferens (CBAVD) — often linked to cystic fibrosis mutations
- Infections that scar the reproductive tract
- Previous surgeries in the inguinal/pelvic region
Sexual or Ejaculatory Problems
- Erectile dysfunction
- Retrograde ejaculation — semen enters the bladder instead of exiting
- Anejaculation — inability to ejaculate
Lifestyle and Environmental Factors
These are increasingly significant — and reversible:
- Smoking (tobacco and gutka) — directly damages sperm DNA
- Alcohol — excessive use lowers testosterone and sperm count
- Obesity — drives hormonal imbalance and oxidative stress
- Diabetes — affects ejaculation and sperm quality
- Heat exposure — long hours at laptops on laps, hot tubs, tight underwear
- Stress — chronic stress affects hormonal signaling
- Anabolic steroids and bodybuilding supplements — devastatingly common cause of azoospermia in young men
- Environmental toxins — pesticides, heavy metals, certain industrial chemicals
- Sleep deprivation
Symptoms of Male Infertility Men Often Ignore
Most men with infertility have no obvious symptoms — which is why testing matters. But these signs warrant earlier evaluation:
- Difficulty getting or maintaining an erection
- Reduced sex drive
- Pain, swelling, or a lump in the testicle
- A heaviness or “bag of worms” feeling in the scrotum (possible varicocele)
- Decreased facial or body hair (possible hormonal issue)
- History of childhood mumps, undescended testis, hernia surgery, or testicular injury
- Past use of anabolic steroids
- Past chemotherapy or radiotherapy
Tests for Male Infertility
The male infertility workup is far simpler than the female one — and a lot of information comes from just two or three tests.
Semen Analysis (The Foundation)
The single most important test in male infertility. WHO 2021 reference values for a fertile sample:
- Volume: ≥1.4 ml
- Sperm concentration: ≥16 million/ml
- Total sperm count: ≥39 million per ejaculate
- Progressive motility: ≥30%
- Total motility: ≥42%
- Normal morphology: ≥4%
For accurate results: 2–7 days of abstinence before the test, sample collected at the lab in a private room (not at home and transported), and ideally repeated 2–4 weeks apart since semen quality fluctuates.
Hormonal Tests
- FSH (raised in primary testicular failure)
- LH
- Testosterone (total and free)
- Prolactin
- TSH
- Estradiol in select cases
Scrotal Ultrasound
Detects varicocele, testicular masses, obstruction, or absence of the vas deferens.
Genetic Tests (in select cases)
- Karyotype for chromosomal abnormalities
- Y-chromosome microdeletion screening for severe oligospermia or azoospermia
- CFTR gene mutation testing for congenital absence of vas deferens
Sperm DNA Fragmentation Index (DFI)
Tests sperm genetic integrity. High DFI is linked to miscarriage and IVF failure even when basic semen parameters are normal.
Post-Ejaculate Urine Analysis
For suspected retrograde ejaculation.
Testicular Biopsy
Reserved for azoospermia to distinguish obstructive from non-obstructive causes.
Treatment Options for Male Infertility
Treatment depends entirely on the underlying cause. There is no single “male infertility treatment” — the right approach must match the diagnosis.
Lifestyle Optimization (First Step for Most Men)
This works far better than most men expect, with results in 2–3 months. Sperm takes about 72–74 days to develop, so changes today show results then.
- Stop smoking, gutka, and tobacco — non-negotiable
- Reduce alcohol to occasional use
- Lose weight if BMI is over 25
- Exercise moderately — but avoid extreme heat exposure (hot yoga, long sauna)
- Eat antioxidant-rich foods — fruits, vegetables, nuts (especially walnuts and pumpkin seeds), fish
- Reduce processed foods and refined sugar
- Sleep 7–8 hours
- Manage stress actively
- Avoid lap-top heat to the groin
- Stop anabolic steroid use completely — and discuss recovery with a specialist
- Take medical-grade antioxidants (CoQ10, vitamin E, vitamin C, zinc, selenium, L-carnitine) under guidance
Medical Treatment
- Hormonal therapy — for hypogonadotropic hypogonadism (clomiphene, hCG, FSH injections)
- Treatment of infections — antibiotics for bacterial prostatitis or epididymitis
- Dopamine agonists — for hyperprolactinemia
- Pseudoephedrine or imipramine — for retrograde ejaculation
Surgical Treatment
- Varicocelectomy — surgical correction of varicocele; can significantly improve sperm parameters in selected men
- Vasectomy reversal — for men who had a vasectomy and now want children
- Microsurgical reconstruction — for obstructive azoospermia
Surgical Sperm Retrieval (For Azoospermia)
Even men with no sperm in the ejaculate can often father biological children using sperm retrieved directly from the testes:
- TESA (Testicular Sperm Aspiration) — needle aspiration of testicular tissue
- PESA (Percutaneous Epididymal Sperm Aspiration) — for obstructive azoospermia
- TESE / microTESE — open surgical retrieval, especially microdissection TESE for non-obstructive azoospermia
The retrieved sperm is used with ICSI in an IVF cycle.
Assisted Reproduction
- IUI — for mild male factor with total motile sperm count above 5 million
- IVF with ICSI — for severe male factor, low motility, abnormal morphology, or after sperm retrieval
ICSI (Intracytoplasmic Sperm Injection) involves injecting a single sperm directly into each egg. It bypasses almost every barrier sperm normally face — and is the reason men with extremely low sperm counts can now father children. Together with IVF, ICSI has transformed male infertility outcomes.
Donor Sperm
When sperm cannot be retrieved or treatment isn’t viable, donor sperm with IUI or IVF is an option. The decision is deeply personal and involves counselling for both partners.
When Should a Man See a Fertility Specialist?
A man should be evaluated:
- After 6 months of trying if the woman is over 35
- After 1 year of trying if the woman is under 35
- Immediately if any of these apply:
- History of testicular trauma, surgery, or undescended testis
- Past chemotherapy or radiotherapy
- History of mumps after puberty
- Diabetes
- Past anabolic steroid use
- Difficulty with erection or ejaculation
- Known low sperm count from a previous test
The earlier the workup, the more options remain on the table.
Don’t Delay Male Fertility Evaluation
The single biggest mistake couples make in their fertility journey is delaying male evaluation. A semen analysis takes 2 hours and costs less than a dinner — but it can save years.
At Prana Women and Fertility Hospital, Miyapur, we offer complete couple-based fertility evaluation, including discreet, comfortable male assessments with same-day or next-day results, and detailed counselling on treatment options. Call (+91) 98858 51333 or book an appointment.
About the Author Dr. Shirisha Reddy Varna is a Gynecologist and Fertility Specialist at Prana Women and Fertility Hospital, Miyapur, Hyderabad. She holds an MBBS, MS (OBGY), FRM, FAMS, MRCOG-1 (UK), DCU (Kiel, Germany), and a Fellowship in Infertility, with extensive experience in managing male and female factor infertility.
Frequently Asked Questions
Male infertility is diagnosed primarily through a semen analysis, supplemented by hormonal blood tests (FSH, LH, testosterone, prolactin), scrotal ultrasound, and in select cases, genetic testing or sperm DNA fragmentation testing. A complete evaluation can usually be completed in 1–2 visits.
Mild to moderate low sperm count often improves with lifestyle changes: stopping smoking, reducing alcohol, losing weight, eating an antioxidant-rich diet, managing stress, and avoiding heat exposure. Improvements take 2–3 months because sperm production takes about 72 days.
ICSI has fertilization rates of 70–80% per injected egg. Pregnancy rates per IVF-ICSI cycle in women under 35 are 40–60% depending on the clinic and embryo quality. ICSI is the most effective treatment for severe male factor infertility.
Yes, in many cases. If the cause is obstructive (sperm is being produced but blocked), surgical retrieval (TESA, PESA) almost always finds sperm. If the cause is non-obstructive (production problem), microTESE can find sperm in 40–60% of cases. The retrieved sperm is used with ICSI.
A semen analysis in Hyderabad typically costs ₹500–₹1,500 depending on the lab. It’s a quick, painless test with results usually available within 2–4 hours.
No. Varicocele surgery is recommended when there is clinically significant varicocele and abnormal semen parameters and a couple actively trying to conceive. Asymptomatic small varicoceles in fertile men usually need no treatment.
Chronic stress can affect hormonal signaling and reduce sperm count and quality, though it’s rarely the sole cause of infertility. Managing stress is an important part of any male fertility treatment plan.
Prana Women and Fertility Hospital in Miyapur offers complete male infertility workup including semen analysis, hormonal evaluation, and treatment options including ICSI under Dr. Shirisha Reddy Varna. Call (+91) 98858 51333 for a consultation.