Male Infertility: What Every Couple Should Know
doctor explaining male infertility to his patient
When a couple is not conceiving, the investigation most often begins with the woman. Tests are ordered, appointments are booked, and months pass — sometimes with the male partner not investigated at all, or only investigated after all female causes have been exhausted.
This approach misses the fundamental statistical reality: male factor contributes to approximately 40 to 50% of infertility cases. In a significant proportion of couples, the primary or sole cause of infertility is on the male side — and yet the woman undergoes all the invasive testing.
The simplest, least invasive, and least expensive fertility test available is a semen analysis. It should be among the first tests done when a couple presents for fertility evaluation — not the last.
Dr. Shachi Singh, consultant gynaecologist and fertility specialist at Prakash Hospital, Sector 33, Noida, explains male infertility for couples navigating this together.
What Is Assessed in a Semen Analysis?
A semen analysis measures several parameters of sperm and seminal fluid:
Sperm count (concentration): Number of sperm per millilitre of semen. Normal: ≥16 million/mL.
Total sperm count: Count × volume. Normal: ≥39 million per ejaculate.
Motility: Percentage of sperm that are moving. Normal: ≥42% motile. Progressive motility (sperm moving forward): ≥30%.
Morphology: Percentage of sperm with normal shape and structure. Normal (Kruger strict criteria): ≥4%.
Volume: Total ejaculate volume. Normal: ≥1.4 mL.
pH and liquefaction: Characteristics of the seminal fluid.
Results are compared against WHO 2021 reference ranges. Abnormalities may be in one or multiple parameters.
Common Causes of Male Infertility
Varicocele: Enlarged veins within the scrotum that cause elevated testicular temperature, impairing sperm production. The most common correctable cause of male infertility — found in 35 to 40% of men presenting with infertility. Treated surgically by a urologist (varicocelectomy) with documented improvement in semen parameters in many men.
Hormonal disorders: Low testosterone, elevated FSH (indicating poor testicular function), or elevated prolactin can impair sperm production. Treated medically or with referral to a urologist/endocrinologist.
Infections: Chlamydia, gonorrhoea, and other infections can cause epididymitis (inflammation of the sperm-transporting tube) and subsequent obstruction. TB of the male genital tract — significant in India — causes ductal blockage.
Obstruction: Blocked vas deferens or epididymis — from infection, vasectomy, or congenital absence. Men with obstruction typically have normal sperm production (normal FSH, normal testicular volume) but zero or very few sperm in the ejaculate. Surgical reconstruction or sperm retrieval (TESA/PESA) combined with ICSI-IVF are treatment options.
Lifestyle factors: Smoking — directly impairs sperm DNA integrity. Alcohol — reduces testosterone. Heat exposure (prolonged hot baths, laptops on the lap, tight underwear) — temporary sperm production impairment. Anabolic steroids — suppress pituitary hormones and halt sperm production.
Genetic causes: Azoospermia (complete absence of sperm) in some men is due to Y chromosome microdeletions or Klinefelter syndrome. Cystic fibrosis gene mutations cause congenital bilateral absence of the vas deferens.
Oxidative stress: Elevated levels of reactive oxygen species in semen — from infection, varicocele, lifestyle, or unknown causes — damage sperm DNA and reduce fertilisation capacity. Antioxidant supplements have some evidence for improving semen parameters in this setting.
What Happens After Abnormal Semen Analysis?
A single abnormal semen analysis is not conclusive — sperm production varies, and illness, stress, or a difficult sample collection can produce a spuriously low result. A repeat semen analysis 6 to 12 weeks after the first (the time for a new sperm generation to complete development) provides a more reliable picture.
Referral to a urologist: For varicocele assessment and treatment, hormonal evaluation, and assessment of azoospermia (where surgical sperm retrieval may be needed).
Blood tests: FSH, LH, testosterone, prolactin — to assess the hormonal axis driving sperm production.
Genetic testing: For severe azoospermia — Y microdeletion analysis and karyotype.
Infertility treatment options based on semen quality:
- Mild male factor: IUI with sperm washing can be effective
- Moderate male factor: IVF is generally more appropriate than IUI
- Severe male factor / obstructive azoospermia: ICSI (intracytoplasmic sperm injection) — injecting a single sperm directly into each egg — combined with surgically retrieved sperm produces pregnancies in many men with otherwise untreatable azoospermia
The Couple's Perspective
Infertility investigation and treatment goes better when it is genuinely a shared process. Male factor investigation is simple (semen analysis is a non-invasive test), inexpensive, and critically informative. Every couple's evaluation should include it — not as an afterthought, but from the very first appointment.
To book a consultation with Dr. Shachi Singh, call: +91 97023 46853
Clinic Hours: Monday to Saturday, 9 AM – 6 PM | Sunday, 10 AM – 2 PM
Clinic Address: D-12A, 12B, Sector-33, G.B. Nagar, Noida, Uttar Pradesh 201301
This blog is for informational purposes. Consult Dr. Shachi Singh or a qualified fertility specialist for evaluation specific to your situation.
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