When a couple struggles to conceive, the assumption — in our society and in many medical settings — is that the problem lies with the woman. Investigations are ordered for the wife. Treatment is started for the wife. And in the meantime, the husband waits. But the medical reality is strikingly different: male factor infertility contributes to approximately 40–50% of all infertility cases. At Mother Hospitals & IVF Center, Boduppal, Dr. E. Prashanthi Reddy insists that both partners are evaluated from the very first visit — because ignoring the male partner delays diagnosis and wastes precious time.
Key fact: In roughly half of all infertility cases, a male factor is either the primary cause or a contributing factor. A semen analysis — a simple, non-invasive test — can identify this within 48 hours. There is no reason to delay it.
Male Infertility — How Common Is It?
Male infertility is far more prevalent than most people realise. Studies across India consistently show that when infertile couples are investigated thoroughly, a male factor is identified in 40–50% of cases. In about 20% of couples, both partners have contributing factors.
Despite these numbers, male infertility carries a disproportionate social stigma — especially in Indian society, where fertility is often unconsciously equated with masculinity. Men frequently resist getting tested, delay the semen analysis, or accept a poor result with silence rather than seeking treatment. This delay is harmful — and unnecessary. Male infertility is, in most cases, diagnosable and treatable. The sooner it is investigated, the sooner the right treatment path can begin.
Causes of Male Infertility
Male infertility can arise from problems at multiple levels — in sperm production, sperm transport, or sperm function. The most common causes include:
- Low sperm count (oligospermia): Fewer than 15 million sperm per mL of semen. Can be mild, moderate, or severe. Even very low counts can achieve fertilisation with ICSI.
- Azoospermia (zero sperm): No sperm present in the ejaculate. Classified as obstructive (a blockage prevents sperm exit despite normal production) or non-obstructive (impaired production in the testis itself). Obstructive azoospermia is highly treatable.
- Poor sperm motility (asthenospermia): Sperm are present but do not swim forward effectively. Forward progressive motility below 32% is considered abnormal. Poor motility severely reduces natural conception chances but responds well to ICSI.
- Abnormal sperm morphology (teratospermia): High percentage of abnormally shaped sperm — affecting the head, midpiece, or tail. When normal forms fall below 4% (Kruger strict criteria), fertilisation is impaired.
- DNA fragmentation: Damage to the genetic material within the sperm. High DNA fragmentation (above 25–30%) is associated with failed IVF cycles, recurrent miscarriage, and poor embryo development — even when the standard semen parameters look acceptable.
- Varicocele: Dilated veins in the scrotum that raise testicular temperature and impair sperm production. Surgical repair (varicocelectomy) can improve sperm parameters significantly.
- Hormonal causes: Low FSH, LH, or testosterone — treatable with hormone supplementation in some cases.
- Lifestyle factors: Smoking, alcohol, obesity, tight clothing, excessive heat exposure (laptops on the lap, hot baths), and anabolic steroid use all adversely affect sperm quality.
Semen Analysis — What Does the Report Mean?
A semen analysis is the cornerstone of male fertility evaluation. The test is done after 2–5 days of abstinence. The sample is produced in a private room at the laboratory and analysed within one hour. Key parameters reported include:
- Volume: Normal is ≥1.5 mL. Low volume may indicate retrograde ejaculation or seminal vesicle issues.
- Sperm concentration: Normal is ≥16 million/mL. Below 16 million/mL is oligospermia.
- Total sperm count: Normal is ≥39 million per ejaculate.
- Progressive motility: Normal is ≥30%. Sperm swimming forward in a straight or large curved path.
- Total motility: Normal is ≥42% (including non-progressive movement).
- Morphology (Kruger strict): Normal forms ≥4%.
- Vitality: Live sperm percentage — normal ≥54%.
- WBC count: Elevated white blood cells may indicate infection or inflammation.
At Mother Hospitals, semen analysis reports are explained personally to both partners — in plain language, without jargon, so both understand exactly what the numbers mean and what the next step should be.
Treatments for Male Infertility
ICSI — Intracytoplasmic Sperm Injection
ICSI is the single most important advance in the treatment of male infertility. In ICSI, a single sperm is selected under a high-powered microscope and injected directly into a mature egg. This means that even with very low sperm counts — as few as one or two motile sperm — fertilisation is possible. ICSI is now the standard of care for all cases of significant male factor infertility at Mother Hospitals, and fertilisation rates with ICSI typically exceed 70–80%.
TESA — Testicular Sperm Aspiration
TESA is used when no sperm appear in the ejaculate (azoospermia). A fine needle is used to aspirate sperm directly from the testicular tissue under local anaesthesia — the procedure takes 15–20 minutes and is performed as a day case. Retrieved sperm are used with ICSI. TESA is successful in the majority of obstructive azoospermia cases and in select cases of non-obstructive azoospermia where focal areas of active sperm production can be identified.
PESA — Percutaneous Epididymal Sperm Aspiration
PESA retrieves sperm from the epididymis — the coiled tube where sperm mature — in cases of obstructive azoospermia where the blockage is at the epididymal level (such as post-vasectomy or post-infection). It is minimally invasive, performed under local anaesthesia, and retrieved sperm are used for ICSI.
Antioxidant Therapy and Lifestyle Modification
For men with mildly reduced parameters or high DNA fragmentation, a structured antioxidant programme (Vitamin C, Vitamin E, CoQ10, selenium, zinc, L-carnitine) combined with lifestyle changes — quitting smoking, reducing alcohol, improving sleep, and regular exercise — can produce meaningful improvements in sperm parameters within 3 months. This is always the starting point for mild cases before proceeding to IVF/ICSI.
The Emotional Side of Male Infertility — A Word for Men
Male infertility is not just a medical problem — it is an emotional one. For many Indian men, receiving a poor semen result triggers feelings of shame, inadequacy, and silence. They do not tell their friends. They may not even fully discuss it with their wives. They carry the weight of it alone.
At Mother Hospitals, we want every man who comes through our doors to know: this is a medical condition, not a measure of your manhood. Millions of men face this. Modern medicine has powerful tools to address it. The first step — getting tested — is the bravest and most productive thing you can do for your family. Dr. Prashanthi and the team at Mother Hospitals approach every male factor case with complete confidentiality and sensitivity.
Dr. Prashanthi's message to couples: "I always evaluate both partners from the first visit. I have seen couples where the wife underwent multiple procedures — and when we finally tested the husband, the primary issue was with him. A semen analysis takes one day and can save months of misguided treatment. Please do not delay it."
Frequently Asked Questions
How common is male infertility?
Male factor infertility contributes to 40–50% of all infertility cases globally and in India. In 20% of couples, both partners have contributing factors. It is equally as common as female infertility, yet is often the last thing evaluated. A semen analysis should be done alongside — not after — female fertility testing.
What is azoospermia (zero sperm count)?
Azoospermia means no sperm in the ejaculate. Obstructive azoospermia (blockage prevents sperm exit) is highly treatable — sperm can be retrieved with TESA/PESA and used for ICSI. Non-obstructive azoospermia (impaired production) is more complex but has treatment options in selected cases. Zero sperm does not always mean fatherhood is impossible.
What does a semen analysis report measure?
Semen analysis measures: sperm concentration (≥16 million/mL normal), total count (≥39 million normal), progressive motility (≥30% normal), morphology by Kruger strict criteria (≥4% normal forms), volume, vitality, and WBC count. DNA fragmentation testing is additional and checks genetic integrity of sperm.
What is ICSI and how does it help male infertility?
ICSI (Intracytoplasmic Sperm Injection) injects a single sperm directly into a mature egg, bypassing the need for sperm to swim and penetrate independently. It achieves fertilisation rates of 70–80%+ even with very low sperm counts. It is the standard treatment for significant male factor infertility at Mother Hospitals.
What are TESA and PESA procedures?
TESA (Testicular Sperm Aspiration) retrieves sperm directly from testicular tissue via a fine needle under local anaesthesia. PESA (Percutaneous Epididymal Sperm Aspiration) retrieves sperm from the epididymis. Both are done as day procedures at Mother Hospitals and the retrieved sperm are used with ICSI. Both are highly effective for obstructive azoospermia.