Male Infertility

Male infertility contributes to roughly half of couples' fertility problems — but is often assumed to be "the woman's issue" in India. Male evaluation should happen alongside, not after, female evaluation. Many causes are treatable; for others, assisted reproduction (IUI, IVF/ICSI) offers a path to parenthood.

When to seek help

• One year of regular unprotected sex without pregnancy.
• Six months if the female partner is over 35.
• Earlier if there is a known cause — history of cryptorchidism, varicocele, testicular trauma, cancer treatment, STI, chronic illness, certain medicines.

What to expect at evaluation

• Detailed history — puberty, past illnesses, surgeries, mumps orchitis, STIs, medicines, tobacco/alcohol, occupational heat/chemical exposure.
• Examination — including check for varicocele, testis size, vas deferens, signs of hormone deficiency.
• Semen analysis — two samples, 2–3 months apart, after 2–5 days' abstinence, at an accredited andrology lab. Tests count, motility, morphology.
• Hormone tests (FSH, LH, testosterone, prolactin, TSH) if semen abnormal.
• Scrotal ultrasound for varicocele/testicular abnormality.
• Genetic tests (karyotype, Y-chromosome microdeletion) in azoospermia or very low counts.

Common causes and treatments

• Varicocele — dilated scrotal veins; surgery improves semen parameters in selected cases.
• Hormonal issues — treatable with specific endocrine therapy.
• Obstructive azoospermia (vas blocked or absent) — surgical correction, or sperm retrieval + ICSI.
• Non-obstructive azoospermia — testicular sperm extraction + ICSI in many cases.
• Infections (past STI, TB of epididymis) — antibiotic treatment.
• Retrograde ejaculation — medicines or retrieval techniques.
• Lifestyle factors — tobacco, alcohol, anabolic steroid use (cause infertility), obesity, high heat (laptop on lap, hot baths), stress.

Avoid

• Unregulated "male power" pills, gym testosterone, anabolic steroids, "fertility drugs" sold online — many reduce sperm production further, and some cause dangerous cardiovascular and liver effects.
• Testosterone replacement when trying to conceive — it usually suppresses sperm production.
• "Ayurvedic fertility treatments" lacking evidence — some contain steroids or heavy metals.

Assisted reproduction

• IUI (intrauterine insemination) — for mild male-factor.
• IVF + ICSI — intracytoplasmic sperm injection; for severe male-factor; excellent success in trained centres.
• Surgical sperm retrieval + ICSI — for obstructive/non-obstructive azoospermia.
• India has many world-class ART centres — but also unregulated ones. Choose an ICMR-registered ART clinic.
• Donor sperm or embryo adoption are options when all else fails — legal frameworks exist.