Male infertility: causes, semen analysis, treatment and which doctor to see
Why male infertility is common but under-tested, the causes, how semen analysis and other tests work, and the treatments including IVF with ICSI.
Also known as: Infertility, Male; Low Sperm Count
What male infertility is
Male infertility means a man's reproductive system makes it hard for his partner to become pregnant — because he makes few or no sperm, the sperm do not move or are not shaped normally, or the sperm cannot get out because of a blockage or a problem with erection or ejaculation.
A male factor is involved in a large share of couples who have difficulty conceiving, on its own or together with a female factor. Yet in India men are often tested late, after their partner has already been through many tests. A semen analysis is simple, non-invasive and should be one of the first tests a couple has.
Fertility is not the same as virility. A man can have normal erections and sex drive and still have a sperm problem.
Symptoms
Most men with infertility have no symptoms other than difficulty conceiving. Some notice signs of an underlying cause:
- Difficulty conceiving after a year of regular unprotected sex
- Erection or ejaculation problems, or very little semen
- Swelling or pain in the testicles, or a lump
- A soft swelling above the testicle that feels like a 'bag of worms' — a varicocele
- Reduced facial or body hair, or breast enlargement, suggesting a hormone problem
- Low sex drive
Causes and who is at risk in India
Common causes include:
- Varicocele — enlarged veins in the scrotum that raise its temperature
- Infections — mumps after puberty, sexually transmitted infections, and genital tuberculosis, which can block the sperm ducts
- Blockages — from past infection, surgery, injury or being born without the vas deferens
- Hormone problems — of the pituitary gland or testicles
- Undescended testicles in childhood, even if corrected
- Genetic conditions, such as Klinefelter syndrome or missing parts of the Y chromosome
- Medicines and treatments — chemotherapy, radiotherapy, and some medicines for other conditions
Lifestyle and environment matter too: smoking and chewing tobacco, heavy alcohol use, obesity, diabetes, and long exposure to heat (such as working beside furnaces or ovens). Testosterone injections, anabolic steroids and some 'muscle-building' supplements sold in gyms can shut down sperm production — sometimes for a long time. Never take testosterone to improve fertility.
How it is diagnosed
The doctor will take a history, including childhood problems, infections, medicines and work, and examine the testicles. Tests include:
- Semen analysis — a sample produced after a few days without ejaculation and examined in a laboratory for sperm count, movement and shape. Because results vary, an abnormal test is repeated.
- Hormone tests — testosterone, FSH, LH and prolactin.
- Scrotal ultrasound — to look at the testicles and check for a varicocele.
- Genetic tests — for men with very low or absent sperm counts.
- Sometimes a urine test after ejaculation, a transrectal scan, or a testicular biopsy.
Your doctor will compare your results with reference ranges and explain what they mean. Semen analysis should be done in a laboratory used to fertility testing, as results depend on careful technique.
Which doctor to see
A urologist, particularly one with an interest in andrology (male reproductive health), assesses and treats male infertility. An endocrinologist helps with hormone problems. Your partner's gynaecologist or fertility specialist will plan treatment for the couple together.
Under the Assisted Reproductive Technology (Regulation) Act, 2021, clinics and sperm banks offering assisted reproduction must be registered with the National Registry of Banks and Clinics of India. You can find urologists in Bengaluru on The Doctor Index, each with a registration you can check.
Treatment
- Lifestyle changes — stopping tobacco, cutting alcohol, losing weight if needed, controlling diabetes, and avoiding heat to the scrotum. Sperm take about three months to develop, so improvements take time.
- Varicocele repair — surgery or a radiological procedure, considered in men with a varicocele and abnormal semen results.
- Hormone treatment — for men with specific hormone deficiencies, under specialist care.
- Treating infections, and surgery to bypass or open blockages in some men.
- Sperm retrieval — surgical extraction of sperm from the testicle or epididymis in men with no sperm in the semen.
- IUI, IVF and ICSI — assisted reproduction; in ICSI, a single sperm is injected into each egg, which allows conception even with very low sperm numbers.
Be wary of tablets, powders and tonics advertised to boost sperm or 'sex power'. Most are unproven, some are unregulated, and none replaces a proper assessment. Do not stop prescribed medicines for other conditions without asking your doctor; some can be switched to options that affect sperm less.
Couples are usually assessed and treated together, because the best plan depends on both partners' results and the woman's age. A modest sperm problem with a young partner may need only time and lifestyle change, while the same result with an older partner may point towards earlier assisted reproduction.
Living with it: protecting your fertility
- Avoid tobacco in all forms and limit alcohol
- Keep a healthy weight and stay active
- Avoid hot baths, saunas and long periods with a laptop on the lap
- Use protection against sexually transmitted infections
- Ask about sperm freezing before cancer treatment
- Seek support — infertility affects men emotionally too
When it is an emergency
Call 112 or 108, or go to the nearest emergency department, for:
- Sudden, severe pain in a testicle, with swelling or vomiting — possible torsion, which needs surgery within hours
- A painful, swollen scrotum with fever
- An erection lasting more than four hours
A painless lump in a testicle is not an emergency but needs a prompt check by a doctor.
Questions to ask at your appointment
- What do my semen results mean, and should the test be repeated?
- What is causing the problem?
- Can it be treated, or do we need assisted reproduction?
- Would treating my varicocele help?
- Are any of my medicines or supplements affecting my sperm?
- How long should we wait for lifestyle changes to show an effect?
Common questions
Questions people ask
- If I have normal erections, can I still be infertile?
- Yes. Sperm production and erections are controlled separately. Many men with low sperm counts have entirely normal sexual function, which is why a semen analysis is needed rather than assuming the man is fertile.
- Can a man with no sperm in his semen become a father?
- Often, yes. In some men with no sperm in the semen, sperm can be retrieved surgically from the testicle and used for ICSI. A urologist will assess the cause and the chances before recommending this.
- Do gym supplements affect fertility?
- Testosterone, anabolic steroids and some unregulated supplements can stop sperm production. Tell your doctor about anything you take. Recovery is possible after stopping, but it can take many months and sometimes needs treatment.
- Are fertility tonics for men effective?
- Most tonics and powders sold for male fertility or 'sex power' have little evidence behind them, and some are unregulated. Some antioxidants are being studied, but none should replace an assessment of the cause by a doctor.
This condition is usually assessed by a urologist. Every profile shows the doctor’s registration and what has been checked.
Urologists in Bangalore
A few urologists listed on The Doctor Index. They are shown because of their speciality, not a stated interest in Male Infertility; ask the clinic whether the doctor sees it.
Related conditions
All reproductive medicine conditions →
Practical reading
All postsSources
- MedlinePlus, US National Library of Medicine — Male Infertility
- World Health Organization — Infertility fact sheet
- National Medical Journal of India — Legal subtleties of the Indian Assisted Reproductive Technology Act of 2021
- MedlinePlus, National Library of Medicine — Male Infertility — Public-domain health-topic summary
Male infertility: causes, semen analysis, treatment and which doctor to see is original text by The Doctor Index; the compiled source draft was used for research. Source: MedlinePlus, National Library of Medicine. Orphadata Science: Free access data from Orphanet. © INSERM 1999; July 2026 data, CC BY 4.0. This product uses the Human Phenotype Ontology (hp/releases/2026-09-01). Only sources listed for this article apply. Source material has been selected and arranged; HPO definitions are reproduced without alteration. No source organisation endorses this compilation. Köhler S et al. The Human Phenotype Ontology project: linking molecular biology and disease through phenotype data. Nucleic Acids Research 2014;42(D1):D966–D974. doi:10.1093/nar/gkt1026.
General information, not advice about your situation. Errors can be reported through the corrections process. Reference TDI-C-1476.