For many Indian couples trying to conceive, the first conversation about fertility often focuses on the woman. Menstrual cycles, ovulation, PCOS, age, thyroid function and ovarian health are discussed in detail, while the man’s reproductive health may receive attention only much later. This approach can delay diagnosis and add unnecessary emotional pressure to women.

Fertility, however, is a shared journey. Male factors can contribute substantially to difficulty conceiving, and infertility may result from male factors, female factors, a combination of both, or sometimes no clearly identifiable cause. The World Health Organization defines infertility as the inability to achieve pregnancy after 12 months or more of regular, unprotected intercourse.

For Indian women and couples, understanding the male side of fertility is therefore not about assigning blame. It is about making fertility evaluation more balanced, timely and effective.

Male Fertility and Infertility: Why Both Partners Need Evaluation

When pregnancy does not occur despite regular attempts, it is natural for a woman to wonder whether something is wrong with her health. She may start tracking ovulation more closely, undergo hormone tests or scans, or worry about conditions such as PCOS. These investigations can be important, but they should not automatically become the starting and ending point of fertility evaluation.

Male fertility depends largely on the production of healthy sperm, their movement, their shape and their ability to reach and fertilise an egg. Problems can occur at several stages, including sperm production, transport through the reproductive tract and ejaculation. WHO notes that male infertility commonly involves problems such as absent or low sperm levels, abnormal sperm movement or morphology, and difficulties with semen ejaculation.

This is why fertility assessment should be approached as a couple’s evaluation rather than a woman’s responsibility alone.

What Causes Male Infertility?

Male infertility can have many causes, and sometimes no single cause can be identified. Medical conditions, hormonal problems, testicular disorders, genetic factors, infections, medications and lifestyle or environmental exposures can all influence reproductive health.

One recognised condition is varicocele, an enlargement of veins around the testicle that can interfere with testicular function and sperm production. Other possible causes include previous infections, testicular injury, undescended testes, hormonal disorders, genetic abnormalities and treatments such as chemotherapy or radiotherapy. Certain medications and anabolic steroid use can also suppress normal sperm production.

Lifestyle factors may also matter. Smoking, excessive alcohol consumption, obesity and exposure to certain environmental pollutants have been associated with poorer reproductive health. These factors do not mean that every man with an unhealthy lifestyle will experience infertility, but addressing modifiable risks can be an important part of fertility care.

Low Sperm Count, Poor Motility and Abnormal Morphology Explained

Many women hear terms such as low sperm count, poor sperm motility or abnormal sperm morphology during fertility discussions without fully understanding what they mean.

Sperm count refers to the number of sperm present in a semen sample. Motility describes how effectively sperm move, which is important because sperm need to travel through the female reproductive tract to reach the egg. Morphology refers to sperm structure and shape.

An abnormal semen report does not automatically mean that natural conception is impossible. Semen parameters can vary, and interpretation requires clinical context. WHO’s laboratory manual provides standardised methods for semen examination, supporting consistent assessment of male reproductive function.

For this reason, couples should avoid interpreting an individual semen result in isolation or assuming that one abnormal report determines their entire fertility future.

Semen Analysis: A Simple but Important Fertility Test

For a man undergoing fertility evaluation, semen analysis is generally an important initial investigation. It provides information about semen volume and sperm concentration, movement and morphology, among other parameters. Patient.info also identifies semen analysis as the initial investigation commonly used in the assessment of male infertility.

Depending on the medical history and the initial findings, a doctor may recommend additional investigations. These could include hormonal testing, physical examination, scrotal evaluation, genetic testing in selected situations or assessment for conditions such as varicocele.

The purpose is not to order every possible test. Good fertility care aims to identify the most likely cause using a step-by-step, evidence-based approach.

How Lifestyle Can Influence Male Fertility

For Indian couples, fertility discussions often focus on diet and lifestyle changes for women. Men benefit from the same attention to overall health.

Maintaining a healthy body weight, avoiding tobacco, limiting excessive alcohol intake, exercising regularly and following a balanced diet can support general and reproductive health. Avoiding non-prescribed anabolic steroids is particularly important because testosterone and anabolic androgen use can suppress the hormonal signals required for sperm production.

Sleep, stress management and reducing unnecessary exposure to environmental toxins may also form part of a broader healthy lifestyle. However, lifestyle changes should complement medical evaluation rather than replace it when infertility is already present.

Does Male Fertility Affect the Woman’s Fertility Treatment?

Yes, and this is one of the reasons early male evaluation matters.

Imagine an Indian couple undergoing months of investigations focused primarily on the woman, followed by ovulation treatment or other interventions, only to discover later that the partner has a significant sperm-related problem. Earlier evaluation could have helped the couple understand the complete picture sooner.

This does not mean that women should stop their own fertility assessment. Female age, ovulation, ovarian reserve, fallopian tube health, uterine conditions and other factors remain important. Instead, both partners should ideally be assessed appropriately so that treatment is planned around the actual needs of the couple.

When Should a Couple Seek Fertility Advice?

The WHO definition of infertility uses 12 months of regular, unprotected intercourse without achieving pregnancy as an important point for evaluation. However, medical assessment may be appropriate earlier depending on age, medical history or known fertility concerns.

A couple should consider seeking professional advice if pregnancy has not occurred despite regular attempts, or sooner if the man has a history of testicular problems, previous genital infections, surgery affecting the reproductive system, chemotherapy or radiotherapy, sexual or ejaculation difficulties, or known hormonal or genetic conditions.

Women should also seek timely advice when they have irregular periods, suspected PCOS, endometriosis, previous pelvic infections or other concerns that may affect fertility.

Male Fertility Treatment Depends on the Cause

There is no single treatment for male infertility because the underlying cause differs from one person to another.

When a correctable medical condition is identified, treating that condition may improve fertility. Hormonal disorders may require specialist management, while selected men with varicocele or reproductive tract obstruction may benefit from surgical treatment. In situations where sperm production or function remains significantly impaired, assisted reproductive techniques such as intrauterine insemination or IVF with or without intracytoplasmic sperm injection may be considered depending on the couple’s circumstances.

Importantly, testosterone therapy should not be started casually by a man who is trying to conceive. Exogenous testosterone can suppress the body’s reproductive hormonal system and reduce sperm production.

Treatment decisions should therefore be personalised rather than based on over-the-counter supplements, internet advice or unproven fertility remedies.

A More Balanced Approach to Fertility in Indian Couples

Fertility challenges can be emotionally exhausting, particularly when women feel that they alone are responsible for finding the reason pregnancy has not occurred. A more compassionate approach recognises that fertility belongs to both partners.

For Indian women, this shift in perspective can be especially reassuring. If your doctor recommends a semen analysis for your partner, it does not mean that your health is being dismissed. It means your fertility journey is being evaluated comprehensively.

Likewise, an abnormal semen report is not a reason for shame or blame. Many causes of male infertility can be evaluated and managed, and modern reproductive medicine offers several options when natural conception becomes difficult.

Conclusion: Male Fertility Should Never Be an Afterthought

Male fertility is an essential part of the fertility equation, yet it is still frequently overlooked. A couple should not spend months assuming that the woman is the only one who needs investigation.

Understanding sperm health, recognising possible risk factors and arranging timely evaluation can help couples move from uncertainty towards a clear treatment plan. The goal is not to determine who is responsible for infertility. The goal is to understand the complete reproductive health of both partners and choose the most appropriate path towards pregnancy.

At Dr. Shweta Bansal Wazir’s practice, fertility care is approached with sensitivity, clinical understanding and respect for both partners. Women seeking fertility guidance can discuss their concerns, understand the possible causes of delayed conception and receive appropriate advice about when partner evaluation may be needed.

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Dr. Shweta Bansal Wazir
Consultant Obstetrician & Gynaecologist
Phone: +91 84481 2800