Male Infertility: Causes, Semen Analysis Results and Treatment Options Explained

When a couple is trying to conceive and pregnancy does not happen as expected, the focus often falls on the woman. However, fertility problems can involve the male partner, the female partner, or both

That is why a fertility evaluation should generally consider both partners rather than assuming that infertility is a female-only issue

For couples looking for male infertility treatment in Hyderabad, understanding the possible causes, initial tests, and available treatment approaches can make the fertility journey clearer

What is male infertility?

Male infertility is when a problem with sperm production, sperm quality or sperm delivery lowers the chance of a female partner getting pregnant. A couple is generally considered to have infertility if they have not conceived after 12 months of regular unprotected intercourse (or 6 months if the woman is 35 or older). In about one-third of couples, the cause lies mainly with the male partner, and in many others, both partners have contributing factors

Most men with fertility problems feel completely healthy. There are often no obvious symptoms, which is why testing matters

Signs that may point to male infertility

While many men have no symptoms, the following can be warning signs:

• Difficulty with erection or ejaculation, or low sexual desire
• Pain, swelling or a lump in the scrotum
• Visible enlarged veins in the scrotum (varicocele)
• Reduced facial or body hair, or other signs of hormone imbalance
• A history of undescended testes, testicular injury, hernia surgery or mumps after puberty
• Previous cancer treatment (chemotherapy or radiation)

Semen analysis: the first and most important test

A semen analysis checks the health of sperm in a sample collected after 2–7 days of abstinence. Because sperm counts can naturally vary, doctors often repeat the test if the first result is abnormal.

Semen analysis normal values (WHO 2021 reference limits)

These values are reference points, not a pass/fail score. A result slightly below a limit does not mean a man cannot father a child, and a “normal” report does not guarantee fertility. Your fertility specialist will interpret the report along with your partner’s results.

Common terms on a semen report

• Oligozoospermia: Low sperm count
• Asthenozoospermia: Poor sperm movement
• Teratozoospermia: High proportion of abnormally shaped sperm
• Oligoasthenoteratozoospermia (OAT): A combination of all three
• Azoospermia: No sperm in the ejaculate

Further tests if the report is abnormal

• Hormone tests: FSH, LH, testosterone and prolactin
• Scrotal ultrasound to check for varicocele or blockages
• Sperm DNA fragmentation test, in selected cases
• Genetic tests (such as karyotype or Y-chromosome microdeletion) for very low counts or azoospermia
• Tests for infection

You can learn more about tests for both partners in our blog on fertility tests couples should take before starting treatment, or explore our fertility assessment services.

Common causes of male infertility

Medical causes

• Varicocele: Enlarged veins in the scrotum that can raise testicular temperature and affect sperm quality. It is one of the most common correctable causes.
• Hormonal imbalance: Problems with the pituitary gland or low testosterone can reduce sperm production.
• Infections: Some infections, including certain sexually transmitted infections, can affect sperm or cause blockages.
• Blockages: Damage or absence of the tubes that carry sperm (for example, after infection or surgery).
• Genetic factors: Conditions such as Klinefelter syndrome or Y-chromosome microdeletions.
• Ejaculation problems: Including retrograde ejaculation, where semen enters the bladder.
• Previous treatments: Chemotherapy, radiation or some long-term medicines.

Lifestyle and environmental factors

• Smoking and tobacco use
• Heavy alcohol use
• Obesity
• Use of anabolic steroids or testosterone supplements (these can sharply reduce sperm production)
• Long-term heat exposure — hot tubs, saunas, tight clothing, or keeping a laptop on the lap for long hours
• High stress and poor sleep
• Exposure to pesticides, heavy metals or industrial chemicals

Male infertility treatment options

Treatment depends on the cause, the severity of the sperm problem, and the female partner’s fertility.

1. Lifestyle changes

Sperm take about 72–90 days to develop, so changes made today show up in a semen test around three months later. Helpful steps include:

• Quitting smoking and limiting alcohol
• Reaching a healthy weight through diet and regular exercise
• Avoiding excess heat around the groin
• Eating a balanced diet rich in fruits, vegetables, nuts and whole grains
• Stopping steroid or testosterone use (under medical guidance)
• Managing stress and sleeping well

2. Medicines

Hormonal treatment can help when infertility is caused by a hormone imbalance. Infections are treated with appropriate antibiotics. Supplements should only be taken on a doctor’s advice, as evidence for many over-the-counter products is limited.

3. Surgery

• Varicocele repair can improve semen quality in men with a clinically noticeable varicocele and abnormal semen results.
• Correction of blockages may be possible in some men.

4. Intrauterine insemination (IUI)

For mild male factor infertility, washed and concentrated sperm is placed directly into the uterus around the time of ovulation. This brings more healthy, moving sperm closer to the egg.

5. IVF with ICSI

ICSI (intracytoplasmic sperm injection) is a lab technique where a single sperm is injected directly into each egg. It has transformed the treatment of male infertility because it needs only a small number of healthy sperm. ICSI is commonly recommended for:

• Very low sperm count or poor motility
• High levels of abnormal sperm
• Previous failed fertilisation with conventional IVF
• Sperm obtained through surgical retrieval

Our advanced treatments page explains ICSI and other assisted reproduction options in more detail.

6. Surgical sperm retrieval for azoospermia

Azoospermia (no sperm in the semen) does not always mean no sperm are being produced. In many men, sperm can be retrieved directly from the testis or epididymis using procedures such as:

• PESA – Percutaneous epididymal sperm aspiration
• TESA – Testicular sperm aspiration
• TESE / Micro-TESE – Testicular sperm extraction, with micro-TESE using an operating microscope to find sperm-producing areas

The retrieved sperm is then used for ICSI.

7. Sperm freezing (male fertility preservation)

Men about to undergo cancer treatment, certain surgeries, or who have declining sperm quality can freeze sperm for future use. Learn more on our male fertility preservation page.

Male infertility treatment at a glance

When should men get a fertility check?

A man should consider a semen analysis:

• When a couple has been trying for 12 months without pregnancy (6 months if the female partner is 35 or older)
• At the same time the female partner begins fertility tests — not after
• If he has a history of testicular problems, surgery, injury or mumps
• Before starting cancer treatment
• If there are signs of hormone imbalance or sexual difficulties

Testing both partners together is the fastest way to find the right treatment.

Breaking the stigma around male infertility

In India, many men delay testing because of embarrassment or the belief that fertility is linked to masculinity. Male infertility is a medical condition, just like diabetes or high blood pressure. It says nothing about a man’s strength or worth. Talking openly with your partner and your doctor, and approaching treatment as a team, makes the journey easier for both of you.

How MOM IVF helps couples with male infertility

At MOM IVF Fertility & Research Center in Hyderabad, we evaluate both partners from the first visit. Our team offers semen analysis, hormonal evaluation, counselling, IUI, IVF with ICSI, surgical sperm retrieval and sperm freezing under one roof. Every plan is based on the specific cause, with privacy and respect at every step.

If you are worried about male fertility, book a consultation with our specialists or call +91 98986 83636. Not sure where to start? Our guide on how to choose the best fertility centre in Hyderabad can help.

Frequently asked questions

1. What is a normal sperm count?
   
   According to WHO 2021 reference values, a sperm concentration of at least 16 million per millilitre, or a total of at least 39 million sperm per ejaculate, is within the reference range. Count is only one part of fertility; motility and shape also matter.

    

2. Can low sperm count be cured?

   It depends on the cause. Low counts caused by lifestyle factors, hormone imbalance, infection or varicocele can often improve with treatment. Even when the count cannot be raised, ICSI allows many couples to conceive.

    

3. How long does it take to improve sperm quality?

   Sperm take about 72–90 days to develop, so improvements from lifestyle changes or treatment are usually seen in a semen test after around three months.

    

4. Can a man with zero sperm count become a father?

   Often, yes. In many men with azoospermia, sperm can be retrieved directly from the testes through procedures like TESA or micro-TESE and used for ICSI. Tests help predict the chance of finding sperm.

    

5. Is a semen analysis test painful?

   No. The sample is collected by masturbation in a private room at the clinic. It is quick, painless and confidential.

    

6. Does age affect male fertility?

    

   Yes, gradually. After about 40–45, semen quality may decline and sperm DNA damage may increase, though the change is slower than the decline in female fertility