For decades, infertility in India has been framed almost exclusively as a woman’s problem. But clinical data tell a different story, one that fertility specialists are increasingly urgent about sharing with the public. According to the Indian Society of Assisted Reproduction, male factor infertility now contributes to approximately 40 to 50 percent of all infertility cases in India. Studies published in leading reproductive medicine journals show that sperm counts in men across South Asia have declined by nearly 20 percent over the past two decades, mirroring a global trend that researchers have described as a reproductive health emergency. The World Health Organization revised its reference values for semen analysis in 2021, and the new thresholds reflect just how significantly population-level sperm quality has changed. Yet in most Indian households, when a couple struggles to conceive, the woman is the first, and often the only, one evaluated.
| “In my clinical experience of over two decades, I still encounter couples where the husband has never had a semen analysis done, even after two or three years of trying to conceive. There is a deep social stigma attached to male infertility in India. Men resist evaluation, and families often prefer not to discuss it. But the science is unambiguous, in nearly half the couples we see, the male partner’s sperm parameters are a significant contributing factor.”
— Dr Nishi Singh, Head of Fertility and IVF Expert, Prime IVF Centre, Gurgaon |
The causes are increasingly tied to modern urban lifestyle. Chronic scrotal hyperthermia from prolonged laptop use and sedentary work habits, exposure to endocrine-disrupting chemicals in plastics, pesticides and personal care products, rising rates of obesity, alcohol consumption, tobacco use and chronic stress, all of these factors measurably impair sperm production, motility and morphology. Occupational exposures also play an underappreciated role. Men working in industries involving heavy metals, solvents, radiation or extreme heat are at elevated risk of compromised sperm quality. A study from AIIMS Delhi found that among men presenting at infertility clinics, over 30 percent had identifiable lifestyle or occupational risk factors that had never been addressed.
The clinical spectrum of male infertility is wide. Azoospermia, the complete absence of sperm in the ejaculate, affects roughly one percent of the general male population and up to 15 percent of infertile men. Oligospermia, or low sperm count, is far more common. Asthenospermia, referring to poor sperm motility, and teratospermia, indicating abnormal sperm morphology, frequently co-exist and compound the difficulty of natural conception.
| “What gives me hope is that many causes of male infertility are treatable or at the very least manageable. Hormonal imbalances can be corrected. Varicoceles, enlarged veins in the scrotum that raise testicular temperature, respond well to surgical correction. And even in men with very severe sperm parameters, procedures like TESA, PESA or micro-TESE allow us to retrieve sperm directly from testicular tissue for use in ICSI. No couple should give up based on a semen analysis report alone without speaking to a specialist.”
— Dr Nishi Singh, Head of Fertility and IVF Expert, Prime IVF Centre, Gurgaon |
Reproductive technology has transformed the outlook for couples dealing with male factor infertility. Intracytoplasmic sperm injection, or ICSI, involves the direct injection of a single sperm into a mature egg, bypassing many of the natural barriers that poor sperm quality creates. Combined with advanced sperm selection techniques such as MACS, magnetic activated cell sorting, which separates healthy sperm from those with fragmented DNA, outcomes have improved significantly.
Public health experts emphasise that awareness is the first and most important step. A basic semen analysis is non-invasive, affordable and available in virtually every city in India. Yet it remains the most frequently postponed test in the infertility evaluation process. The conversation around infertility in India needs to include men, in the clinic, at home and in public health messaging. Acknowledging the male factor is not about assigning blame. It is about finding the full picture so that the right treatment can begin.
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