Just figure this: About 17.5% of the adult population – or roughly one in six worldwide – experience infertility, according to a report by the World Health Organization (WHO). Incidentally, almost half of all these cases are contributed by male-related factors. This often-overlooked reality, which otherwise places the burden of infertility primarily on women, is leading to a silent reproductive health crisis in India.
“Male infertility accounts for a significant share of infertility in India, contributing to nearly 40-50% of cases, either independently or alongside female factors,” says Dr Kalpana Jain, fertility specialist at Birla Fertility and IVF, Guwahati. Delayed diagnosis and treatment are still pertinent issues, as “fertility is still largely viewed as a female health issue”, she adds.
Speaking of the high prevalence of male infertility, Dr Nikita Lad Patel, IVF specialist and fertility preserving surgeon at Apollo Fertility, says, “This is likely due to multiple factors such as the country’s large population, lack of awareness about fertility and reproductive health, and limited access to quality healthcare.” Much like female infertility, the male burden is also caused by a number of factors, many of them lifestyle related, adds Dr Patel. “Late working hours, smoking, obesity, sedentary lifestyle, poor diet and pollution, mainly in metropolitan cities, are to blame. Stress due to work pressure, demanding jobs, late night work culture, and long sitting hours also leads to decreased testosterone levels, which affects not only sperm production but also motility,” she explains.
“Male infertility can result from a range of factors, including low sperm count or motility, hormonal imbalances, genetic conditions, infections, and varicocele (an enlargement of veins within the scrotum),as well as heat or exposure to environmental toxins,” explains Dr Jain. While not all causes are preventable, they are modifiable with changes in lifestyle habits and treatment, she adds.
Dr Amol Wankhede, infertility specialist at Apollo Fertility, Thane, says, “About 700 patients visited our clinic in the past one year related to male fertility issues. The sperm counts of men are at times barely normal – it’s mainly near to the lower limit of normal in the biological reference interval. The gap between average semen parameters and cut-off levels is decreasing.” Dr Patel recalls a specific case of a couple who were attempting to conceive at the ages of 27 (female) and 36 (male), but were facing challenges due to infertility.
The man had been diagnosed with azoospermia, a complete absence of sperm in ejaculate. The couple consequently underwent counselling, and was prescribed testicular sperm extraction, which is a minor surgical procedure to retrieve sperm directly from the testicle, followed by intracytoplasmic sperm injection, which is an advanced form of in vitro fertilisation (IVF) where a single, healthy sperm is injected directly into a mature egg to achieve fertilisation in a laboratory setup. This process created a body of seven embryos, and the couple ended up with a healthy baby girl, who is now two-and-a-half years old. Inspired by the success of the process, the couple once again tried IVF with the remaining frozen
embryos from the procedure, and the woman is now two months into her pregnancy with twins.
Myths & reality
“One of the most persistent myths and misconceptions around male infertility is the belief that fertility is a measure of masculinity or sexual ability. Another misconception is that having normal sexual performance guarantees fertility,” says Dr Jain, adding: “In reality, the two are completely unrelated.” “These misconceptions create stigma, making many men reluctant to come forward for testing,” she frets.
“As a result, simple evaluations such as semen analysis, which are neither invasive nor complicated, are often delayed, adding unnecessary time, stress, and emotional strain for couples.” “Other myths include infertility being associated with masculinity, masturbation causing infertility and erectile dysfunction being synonymous with infertility. Some others include boxers being better than briefs to prevent infertility, the age factor not affecting male fertility, prior successful pregnancies ensuring a future of complete fertility, and finally, the misconception that male infertility cannot be treated,” Dr Patel adds.
Instead, so as to not rely on and panic over such myths, “We advise our patients not to view infertility as a personal failure but as a treatable medical condition. The first step is a comprehensive evaluation, including semen analysis, hormonal testing, and clinical assessment,” says Dr Jain, “Once the underlying cause is identified, treatment may range from lifestyle modification and medical therapy to surgical correction or assisted reproductive techniques.” Dr Patel says that for men, post-diagnosis, a lot of treatment options are available for each condition.
“For example, varicocele is one of the most common reversible conditions which at times would not need any treatment in mild cases. Otherwise, treatment options include minimally invasive procedures such as surgical tying of the veins or embolisation to redirect blood flow,” she explains.
Speaking of hormonal changes, she says, “Lifestyle changes and medical interventions such as testosterone replacement (TRT) for low testosterone or specific medications for issues like thyroid or insulin resistance are recommended.” There are several factors that can lead to untimely diagnosis of male fertility. “This could include lack of awareness, hesitation to reach out to doctors, beliefs in myths and assuming that infertility is to be blamed on the women,” shares Dr Patel. “The tendency to test women first means that men are often evaluated months or even years into treatment, reducing the chances of timely intervention,” Dr Jain adds.
Help at hand
“Patients coming to us are mostly in the reproductive age group of 25-40 years,” says Dr Wankhede. “Some come for fertility treatment while others evaluate their fertility potential. In both the scenarios, the semen parameters show a declining trend in sperm count, motility and morphology.” “In routine clinical practice, a substantial proportion of couples presenting each month have a clear male-factor contribution, either as the primary cause or alongside female factors,” says Dr Jain, “reinforcing the need for early, joint fertility assessment and a shift in how society approaches reproductive health.”
She further says that to try and ensure good reproductive health, sperm viability and keep infertility relatively at bay, individuals need only to follow a few healthy lifestyle habits – “maintaining a healthy weight, exercising regularly, avoiding tobacco and excessive alcohol, managing stress, getting adequate sleep, and seeking early medical advice can significantly improve reproductive health and outcomes”.
Dr Patel advises, “Micronutrients such as zinc, vitamin C, and selenium are required for sperm production.” She warns that steroid supplementation ought to be avoided, as it can harm sperm production. “Include food rich in antioxidants and avoid high caloric junk food, high sugar, and processed food,” she adds.
BOX 1 – Possible causes
- Lengthy work timings
- Smoking
- Obesity
- Sedentary lifestyle
- Poor diet
- Pollution
- Low sperm count or motility
- Hormonal imbalances
- Genetic conditions
- Infections
- Varicocele
BOX 2 – Preventive measures
- Healthy weight, regular exercise
- Avoid tobacco, alcohol use
- Manage stress, get adequate sleep
- Include vitamin C, zinc, selenium in diet
- Avoid use of steroid supplements
- Include foods rich in antioxidants