Male Infertility: What the Tests Actually Show

When a couple cannot conceive, the investigation still tends to begin — and sometimes end — with the female partner. That sequence costs time.

A male factor is present in roughly half of couples who struggle to conceive, and in about a fifth it is the only factor. The male assessment is also faster, cheaper and less invasive than most of the female workup. There is no good reason for it to come second.

When should you get checked?

• After twelve months of regular unprotected intercourse without conception
• After six months if the female partner is over 35
• Straight away if there is a known risk: undescended testes as a child, previous testicular surgery or torsion, chemotherapy or radiotherapy, a groin hernia repair in childhood, or a testicular injury

What does a semen analysis actually tell you?

It is the first test, and it measures several things at once:

Measure	What it means
Volume	How much fluid
Concentration	Sperm per millilitre
Total count	Volume × concentration
Motility	The proportion swimming, and how well
Morphology	The proportion normally shaped
Vitality	The proportion alive

Two things about this test matter more than the numbers:

One result means very little. Sperm take about 74 days to produce. A fever, a viral illness, a stressful month, a course of medication, or simply a different abstinence period will shift the result. Always repeat after two to three months before drawing conclusions.

“Normal” is not a fertility guarantee, and “abnormal” is not a verdict. The reference values describe populations, not individuals. Men with results below the range conceive naturally; men within it sometimes do not.

What else gets tested?

• Hormones — testosterone, FSH, LH, prolactin. FSH is particularly informative: a high FSH with a low count usually points to a production problem, while a normal FSH with no sperm suggests a blockage.
• Scrotal ultrasound — to look for varicocele, obstruction or testicular abnormalities.
• Genetic testing — karyotype and Y-chromosome microdeletion, where the count is very low or absent.
• Post-ejaculatory urine — checks for retrograde ejaculation, where semen goes into the bladder.

The treatable causes

Varicocele. Enlarged veins draining the testicle, found in around 40 percent of men with infertility. They raise testicular temperature, which impairs sperm production. Surgical repair is a day procedure, and improvement in semen parameters typically takes three to six months to appear.

Hormonal deficiency. Uncommon but very treatable with medication.

Infection. Of the prostate or epididymis, treatable with antibiotics.

Obstruction. A blockage anywhere from the epididymis to the ejaculatory duct. Sometimes correctable surgically; otherwise sperm can be retrieved directly.

Retrograde ejaculation. Often medication-related, sometimes from diabetes. Frequently manageable. It can also follow prostate surgery, which is why men planning a family should say so before any prostate procedure.

Reversible lifestyle factors. Smoking, heavy alcohol, anabolic steroids (a common and under-declared cause), obesity, prolonged heat, and some prescription medicines. Worth being candid with your doctor about all of these — the consultation is confidential and steroid use in particular is both a frequent cause and a frequently hidden one.

What if there is no sperm at all?

Azoospermia is not the end of the road. The critical question is whether it is obstructive — production is fine but the sperm cannot get out — or non-obstructive, meaning production is impaired.

Obstructive cases can often be corrected surgically, or sperm retrieved easily. Even in non-obstructive azoospermia, sperm can frequently be found within the testis by micro-TESE and used for ICSI. Many men in this position go on to have biological children.

The practical things that help

• Stop smoking, and cut alcohol
• Come off anabolic steroids entirely — and tell your doctor
• Lose excess weight
• Avoid prolonged heat: hot baths, saunas, a laptop on the lap, long unbroken driving
• Aim for intercourse every two to three days across the cycle, rather than trying to time it precisely
• Review any regular medication with your doctor

Getting assessed in Uppal

Dr. Srikanth Munna consults in urology and andrology at UNO Super Speciality Clinics, Uppal, Monday to Saturday, 6–9 PM. Consultations are private, and a quieter evening slot can be requested.

Bring any previous semen analyses — including old ones, since the trend is informative — plus hormone reports and details of any medication. Where the answer turns out to be assisted reproduction, you will get a straight explanation of what that involves rather than being handed a referral without context.