Male fertility evaluation
Male factor infertility means that a man's sperm count, movement or shape is a main or contributing reason a couple has not conceived. It is found in about half of couples with infertility. At EVE Women and Fertility Clinic in Gunjur, Bangalore, Dr. Swati Shree arranges a semen analysis and a careful counselling visit for the male partner as an early step, since the test is simple and the answer can change the whole plan.
At a glance
- How common
a male factor contributes to about half of couples' infertility
- First test
semen analysis, after 2 to 7 days of abstinence
- Result read against
WHO laboratory manual, 6th edition (2021) reference limits
- Lower reference limits
volume 1.4 mL, concentration 16 million per mL, total number 39 million, total motility 42 percent, progressive motility 30 percent, normal forms 4 percent
- Repeat
if abnormal, repeat after about 2 to 3 months, as sperm take about 3 months to form
- Common causes
varicocele, infection, hormonal problems, lifestyle factors, medicines, genetic causes
- No sperm in the semen (azoospermia)
TESA or PESA may retrieve sperm for IVF with ICSI
Understanding the semen report
| Term | What it means |
|---|---|
| Volume | The amount of semen |
| Concentration | Sperm per millilitre |
| Total motility and progressive motility | The percent of sperm that move, and move forward |
| Morphology | The percent of sperm with normal shape (a low number is common and not alarming alone) |
| Azoospermia | No sperm in the sample |
| Oligozoospermia, asthenozoospermia, teratozoospermia | Low count, poor motility, abnormal shape |
These are lower reference limits from healthy fertile men, not pass or fail marks. A result under a limit does not mean conception is impossible, and a result above does not guarantee it.
Common causes
- Varicocele: enlarged veins around the testicle, a frequent and treatable cause
- Hormonal causes: problems with pituitary or testicular hormones
- Infections and past mumps after puberty
- Blockage of the sperm ducts, as in obstructive azoospermia
- Genetic causes in severe cases, such as Klinefelter syndrome or Y chromosome microdeletions
- Lifestyle and medicines: smoking, heavy alcohol, obesity, anabolic steroids and testosterone products, which can switch off sperm production, and some medicines
- Heat: frequent hot baths or sauna and prolonged laptop on the lap have limited evidence, but avoiding them costs nothing
What happens at EVE
Counselling visit
Dr. Swati talks with the male partner, with respect and privacy. She asks about medical and surgical history, medicines, habits, and sexual function.
Semen analysis
A sample is given after 2 to 7 days of abstinence.
Examination or referral
If needed, a physical examination or scrotal ultrasound is arranged, sometimes by a urologist or andrologist.
Further tests
Hormone tests, genetic tests or a sperm DNA fragmentation test are done only when they will change the plan.
Plan
Options include treating the cause, lifestyle changes, IUI, IVF with ICSI, and TESA or PESA in azoospermia.
How to prepare for the semen sample
- Abstain for 2 to 7 days, as advised
- Wash hands, and collect the full sample in the container given
- Keep the sample at body temperature and bring it quickly, usually within 30 to 60 minutes
- Tell us about fever in the last 3 months, medicines and supplements
Limits
A single normal sample is reassuring, but sperm counts vary, so results are read together with a repeat if abnormal. A semen analysis does not show how well sperm fertilise an egg.
FAQs
What is a normal sperm count?
The WHO 2021 manual gives a lower reference limit of 16 million sperm per millilitre, and 39 million in the whole sample. These are lower limits of normal in fertile men, not a pass mark. Dr. Swati reads your full report, including motility and shape. WHO reference values are about 16 million per mL concentration and 39 million per ejaculate, with motility and shape also counted. One slightly low value matters less than the trend across two tests.
Can male infertility be treated?
Often, yes. Some causes can be treated directly, such as a varicocele or an infection. Lifestyle changes improve sperm in many men. If sperm numbers or motility stay low, IUI, IVF with ICSI or sperm retrieval can help. The right choice depends on your report. Often, yes, depending on the cause: infections, hormones, varicocele, lifestyle and some blockages are treatable. When direct treatment falls short, ICSI with IVF can work with very few sperm.
How do I give a semen sample?
After 2 to 7 days without ejaculation, collect the sample by masturbation into the clean container given, with clean hands. Do not use lubricants or condoms. Keep it at body temperature and deliver it promptly. We explain this when you book.
What if the first semen report is abnormal?
Repeat the test after 2 to 3 months, because sperm production takes about three months and results vary. Dr. Swati also looks for a cause. A repeat avoids unnecessary worry or unnecessary treatment.
Does age affect male fertility?
Sperm quality and DNA integrity decline slowly with age, and some risks rise for fathers over 40 to 45. This is a smaller effect than the age effect in women, and many men remain fertile into later life. Yes, though far more gradually than in women. Counts and motility decline with age and DNA damage rises, which is why very low values or repeated failures deserve a proper urology review.
Do tight underwear, mobile phones or hot baths cause infertility?
Evidence is limited and the effects are small. Smoking, heavy alcohol, obesity, anabolic steroids and untreated varicocele matter more. Avoiding heat is harmless but should not replace testing.
Sources
- WHO laboratory manual for the examination and processing of human semen, 6th edition (2021)
- AUA/ASRM Guideline: Diagnosis and treatment of infertility in men (2020)
- ASRM Practice Committee, Diagnostic evaluation of the infertile male (2015)
- EAU Guidelines on Sexual and Reproductive Health
