Difficulty conceiving is a concern that can involve the male partner, the female partner, both partners, or sometimes factors that cannot be identified immediately. A timely evaluation of both partners can help identify potentially treatable causes and guide the next steps.
For men in Mohammed Ali Road and surrounding areas, a urological or andrological assessment can help evaluate sperm production, reproductive health, hormonal factors and other conditions that may affect fertility.
What Is Male Infertility?
Infertility refers to difficulty achieving a pregnancy after a period of regular, unprotected sexual intercourse.
Infertility is a couple-related condition, so evaluation should generally involve both partners rather than automatically attributing delayed conception to either the man or the woman.
Male factors may contribute to infertility in a substantial proportion of couples. The EAU recommends evaluating both partners and assessing men who seek medical help for fertility problems.
When Should a Couple Consider Fertility Evaluation?
For couples who have not achieved pregnancy after 12 months of regular, unprotected intercourse, fertility evaluation is generally recommended.
Earlier assessment may be appropriate when there are known or suspected factors that could affect fertility.
For men, earlier evaluation may be appropriate in situations such as:
- Previous testicular problems
- Undescended testis during childhood
- Previous testicular torsion or significant genital injury
- Previous genital or pelvic surgery
- Previous chemotherapy or radiotherapy
- Known hormonal problems
- Significant sexual or ejaculatory difficulties
- Previous or current use of anabolic steroids or other potentially fertility-affecting substances
- Previous abnormal semen analysis
- Testicular abnormalities or significant varicocele
- A history suggesting a possible genetic or reproductive disorder
The appropriate timing depends on the circumstances of the couple rather than a single rule applied to everyone.
What Can Affect Male Fertility?
Male reproductive function depends on several processes, including sperm production, sperm maturation, transport and ejaculation.
Potential contributing factors include:
- Abnormal sperm production
- Reduced sperm concentration
- Reduced sperm movement
- Abnormal sperm morphology
- Varicocele
- Testicular disorders
- Hormonal abnormalities
- Genetic factors
- Previous genital or urinary infections
- Undescended testes
- Testicular injury or torsion
- Certain medications
- Anabolic steroid or testosterone use
- Previous chemotherapy or radiotherapy
- Problems affecting sperm transport
- Ejaculatory or sexual dysfunction
- Certain systemic or metabolic conditions
- Lifestyle and environmental factors
Several factors may coexist in the same individual.
The EAU specifically recognises genetic, urogenital, endocrine, malignant and treatment-related causes among factors associated with male infertility.
Does Good Sexual Function Mean Fertility Is Normal?
Not necessarily.
A man may have normal erections, sexual desire and ejaculation and still have an abnormal semen analysis.
Similarly, an erectile or ejaculatory problem does not automatically mean that sperm production is abnormal.
Sexual function and reproductive function are related but are not the same thing.
This distinction is important because fertility cannot reliably be judged from sexual performance alone.
What Happens During the First Consultation?
A male fertility evaluation generally begins with a detailed medical and reproductive history.
The doctor may ask about:
- How long the couple has been trying to conceive
- Previous pregnancies
- Previous fertility investigations
- Childhood testicular conditions
- Undescended testes
- Testicular injury or torsion
- Previous infections
- Genital or pelvic surgery
- Medications
- Testosterone or anabolic steroid use
- Smoking and alcohol use
- Recreational drug use
- Occupational or environmental exposures
- Sexual function
- Ejaculation
- Previous fertility treatment
- Family history of reproductive or genetic problems
Some questions may feel personal, but they can provide clinically important information about potential causes of reduced fertility.
What Does a Semen Analysis Show?
Semen analysis is one of the fundamental investigations in male fertility assessment.
It can provide information about:
- Semen volume
- Sperm concentration
- Total sperm number
- Sperm motility
- Sperm morphology
- Other semen characteristics when indicated
The test should be performed and interpreted using standardised laboratory methods. The WHO Laboratory Manual for the Examination and Processing of Human Semen, 6th edition provides internationally standardised procedures for semen examination.
However, semen analysis is not a simple fertile-versus-infertile test.
A semen result below or above a reference value does not by itself determine whether a couple will or will not achieve pregnancy naturally. The WHO specifically notes that semen parameters alone cannot reliably distinguish fertile from subfertile individuals.
The result therefore needs to be interpreted together with the clinical history, examination and the fertility status of both partners.
Is One Semen Analysis Enough?
Not always.
Semen parameters can vary between samples.
If the initial semen analysis is abnormal, the EAU recommends repeat semen analysis, with at least two consecutive analyses when the baseline analysis is abnormal.
The timing and need for repeat testing should be determined according to the individual clinical situation.
This is one reason why a single abnormal semen report should not automatically be interpreted as permanent infertility.
Are Hormone Tests Necessary for Every Man?
No.
Hormonal evaluation is selected according to the clinical findings and semen parameters.
Depending on the situation, testing may include hormones such as:
- Follicle-stimulating hormone (FSH)
- Testosterone
- Luteinising hormone (LH)
- Prolactin or other hormones when clinically indicated
Hormonal assessment becomes particularly relevant when there is severe oligospermia or azoospermia, reduced sexual desire, erectile dysfunction, small or atrophic testes, or other findings suggesting an endocrine problem.
The AUA/ASRM guideline specifically recommends hormonal evaluation including FSH and testosterone in infertile men with conditions such as impaired libido, erectile dysfunction, oligozoospermia, azoospermia, atrophic testes or clinical evidence of hormonal abnormality.
When Are Genetic Tests Needed?
Genetic testing is not required for every man undergoing fertility evaluation.
It may be considered when semen findings and the clinical examination suggest a significant impairment of sperm production or a possible genetic cause.
Depending on the circumstances, evaluation may include tests such as:
- Karyotype
- Y-chromosome microdeletion testing
- CFTR-related testing in selected cases of suspected congenital absence of the vas deferens
- Other genetic testing when clinically indicated
The decision depends on the degree and pattern of sperm abnormality and other clinical findings.
The EAU recommends genetic evaluation in appropriately selected men rather than as a routine test for every fertility patient.
Is Ultrasound Required?
Not necessarily for every man.
A physical examination remains an important part of male fertility assessment.
Scrotal ultrasound may be recommended when there is a testicular abnormality, suspected varicocele, uncertainty regarding testicular size or another clinical indication.
Other imaging studies are generally selected according to the suspected underlying problem rather than performed routinely.
Can Lifestyle Changes Improve Male Fertility?
Lifestyle factors can influence reproductive health, but infertility should not automatically be blamed on lifestyle.
Measures that may support general reproductive health include:
- Avoiding tobacco
- Avoiding anabolic steroids and unsupervised testosterone use
- Limiting excessive alcohol consumption
- Maintaining a healthy body weight
- Regular physical activity
- Adequate sleep
- Managing relevant metabolic conditions
- Avoiding unnecessary exposure to potentially harmful substances
However, lifestyle measures cannot correct every cause of male infertility.
A structural, genetic, hormonal or testicular problem may require specific medical evaluation and treatment.
What Should Men Avoid Before Fertility Assessment?
One common mistake is starting multiple fertility supplements without understanding the underlying problem.
Another is taking testosterone or anabolic steroids while trying to improve sexual performance or physical strength.
Exogenous testosterone can suppress sperm production and should not be used as a treatment for male infertility in men who wish to father children. The current EAU guideline gives a strong recommendation against testosterone therapy for treatment of male infertility in men wishing to become fathers.
Men should therefore discuss testosterone or other hormonal products with a qualified doctor before using them when fertility is a concern.
What Happens If the Semen Analysis Is Abnormal?
An abnormal result does not automatically mean that natural conception is impossible.
The next step depends on:
- The degree and type of abnormality
- Whether the finding persists on repeat testing
- Physical examination
- Hormonal profile
- Testicular function
- Presence of varicocele or another structural problem
- Genetic findings when relevant
- Sexual and ejaculatory function
- The female partner's fertility factors
- Duration of infertility
- The couple's reproductive goals
Some men may benefit from treatment of an underlying condition.
Others may require fertility-directed procedures or assisted reproductive techniques depending on the overall circumstances.
The objective is to identify potentially treatable factors and provide the couple with realistic options.
Does Male Infertility Mean There Is No Chance of Having a Child?
No.
An abnormal semen analysis or diagnosis of male-factor infertility does not automatically mean that biological parenthood is impossible.
The appropriate options depend on the underlying cause and the reproductive status of both partners.
Some conditions can be treated directly. In other situations, assisted reproductive techniques may be considered.
The appropriate pathway should be determined after proper evaluation rather than based on a single semen report.
Why Should Both Partners Be Evaluated?
Fertility is a couple-related outcome.
The EAU recommends investigating both partners simultaneously so that the possible causes of delayed conception can be understood more completely.
This is particularly important because the age and reproductive health of the female partner can influence the urgency and choice of fertility treatment.
Therefore, male fertility assessment should complement—not replace—the appropriate evaluation of the female partner.
When Should a Man Consider a Urological or Andrological Consultation?
Consider an assessment when:
- Pregnancy has not occurred after the appropriate period of trying
- A previous semen analysis was abnormal
- There is very low sperm count or no sperm in the semen
- There is a history of undescended testes
- There has been testicular injury or torsion
- There is a known or suspected varicocele
- There is a history of genital or pelvic surgery
- There are sexual or ejaculatory difficulties
- There is concern about testosterone or hormonal function
- There has been previous chemotherapy or radiotherapy
- Fertility is a concern before treatment that may affect sperm production
Earlier evaluation may be particularly important when significant reproductive risk factors are already known.
Red Flags and Situations Requiring Prompt Assessment
Male infertility itself is usually not an emergency.
However, prompt medical evaluation is appropriate for:
- A new testicular lump or significant change in testicular size
- Sudden severe testicular pain
- Significant testicular or scrotal swelling
- Blood in the semen that is persistent or associated with other concerning symptoms
- Significant genital trauma
- Acute severe scrotal symptoms
- Severe pain associated with fever or systemic illness
These symptoms may have causes unrelated to infertility and should not simply be attributed to a fertility problem.
Male Fertility Evaluation in Mohammed Ali Road and Mumbai
For men in Mohammed Ali Road and surrounding areas of Mumbai, fertility concerns can be assessed through a structured urological and andrological evaluation.
Dr Zaffar K. Sayed – Consultant Urologist, Andrologist & Uro-Oncosurgeon provides evaluation of male fertility concerns, with semen analysis, examination and additional investigations recommended according to the individual clinical situation.
The purpose of assessment is not simply to identify an abnormal semen report. It is to understand the possible cause, consider potentially treatable factors and help the couple understand appropriate options.
Key Message
Male fertility depends on sperm production, sperm function, reproductive anatomy, hormones and several other factors.
A man can have normal sexual function and still have an abnormal semen analysis, while one abnormal semen analysis does not necessarily mean permanent infertility.
A structured evaluation of both partners provides a more complete picture of the reasons for delayed conception and helps guide appropriate next steps.
Early assessment can be particularly useful when there are known testicular, hormonal, genetic, sexual or reproductive risk factors.
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