Mumbai: In India, when a couple struggles to conceive, the first question society often asks is, “What is wrong with the woman?”. So the first medical tests, ranging from hormonal checks and scans to fertility evaluations, are usually completed for the woman, while the man is often tested much later. Yet the science tells a very different story. Male factors contribute to nearly 40 to 50 per cent of infertility cases in India, making men equally responsible for reproductive challenges faced by couples.
Despite this, male infertility remains one of the least discussed and most underdiagnosed health issues in the country. The scale of the problem is becoming increasingly difficult to ignore. India is estimated to have over 27 million people facing infertility, and nearly one in six couples struggles to conceive, particularly in urban areas.
At the same time, studies suggest that only about 25 per cent of Indian men meet normal semen parameters, pointing to a widespread but largely silent reproductive health concern.
Even more worrying is the evidence that sperm health is deteriorating over time. Doctors report that the average sperm count in Indian men has fallen sharply, from around 60 million per millilitre three decades ago to nearly 20 million today in many clinical observations.
Lifestyle diseases such as obesity and diabetes, rising stress levels, environmental toxins, and delayed parenthood are all being linked to this decline.
Yet despite these alarming trends, conversations around male fertility remain overshadowed by stigma and cultural notions of masculinity. For many men, fertility testing is still perceived as a challenge to identity rather than a routine health check.
Against this backdrop, experts gathered at the 6th edition of the ETHealthworld Fertility Conclave for a panel discussion titled “Tackling Male Infertility — The Silent Crisis.”
The panel featuring Dr. Priyank Kothari, Urologist & Andrologist, Men’s Health Specialist, Dr. Parzan Mistry, Gynaecologist and Infertility Specialist, Medical Director- Gynafem, Dr. Rishikesh Chandrashekhar Velhal, Consultant Urologist and Andrologist, Apollo Hospital, Navi Mumbai; and Chetan Raj Singh, Senior President – Business, Advy Chemical Pvt Ltd explored the clinical causes, diagnostic gaps, social barriers, and emerging technologies shaping male infertility in India, while calling for a shift toward earlier diagnosis, greater awareness, and a more couple-centric approach to fertility care. The session was moderated by by Prathiba Raju, Senior Assistant Editor, ETHealthworld.
Opening the discussion, answering to a question on why does male infertility continue to remain a difficult subject to discuss openly? While infertility conversations often revolve around women, the biological reality tells a different story—male factors play an equally important role.
Responding to this, Dr Kothari identified three key drivers emerging in clinical practice. The first and perhaps most significant is metabolic syndrome, which is increasingly being linked to unexplained or idiopathic infertility. Rising rates of obesity, diabetes, and lifestyle-related disorders are affecting hormonal balance and overall reproductive health in men.
The second factor he highlighted was the growing exposure to endocrine disruptors, which are becoming more prevalent with urbanisation. Environmental pollutants, chemicals, and even excessive gadget exposure may be influencing fertility patterns, although the exact mechanisms are still under investigation.
The third category involves reversible causes of infertility, such as varicocele or infections, which can impair fertility but may be corrected with timely diagnosis and treatment.
The conversation then moved to a larger global concern—the decline in sperm counts worldwide. Addressing this, Dr Velhal pointed out that several decades of epidemiological data show a measurable decline in sperm concentration globally.
According to Dr Velhal, sperm counts observed decades ago were significantly higher compared to present-day figures. Studies indicate that sperm concentration has declined steadily over the last six to seven decades, with both quantity and quality of sperm showing deterioration.
He explained that lifestyle-related conditions such as diabetes, obesity, and metabolic syndrome are major disruptors contributing to this decline. At the same time, exposure to environmental toxins—including chemicals, polymers, microplastics, and other pollutants—may also be affecting male reproductive health.
Another critical contributor, he noted, is chronic stress, which now begins early in adolescence and continues through adulthood. Increasing academic pressure, lifestyle stress, and work-related stress could be indirectly influencing hormonal balance and fertility outcomes.
Dr Mistry spoke candidly about how fertility treatments fail due to male infertility that is diagnosed too late.
“Fertility treatment should not be equated solely with IVF. Many couples assume that visiting a fertility specialist immediately leads to IVF, but in reality, treatment typically progresses through multiple stages starting with natural attempts, followed by intrauterine insemination (IUI), and only then moving toward IVF if required,” Dr Mistry said.
He stressed that identifying the underlying cause of male infertility is crucial before advancing to more complex interventions. Conditions such as varicocele or infections can often be treated successfully, improving fertility outcomes without necessarily requiring IVF.
Dr Mistry also pointed out that semen analysis should not be limited to just sperm count and motility. Several other parameters including sperm consistency, liquefaction time, and biochemical markers such as fructose levels provide valuable insights into reproductive health.
More advanced diagnostic tools, such as DNA Fragmentation Index (DFI) testing, are also gaining prominence. According to him, DFI helps evaluate the integrity of sperm DNA and can provide answers in cases where fertilisation fails, embryos do not develop properly, or couples experience repeated miscarriages.
From the diagnostic technology perspective, Dr. Singh discussed how the landscape of male infertility testing is evolving. He explained that for many years, most fertility interventions focused heavily on women, while male infertility received comparatively little attention.
Recognising this gap, his organisation decided to focus specifically on male infertility diagnostics. One of the challenges in traditional testing, he explained, is the variability in manual semen analysis, where results may differ depending on who performs the test.
“To address this, AI-driven semen analysis technologies have been introduced to standardise the process and reduce observer variability. Over the past three years, such technologies have already been adopted across hundreds of IVF centres, helping streamline laboratory processes,” Dr Sing said.
He stressed that semen analysis should not be restricted to couples already undergoing fertility treatment. Instead, greater awareness is needed so that men consider fertility testing as part of routine health monitoring.
Despite advances in technology and diagnostics, the panel acknowledged a major paradox on how semen analysis is one of the simplest and most affordable fertility tests available, yet male testing is often delayed.
Addressing this issue, Dr Velhal explained that part of the delay stems from longstanding infertility guidelines, which typically define infertility as the inability to conceive after one year of trying.
These guidelines were formulated decades ago when the average age of marriage was much lower. Today, however, many couples marry in their early or mid-thirties, meaning the biological window for conception is narrower.
Waiting an entire year before initiating fertility investigations may therefore lead to lost time for many couples.
Another major factor, according to Dr Velhal, is the psychosocial stigma surrounding male fertility testing. In many cultures, fertility is closely linked with masculinity. As a result, men may hesitate to undergo testing, assuming that normal sexual performance automatically implies normal fertility.
He clarified that this assumption is often incorrect. Many men who are otherwise physically healthy may still experience conditions such as azoospermia or oligospermia, which affect fertility but remain undetected without proper testing.
Building on this point, Dr Kothari emphasised that infertility evaluation should ideally follow a couple-centric approach. Instead of evaluating men and women separately, both partners should undergo basic fertility assessments at the same time.
He also suggested that semen analysis could potentially become part of routine health check-ups for men above the age of 25, especially as delayed marriage and delayed parenthood become increasingly common in urban populations.
Interestingly, semen parameters may also serve as indicators of broader health conditions. In some cases, abnormalities in semen quality have been linked to metabolic and cardiovascular health risks.
The experts also discussed the growing awareness around fertility preservation. While egg freezing has become a widely discussed option for women, awareness about sperm freezing is also gradually increasing among men who wish to preserve fertility for the future.
Concluding the session, Dr. Velhal noted that while advances in IVF have made it possible to achieve fertilisation even in complex cases, technology alone cannot solve the growing infertility burden.
Instead, greater emphasis must be placed on prevention, lifestyle interventions, early diagnosis, and public awareness.
Experts agreed that addressing male infertility requires a shift in both clinical practice and societal mindset. By bringing men into the fertility conversation and encouraging earlier testing, healthcare providers can help ensure more balanced and effective reproductive care.
