🔬 Men's Health
Male Fertility & Semen Analysis
40–50% of infertility in couples is a male factor — and it is testable in 30 minutes.
When a couple is struggling to conceive, attention almost always goes to the woman first. Yet male factor infertility is responsible for at least half of all cases. A simple semen analysis provides answers quickly, is non-invasive, and opens the door to highly effective treatment options.
Signs and Symptoms
✓ Trying to conceive for 12 months without success (6 months if over 35)
✓ History of mumps (orchitis) in adulthood
✓ Visible varicocele (varicose veins of the scrotum) or scrotal swelling
✓ Previous chemotherapy or radiotherapy
✓ Undescended testicle(s) in childhood
✓ Hormonal symptoms: low libido, reduced body hair, gynaecomastia (breast tissue growth)
When to Seek Help
RoutineActively trying to conceive for 12 months (6 months if partner is over 35) — semen analysis as first-line investigation alongside female fertility workup
SoonHistory of testicular surgery, varicocele, or STI — do not wait 12 months; assess early as treatment may be time-sensitive
NowSudden complete absence of semen production (anejaculation) or blood in semen with pelvic pain — may indicate acute obstruction or infection requiring urgent review
Tests & Diagnosis
🧪 Semen Analysis (WHO 2021 criteria)
Produced by masturbation after 2–7 days abstinence. Measures: Volume (normal ≥1.4 mL), Sperm concentration (normal ≥16 million/mL), Total motility (normal ≥42%), Progressive motility (swimming forward; normal ≥30%), Morphology (normal form by Kruger criteria ≥4%). Two samples, 4–12 weeks apart, are needed before diagnosing a sperm disorder.
🧪 Hormone Panel (FSH, LH, Testosterone, Prolactin)
FSH and LH are pituitary hormones that drive testicular function. Elevated FSH with low sperm count = testicular failure (non-obstructive azoospermia). Low FSH + low testosterone = hypogonadotrophic hypogonadism (pituitary problem — treatable). Elevated prolactin suppresses testosterone.
🧪 Scrotal Ultrasound
Detects varicocele (the most common correctable cause of male infertility), testicular volume, and any masses. A varicocele on ultrasound in an infertile man with abnormal semen parameters warrants referral for varicocelectomy.
🧪 Sperm DNA Fragmentation Index (DFI)
Advanced test for men with normal semen parameters but recurrent miscarriage or failed IVF cycles. High DFI (>25%) indicates damaged sperm DNA that may reach and fertilise the egg but fail to support embryo development. Treated with antioxidants, lifestyle change, or surgical sperm retrieval for ICSI.
Frequently Asked Questions
What is azoospermia and is it treatable?
Azoospermia means no sperm are found in the ejaculate. It has two causes: Obstructive azoospermia — sperm are being produced but cannot exit due to a blockage (vas deferens damage from STI, vasectomy, or congenital absence). Sperm can be surgically retrieved for ICSI — highly treatable. Non-obstructive azoospermia — the testes are producing few or no sperm due to testicular failure. Some men with non-obstructive azoospermia still have pockets of sperm retrievable by testicular microdissection (micro-TESE) for ICSI. Hormone panel and testicular biopsy guide the approach.
Can anabolic steroids cause permanent infertility?
Exogenous testosterone and anabolic steroids suppress the pituitary's production of FSH and LH — the signals the testes need to produce sperm. Men on anabolic steroids often have zero sperm (complete azoospermia). Recovery after stopping steroids takes 6–18 months and is not guaranteed with long-term use. Men on testosterone replacement therapy for hypogonadism who want to conceive should use gonadotrophin injections instead, which stimulate testicular function rather than suppressing it.
Is semen analysis the same as a fertility test?
Semen analysis is the primary fertility test for men, but it does not assess all aspects of male fertility. It measures sperm quantity, movement, and shape — but not sperm DNA integrity (fragmentation), anti-sperm antibodies, or the ability of sperm to fertilise an egg. A normal semen analysis is reassuring but does not guarantee fertility; a couple with normal semen analysis and unexplained infertility may have a DNA fragmentation issue detectable only with advanced testing.
How do I produce the semen sample correctly?
Abstain from ejaculation for 2–7 days before the test (longer abstinence paradoxically worsens results). Produce the sample by masturbation into the sterile container provided — do not use a condom or lubricant (both damage sperm). Bring the sample to the lab within 30–60 minutes, kept at body temperature (in a trouser pocket, not a bag). Masturbation for semen analysis is medically necessary and entirely private — do not allow embarrassment to delay diagnosis.