Let’s Talk About the Elephant in the Room
In almost every couple who comes to see me, the woman has already had a pile of tests done. Blood work, ultrasounds, maybe an HSG. And when I ask about the semen analysis, I often get a pause — sometimes an awkward look — and “we haven’t done that yet.”
Male infertility accounts for about 40% of all cases where a couple can’t conceive. Another 20% involve factors from both partners. This means in the majority of infertility cases, there is a male component. And yet the semen analysis is often the last test done, not the first.
I don’t say this to be harsh. I understand the cultural and emotional weight around male fertility. But addressing it early isn’t an accusation — it’s practical medicine that saves time and avoids unnecessary procedures for the woman.
What a Semen Analysis Actually Measures
A standard semen analysis looks at:
- Count: How many sperm per millilitre (normal ≥15 million/ml)
- Motility: What percentage are moving, and how well (normal ≥40% progressive motility)
- Morphology: What percentage have a normal shape (normal ≥4% by Kruger)
- Volume: Total semen volume (normal 1.5–5ml)
A normal-looking semen analysis doesn’t always rule out male factor though — sperm DNA fragmentation (damage to the genetic material inside sperm) can cause recurrent miscarriage and IVF failure even when the basic analysis looks fine.
Common Causes Worth Knowing
- Varicocele: Enlarged veins in the scrotum that raise temperature and damage sperm. The most common treatable cause — surgical repair can significantly improve parameters.
- Hormonal issues: Low testosterone, high prolactin, thyroid problems
- Past infections: Mumps orchitis, STIs, epididymitis — all can affect the testes
- Lifestyle factors: Smoking, heavy alcohol, steroids, heat exposure (tight underwear, laptop on lap, frequent saunas)
- Azoospermia: No sperm in the ejaculate — may be obstructive (blockage) or non-obstructive (production issue)
What Can Be Done
For mild-moderate male factor, IUI with sperm washing concentrates the best sperm and significantly improves the odds.
For severe cases, IVF with ICSI — where a single sperm is injected directly into an egg — can achieve fertilisation even with very few motile sperm.
For azoospermia, sperm can often be surgically retrieved directly from the testes (TESA/PESA) and used for ICSI.
A Word for the Men Reading This
Getting a semen analysis does not reflect on your masculinity, your virility, or your worth as a man or partner. It’s a diagnostic test — like a blood test. Getting it done is one of the most caring things you can do for your partner.
We Evaluate Both of You From the Start
At Punit Fertility in Kandivali, we assess both partners from the very first consultation. It saves time, avoids unnecessary testing, and gives us the complete picture faster.