I have seen increasing numbers of Indian men coming to me worried about fertility. The data support that concern: globally, the number of men affected by infertility rose by roughly 19% from 1990 to 2019.
In India, men now contribute to approximately 40-50% of infertility cases among couples.
In this article, I explain why male infertility is increasing in India, what the main causes are, what I test for, and what you can do immediately.
What the numbers show
Infertility affects millions of couples. According to the World Health Organization (WHO), one in every six people of reproductive age worldwide will experience infertility in their lifetime.
In India, estimates suggest 15-20% of couples face infertility, and in up to half of these, male factors are involved.
When a man alone is responsible, that accounts for about 20% of cases; when male and female factors co-exist, male contribution rises to about 50% of all infertility.
These numbers show that male fertility is no longer a minor issue; it is central to the fertility picture in India.
Why The Rise? The Main Causes Explained
Here are the major contributors to the rising male infertility burden in India:
Lifestyle drivers
Poor diet, obesity, heavy alcohol use, smoking, and lack of exercise all reduce sperm quality. These habits change hormones, raise scrotal temperature, increase oxidative stress, and damage sperm production. The Indian context, with urban stress patterns and sedentary life, amplifies the effect.
Environmental and occupational exposures
In India, exposure to pesticides, industrial chemicals, heat stress, and pollution plays a significant role. These agents act as endocrine disruptors; they change hormone levels or damage sperm DNA. Many men are unaware of the hidden exposures.
Infections, fever, and urological causes
Repeated urinary tract infections, sexually transmitted infections, high fevers, and untreated varicocele (enlarged veins in the scrotum) can block sperm flow or reduce sperm production. In one Indian study, 21% of men with infertility had obstructive azoospermia (complete absence of sperm in semen) due to blockages.
Varicocele: Common and often missed
Varicocele is one of the most common correctable causes of male infertility. It increases testicular temperature and reduces sperm quality. Many men don’t know they have it until a fertility evaluation.
Genetics, sperm DNA fragmentation, and epigenetics
Beyond the count and shape of sperm, damage at the DNA level (sperm DNA fragmentation) and genetic mutations affect fertility. In one Indian cohort, 9.3% of men screened had detectable genetic abnormalities.
Standard semen tests do not always capture this damage.
Diagnostic, reporting, and access issues
In India, the true scale of male infertility may be under-estimated because testing is inconsistent, lab standards vary, and many men delay seeking help due to social stigma. This means problems are detected late, and the “rising” numbers may reflect both real increases and better detection.
What a man should do first: A practical first-line checklist
Here is what I ask every man to do as soon as possible:
- Stop smoking and heavy alcohol use.
- Lose weight if you are overweight; adopt a balanced diet rich in vegetables, lean protein, and whole grains.
- Exercise regularly (moderate intensity) and avoid prolonged sitting.
- Control body temperature: avoid very hot baths/saunas, avoid laptop on your lap for long periods, wear loose underwear.
- Minimise exposure to known chemicals: agricultural pesticides, heavy metals, industrial solvents.
- Treat infections early: urinary, prostate, and sexually transmitted infections.
- Improve sleep and reduce stress: chronic stress increases hormone imbalance and oxidative damage.
- Book a semen analysis and hormonal screen rather than waiting. Early detection is key.
Tests I recommend (simple pathway)
When you come to me, this is typically how I proceed:
- Semen analysis (repeat after 2–3 months to confirm) using WHO criteria.
- Hormonal profile: testosterone, FSH, LH.
- Scrotal ultrasound if varicocele or obstruction is suspected.
- If initial tests are normal but fertility is still an issue, sperm DNA fragmentation test and genetic screening are performed in severe cases.
When to see a urologist or fertility specialist
I advise seeing a specialist if you have tried unprotected intercourse for 12 months without conception, especially if you have known risk factors (history of testicular surgery, infections, smoking, chemotherapy). Early referral gives better chances of success and avoids wasting time.
Treatments and realistic outcomes
Depending on the cause, many men can improve their fertility. Medical therapy for hormonal issues, varicocele surgery, lifestyle correction, and, when needed, assisted reproductive technologies (IUI, IVF, ICSI) are available. While some causes (genetic defects) may not be fully reversible, significant improvement is often possible with early action.
What I want every man in India to know
- You are not alone. Male infertility contributes to half of all couple’s infertility.
- Acting early increases your chances.
- Most causes are modifiable: lifestyle and environment matter.
- Simple tests can uncover hidden problems like varicocele or sperm DNA damage.
- Fertility is not just about having children; it reflects your overall health.
FAQ
Q1. Why is male infertility increasing in India?
- I see multiple reasons: lifestyle factors (smoking, obesity), environmental exposures (pesticides, heat), infections, and anatomical or genetic issues. India’s rapid urbanisation and occupational risks add to the increase.
Q2. How soon should a man get checked for infertility?
- If you’ve been trying with your partner for 12 months without success, you should see a specialist. If you have known risk factors (varicocele, infection, chemotherapy) you should come earlier.
Q3. Can I improve my sperm count and quality with lifestyle changes?
- Yes. I advise you to stop smoking, limit alcohol, maintain a healthy weight, avoid excess heat around the testicles, and reduce chemical exposures. These changes can improve sperm parameters significantly.
Q4. What tests will I need for male infertility?
- I typically order a semen analysis, hormonal profile (testosterone, FSH, LH), and if needed, a scrotal ultrasound. In tricky cases, I may recommend sperm DNA fragmentation or genetic testing.
Q5. Does having a low sperm count mean I cannot have children at all?
- No. A low sperm count does not mean zero chance. Many men with low counts succeed with lifestyle change, medical treatment, or assisted reproductive techniques. Early action improves outcome.
