Sudden severe testicular pain is an emergency. Go to hospital immediately. Testicular torsion must be treated within hours to save the testis. Also seek urgent care for a painless testicular lump.
A male factor is present in around half of couples who cannot conceive, and it is the single most under-investigated area in fertility medicine. In many couples only the woman is tested.
A semen analysis is cheap, quick and available almost everywhere. Having two done properly, before any expensive treatment is planned, is the most useful thing most couples reading this page can do.
Sperm production takes about seventy-two days, and it is sensitive to a wide range of influences — heat, illness, medication, hormonal problems, infection and structural abnormalities. A single abnormal semen analysis may reflect a fever three months earlier rather than a permanent problem, which is why repeating it after six to twelve weeks matters before any conclusion is drawn.
The results are described in terms of concentration, motility and morphology. Low count is oligospermia; absent sperm in the ejaculate is azoospermia. Azoospermia divides into obstructive, where production is normal but the passage is blocked, and non-obstructive, where production itself has failed. That distinction determines everything about what can be done.
Varicocele — dilated veins around the testis — is the commonest identifiable and correctable cause, present in a substantial proportion of men with abnormal semen parameters. Its repair improves parameters in many men, though the effect on live birth rates is debated.
Several causes are genuinely treatable. Hormonal deficiency responds to treatment. Infection can be cleared. Certain drugs, including testosterone supplements taken for bodybuilding, suppress sperm production entirely and are reversible on stopping — a cause we see more often than most clinics acknowledge.
Sperm production is affected by fever, illness, medication, heat and stress in the preceding three months, and results fluctuate considerably in the same man. A single abnormal result should always be repeated after six to twelve weeks, in a laboratory that follows proper standards, after two to five days of abstinence. Couples are regularly advised towards expensive treatment on the basis of one poor sample that would have been normal on repeat. Equally, a man should never be told the result is fine without seeing the actual numbers — normal ranges are lower than most people assume and a result at the bottom of normal is worth discussing.
Two semen analyses first; further testing depends on what they show.
A letter saying the semen analysis was abnormal tells us almost nothing. We need the concentration in millions per millilitre, the percentage with progressive motility, the morphology percentage, the volume, and the period of abstinence before the sample. Send both analyses with dates, the hormone profile, and any scrotal ultrasound. Also tell us about any testosterone or steroid use, past or present — it is a common and entirely reversible cause.
Some causes are correctable. Where they are not, ICSI works with very few sperm.
Stopping testosterone or anabolic steroids, which suppress sperm production and are reversible over months. Treating hormonal deficiency, infection, or thyroid disease. Weight loss, stopping smoking, reducing alcohol and avoiding excessive heat. These cost little and can change the picture entirely.
Surgical or radiological treatment of dilated veins around the testis. It improves semen parameters in a substantial proportion of men, and is most worth considering in a man with a palpable varicocele and abnormal parameters where the female partner has no significant problem and time allows.
Where no sperm appear in the ejaculate, they can frequently be retrieved directly from the epididymis or testis. In obstructive azoospermia retrieval nearly always succeeds. In non-obstructive azoospermia, microdissection TESE finds sperm in a meaningful proportion of men, and the surgeon's experience matters considerably.
A single sperm injected directly into each egg, bypassing every barrier to natural fertilisation. It works with very few sperm and even with surgically retrieved, immotile sperm. It is the standard treatment for significant male factor infertility and has transformed what is possible.
Two properly performed tests, twelve weeks apart, before any conclusion or expensive plan.
Testosterone use, hormonal deficiency, infection and varicocele are all treatable. These come before IVF.
FSH, testicular size and sometimes biopsy distinguish them, and the chance of retrieving sperm differs enormously between the two.
If you are taking testosterone or have taken anabolic steroids, tell us. It suppresses sperm production completely, it is reversible over months, and it is a cause clinics frequently fail to ask about.
Testicular torsion is measured in hours and a testicular lump needs urgent assessment. Both are treated where you are, immediately.
Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.
Not necessarily, and not yet. A single abnormal result should be repeated after six to twelve weeks, because sperm production is affected by illness, fever, medication and heat in the preceding three months. Several reversible causes should also be excluded first. Couples are regularly moved towards expensive treatment on the basis of one poor sample.
Usually not. Azoospermia divides into obstructive, where production is normal but the passage is blocked, and non-obstructive, where production has failed. In obstructive cases sperm retrieval nearly always succeeds. Even in non-obstructive azoospermia, microdissection TESE finds usable sperm in a meaningful proportion of men, and ICSI then needs very few.
Sometimes. Repair improves semen parameters in a substantial proportion of men with a clinically palpable varicocele and abnormal results. Its effect on live birth rates is debated, and it takes months to show benefit. It is most worth considering in younger couples where the female partner has no significant problem and there is time to wait.
Quite possibly. Testosterone supplements and anabolic steroids suppress sperm production completely and are a common cause we see, particularly in younger men — and they are reversible over months after stopping. Certain other drugs, including some used for blood pressure, ulcers and hair loss, also affect sperm. Bring a full list of everything you take.
The evidence for antioxidant supplements is weak and inconsistent, and they are heavily marketed. What does help is stopping smoking, reducing alcohol, losing excess weight, avoiding excessive heat, and stopping any testosterone or steroid use. Those are free and better supported than anything sold in a bottle.
In some cases. Y chromosome microdeletions are passed to sons, who will have the same problem. Absence of the vas deferens is associated with cystic fibrosis gene mutations and warrants testing both partners. This is why genetic testing is recommended in severe male factor infertility before ICSI, so you can make an informed decision.
Send both semen analyses with the full numbers, not a summary. Tell us about any testosterone or steroid use — it is a common, reversible cause that is often not asked about.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
WhatsApp +91 83035 86344 · Phone +91 83035 86344 · Email tibhind@gmail.com
Coordinators available 9:00–20:00 IST. We speak Arabic, English, Russian and Bengali.