Male Infertility Causes & Diagnosis in Ahmedabad

When a couple cannot conceive, the conversation almost always starts with the woman. Tests are arranged for her. Specialist appointments are made for her. She carries the emotional weight of investigation while the man waits.

This is medically wrong. Male factor infertility is the sole or contributing cause in approximately 50% of all infertility cases. And yet, in many couples we see at Wellspring IVF, the man has never had a single test done.

The semen analysis — a painless, 30-minute test — is one of the most informative and most underutilised investigations in fertility medicine. It gives us a complete picture of sperm count, motility, morphology, and DNA health. And critically: a low result is not a reflection of masculinity. It is a medical variable. Nothing more, nothing less.

At Wellspring IVF & Women’s Hospital, Dr. Pranay Shah treats the man as a patient — with his own diagnosis, his own treatment plan, and his own clinical pathway. Not as an afterthought. Not as just a sample provider. As half of the equation.

A standard semen analysis tells us count, motility, and morphology. But it does NOT tell us about sperm DNA quality. A man can have a perfectly normal semen analysis and still have high DNA fragmentation — meaning his sperm appear fine but carry damaged genetic instructions.

High DFI (above 25%) is associated with:

• Repeated IUI failures despite reasonable sperm count
• Repeated IVF failures despite fertilisation occurring
• Recurrent early miscarriage where female factors have been ruled out

Dr. Shah recommends DFI testing in cases of unexplained infertility, recurrent IUI/IVF failure, and recurrent miscarriage. Available in-house at Wellspring IVF. Call 9099946050 to arrange.

Unlike female infertility — where a scan can immediately reveal fibroids, cysts, or blocked tubes — male infertility is invisible to the naked eye. It requires systematic lab and imaging investigation. Here is our complete approach:

Varicocele — Present in 35–40% of Infertile Men

What it is: Enlarged varicose veins inside the scrotum that raise testicular temperature by 1–2°C. Sperm production requires temperature precisely 2–3°C below body temperature. Even a small rise causes measurable damage to count, motility, and DNA.

Why it matters most: Varicocele is the single most common reversible cause of male infertility. Found in 35% of men with primary infertility and up to 80% of men with secondary infertility.

Diagnosis: Scrotal Doppler ultrasound — this cannot be reliably detected on physical examination alone. Dr. Shah arranges a Doppler scan for all men with abnormal semen parameters.

Treatment: Microsurgical or laparoscopic varicocelectomy. In 60–70% of cases, sperm parameters improve significantly within 3–6 months — sometimes enough to convert an ICSI case into a natural conception or IUI case.

 Hormonal Imbalance — The Often-Missed Cause

Primary hypogonadism: Testes fail to produce adequate testosterone despite normal pituitary signals. FSH is elevated. Sperm production is impaired. May require HCG injections.

Secondary (hypogonadotropic) hypogonadism: The pituitary gland is not signalling the testes adequately. FSH and LH are low. Testes may respond to hormone stimulation with Clomiphene, Letrozole, or HCG.

Hyperprolactinaemia: Elevated prolactin from a pituitary adenoma suppresses testosterone. Treatable with Cabergoline. Sperm production typically recovers within 3 months.

Thyroid dysfunction: Both hypo- and hyperthyroidism impair sperm quality. A simple TSH blood test identifies this — and treatment is straightforward.

Diagnosis: Fasting blood test: FSH, LH, Total Testosterone, Prolactin, TSH, SHBG, Oestradiol.

Genetic Causes — Known Before Starting Treatment

Y-chromosome microdeletion (YCM): Deletions in the AZFa, AZFb, or AZFc regions of the Y chromosome directly impair spermatogenesis. AZFc deletions still allow TESA sperm retrieval; AZFa/b deletions typically do not. Testing before surgery is non-negotiable.

Klinefelter syndrome (47,XXY): Extra X chromosome causes primary testicular failure. Most common sex chromosome abnormality. Azoospermia is typical but Micro-TESE may find sperm in focal areas.

CFTR gene mutation: Causes Congenital Bilateral Absence of the Vas Deferens (CBAVD) — a physical obstruction. Sperm production is normal; the exit path is absent. PESA retrieves sperm from the epididymis.

Why genetic testing matters: If a Y microdeletion is passed to a son born through ICSI, he will inherit the same fertility issue. Pre-implantation genetic testing (PGT) can screen embryos before transfer. Couples are counselled on this before proceeding.

Lifestyle & Environmental Factors — Reversible With Action

Oxidative stress: The primary mechanism by which lifestyle factors damage sperm. Free radicals attack sperm membranes and DNA. Antioxidant supplementation (CoQ10, Zinc, Selenium, Vitamin C+E) significantly reduces oxidative damage.

Smoking: Reduces sperm count by up to 22%, motility by 13%, and significantly increases DNA fragmentation. Effects partially reverse within 3 months of stopping.

Alcohol: More than 5 units/week suppresses testosterone and damages sperm morphology. The effect is dose-dependent and reversible.

Obesity (BMI > 30): Increases scrotal temperature and converts testosterone to oestrogen via adipose tissue aromatisation. Losing 10% body weight can meaningfully improve sperm parameters.

Anabolic steroids / testosterone therapy: Exogenous testosterone completely shuts down the pituitary-gonadal axis. Men on testosterone therapy often have zero sperm count. Recovery after stopping can take 12–24 months and is not guaranteed.

Heat exposure: Prolonged laptop use on the lap, hot baths, saunas, and tight underwear all impair spermatogenesis. Simple behavioural changes — cooling the scrotal environment — are part of the treatment protocol.

Infection & Obstruction — The Plumbing Problem

Sexually transmitted infections (STIs): Chlamydia and gonorrhoea are the most common infectious causes of epididymal and vas deferens blockage in India. Often silent — the infection resolved years ago but left scarring.

Tuberculosis (TB): Genital TB is significantly more prevalent in India than globally. It scars the epididymis and vas deferens, causing obstructive azoospermia. Diagnosed with culture, PCR, and sometimes surgical biopsy.

Previous surgeries: Inguinal hernia repair, hydrocoele surgery, or orchidopexy can inadvertently damage the vas deferens or epididymis. History-taking is essential.

Retrograde ejaculation: Semen travels backward into the bladder instead of forward through the urethra. Common after prostate surgery, diabetes neuropathy, or certain medications. Sperm can be retrieved from urine for IUI or ICSI.