When a couple is unable to have a baby, the first person to blame is the woman and in many Nepali families, this can result in pressure or cruel comments. But fertility is a shared matter. Both partners can have health conditions that make pregnancy difficult.Male infertility is a common medical condition. It may result from low sperm production, problems with sperm delivery, sperm shape or movement, or other health conditions.
Male infertility is a health condition. It is not a weakness or lack of masculinity and is often treatable with appropriate care.
This blog uses simple language to explain male infertility and how online fertility care with a trusted provider Upachar Sewa, may be a good first step towards understanding the options.
Medical disclaimer: This blog is meant for education only. It cannot diagnose, treat, or prescribe medication for infertility. Do not take fertility medicines, testosterone injections, or supplements without proper medical guidance.
What is Male Infertility?
Infertility is defined as the inability of a couple to achieve pregnancy within one year of having regular unprotected sex. If the female partner is older or either partner has a fertility concern, medical advice should be sought sooner.
Male infertility means a male-related health concern may reduce chances of pregnancy. Sometimes the male partner is the only cause, sometimes both partners have fertility-related health concerns, and sometimes tests cannot identify a cause.
The World Health Organization has classified a variety of male-related infertility concerns including semen delivery problems, absence of sperm, sperm shape or movement problems, hormonal imbalance, testicular issues, impaired sperm function, or other reproductive tract concerns.
Sperm are small cells made in the testes. Ejaculating semen carries sperm out of the body and into the female reproductive tract, where they must swim to meet an egg and fertilize it. For conception to occur, a man must produce healthy sperm with normal shape and movement, and be able to ejaculate semen with enough force to propel the sperm into the egg.
- Male infertility may result from a problem with:
- Sperm production or sperm count
- Sperm movement (motility)
- Sperm shape (morphology)
- Delivery of semen or sperm
- Hormone levels
- The testes or reproductive tract
- Sexual function
- Frequency or timing of intercourse
A man may have male infertility without realizing it. That is why testing is so important.
Why Men Stay Silent About Male Infertility
Many men in Nepal are taught from a young age that female partners are solely responsible for fertility. Men may feel ashamed to admit that a sexual health concern may be affecting their ability to have children, or fear that family members or peers will ridicule them.
This can lead to years of testing and treatment with no success, as the couple may not seek medical care for the male partner. During this time, the woman may suffer stress and pressure from her own family.
Common reasons men do not seek medical care for infertility include:
- Feelings of shame or embarrassment
- Discomfort discussing sexual health or concerns
- Belief that infertility reflects negatively on their masculinity or courage
- Lack of education or awareness about male infertility
- Pressure from family members or partners to seek care
- Discomfort with semen analysis testing
- Concerns about costs or financial strain
- Belief that their condition will improve on its own
- Belief that existing children means there is no need for treatment
- Concerns about privacy or confidentiality
There is no shame in seeking or receiving care. Infertility is not a personal failing but a health concern that requires thoughtful management. Seeking care as soon as possible enables both partners to obtain the necessary tests and make informed decisions about their treatment.
Common Causes of Male Infertility
Male infertility may have a variety of causes, or no clear cause. A doctor will review a man’s medical history, conduct a physical exam, and order semen analysis and hormone tests.
Low sperm count
A low sperm count means semen contains fewer sperm than is typical for fertilization to occur
Causes of low sperm count may include:
- Hormone imbalance
- Testicular injury or surgery
- Infection
- Varicocele
- Medications
- Genetic conditions
- Exposure to extreme heat
- Smoking or tobacco use
- Alcohol or substance abuse
- Chemotherapy or radiation
- Unidentifed causes
- No sperm in semen (azoospermia)
Sometimes semen contains no sperm at all. This is called azoospermia. It may occur if the testes are not producing sperm, or if there is a blockage preventing sperm from being ejaculated. Although it may seem impossible to conceive with no sperm in the semen, medical treatment may be successful in some cases. Further testing is necessary to confirm whether the testes are producing sperm.
Poor sperm movement (motility)
Sperm must be able to move well in order to reach and fertilize an egg. Sperm movement concerns may be caused by infection, inflammation, varicocele, smoking, exposure to heat, illness, or problems with sperm production.
Abnormal sperm shape (morphology)
Many men have some sperm with abnormal shape, but a high percentage of abnormal sperm may be a sign of infertility. Abnormal shape may be caused by genetic conditions, illness, or infection.
One abnormal semen analysis does not necessarily mean a man is infertile. Test results can fluctuate due to illness or other factors, and a doctor may recommend repeating the test.
Varicocele
A varicocele is a swelling of veins around one or both testes. It may feel like a bag of worms or cause discomfort or uneven testicle size. It may reduce fertility in some men by affecting testicular temperature and sperm production. Not all men with varicocele require treatment: a urologist or male infertility specialist can recommend whether varicocele is serious enough to require treatment.
Hormonal imbalance
Hormones control many bodily functions, including sperm production. Conditions affecting the brain, thyroid, or testes can reduce hormone levels and impair fertility. Low testosterone may reduce sex drive, erections, and production. However, testosterone medications may reduce sperm production in some men, and men attempting to conceive should speak to a doctor before using them.
Infections
Infections of the testes, epididymis, prostate or reproductive tract can reduce fertility. Sexually transmitted infections may cause inflammation or blockages. Mumps after puberty can also cause infections in the testes.
Men with infections may experience pain or discomfort when urinating, unusual discharge, swelling or pain in the testes or groin area, or fever. They should speak to a doctor about testing and treatment.
Blockage
Sperm may be produced normally but may be unable to exit the body due to a blockage. Surgery, infection or other conditions may cause reproductive tract blockage. A doctor may perform various tests to confirm the diagnosis.
Sexual or ejaculatory concerns
Ejaculation is necessary for conception to occur. Pregnancy may be difficult if semen is not ejaculated into the vagina, or if a man experiences erectile dysfunction, premature ejaculation, delayed ejaculation, painful intercourse, or other sexual health concerns. These are medical conditions that can often be successfully treated. Men should speak to a qualified physician rather than attempting self-treatment.
Lifestyle and Male Fertility
Lifestyle factors can impact overall health, which in turn may impact sperm production and function. Many Nepali men work in hot conditions, sit for long periods, smoke tobacco, consume alcohol, or do not get enough sleep. These factors do not directly cause infertility, but making healthy lifestyle choices can improve general health.
Lifestyle factors that may impact male fertility include:
- Smoking cigarettes
- Using tobacco
- Consuming alcohol
- Using cannabis or other drugs
- Using anabolic steroids
- Being overweight or underweight
- Not getting enough exercise
- Not getting enough sleep
- Having health conditions such as diabetes or high blood pressure
- Chronic illness or stress
- Exposure to pesticides or other chemicals
- Exposure to extreme heat or tight clothing at work
Men who smoke cigarettes or use other tobacco products are more likely to have reduced sperm count and motility. Obesity can also reduce fertility.
Studies suggest that abnormal semen analysis results are more common in Nepali men who chew tobacco or consume alcohol, compared to men who do not. However, these studies were conducted on men who already sought care for infertility concerns, and individual results cannot be predicted.
Making healthy lifestyle choices can support sperm production. Good choices include:
- Do not smoke or use tobacco.
- Limit or avoid alcohol.
- Do not use anabolic steroids (unless prescribed for a medical condition)
- Maintain a healthy weight.
- Eat a healthy diet that includes plenty of fruits, vegetables, wholegrain foods, legumes, eggs, fish, or other nutritious food.
- Get regular exercise.
- Get enough sleep.
- Manage stress through walking, breathing exercises, counseling, or support groups.
- Treat illnesses such as diabetes, thyroid conditions, or infections.
- Speak to a doctor about chemical exposure at work.
- Avoid extreme heat exposure.
Lifestyle changes cannot replace medical care if infertility has been diagnosed or for a year or more. Men should speak to a doctor about concerns.
When Should a Man See a Doctor About Male Infertility?
A couple should seek medical advice if they have not become pregnant after one year of regular unprotected sex, or if the female partner is over 35 or has irregular periods. Men should speak to a doctor about male infertility if they have any of the following concerns:
- History of undescended testes
- Testicular injury, surgery, or infection
- Testicular swelling or pain
- Previous mumps (after puberty)
- History of sexually transmitted infections
- Previous chemotherapy or radiation
- Diagnosed varicocele
- Erectile or ejaculatory concerns
- Very low sex drive or interest in sex
- Using testosterone or anabolic steroid medications
- Previous fertility concerns or treatments
- Serious illness with high fever
- Genetic or hormonal condition
- Sudden testicular pain or swelling (this is a medical emergency and requires immediate care)
How is Male Infertility Diagnosed?
A doctor will typically begin with a consultation to discuss a man’s general health, sex life, medical history and medications, and lifestyle. They may also perform a physical exam and request hormone tests, semen analysis, testicular ultrasound, infection screening, or genetic testing.
The American Society for Reproductive Medicine and American Urological Association recommend a reproductive history and semen analysis as the initial infertility evaluation for men. Men with abnormal semen analysis or suspected male infertility should be evaluated by a male reproductive tract specialist.
Understanding semen analysis
A semen analysis is a lab test to evaluate the qualities of semen. The lab will examine the semen sample for:
- Volume
- Sperm concentration
- Total sperm count
- Sperm movement
- Sperm shape
- Living sperm percentage
- Signs of infection
The procedure takes place in a private room at a lab facility. The doctor or lab will give instructions about how to prepare for the test, which may involve avoiding ejaculation for a period of time beforehand.
A single semen analysis is not enough to diagnose male infertility. Sperm production fluctuates, and one abnormal result does not necessarily indicate infertility. Doctors may recommend repeat testing, especially if there are known risk factors. The AUA/ASRM recommends repeating semen analyses in at least two separate samples, ideally taken about a month apart, if the first sample is abnormal.
Do not panic if you receive abnormal results. Abnormal semen analysis results do not automatically mean that a man is infertile. A qualified infertility specialist can help determine what the results mean.
Treatment for Male Infertility
Treatment depends on the diagnosis and may involve medication, surgery, or assisted reproductive treatment. It may also involve making lifestyle changes. Decisions should be made in consultation with a doctor, taking into account the patient’s general health and other factors.
Common treatments for male infertility include:
- Lifestyle and dietary changes
- Treatment for infection
- Hormone medications
- Surgery (for blockage, varicocele, or other concerns)
- Treatment for erectile or ejaculatory concerns
- Sperm retrieval procedures
- Intrauterine insemination (IUI)
- In vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI)
- Donor sperm, if applicable
- Fertility preservation (egg or sperm freezing) if necessary
- Medications
Some men benefit from hormone treatments or other medications, but these should be prescribed by a doctor. Testosterone medications can reduce sperm production in some men. Herbal or “natural” male fertility medications are not proven to be effective and may have harmful side effects.
Surgery
Surgery may be recommended for certain conditions, including varicocele, blockage, or sperm retrieval. It is not appropriate for everyone, and a urologist or male infertility specialist will be able to recommend the best course of treatment based on each individual’s needs.
Assisted reproductive treatment (ART)
ART involves a range of procedures designed to help men and women conceive, including IUI, IVF, and ICSI. IUI involves placing sperm directly inside the uterus around the time of ovulation. IVF involves fertilizing an egg with sperm in a laboratory and then implanting the fertilized egg in the uterus. ICSI may be recommended for men with very low sperm count or motility.
ART procedures are not guaranteed to be successful. Patients should speak to their doctor about success rates, risks, costs, and other options.
Emotional Support and Male Infertility
Male infertility can be emotionally challenging for men and their partners. Men may experience anger, depression, guilt, or shame, and may become withdrawn or avoid social situations. They may feel that their masculinity is threatened or that they have failed their partner or family. These thoughts can lead to depression or anxiety and should be addressed with a counselor or trusted support network.
The partner may feel frustrated or hopeless, and may benefit from speaking to a counselor as well. Couples should try to talk to each other openly and honestly, and avoid placing blame. They may want to keep medical details private from friends or family who may not be supportive. They may need to set boundaries with unsupportive relatives and avoid toxic family dynamics.
Everyone should make their own decisions about how to share details about their diagnosis. Men should continue to take care of their physical and mental health regardless of their diagnosis.
Family members and partners should avoid saying hurtful or dismissive things, such as “It must be her fault,” or “You just need to relax.” Such comments are not helpful and can make the situation worse. Everyone should make decisions based on facts and not myths or old beliefs.
How Can Upachar Sewa Help?
For men who prefer to speak to a doctor online first, Upachar Sewa can help them review reports, understand test results, and decide what next steps to take.
Online male infertility care can help with:
- Initial concerns about male infertility
- Reviewing semen analysis reports
- Interpreting abnormal test results and deciding whether to repeat testing
- Discussing medications
- Referrals to a urologist, andrologist, gynaecologist, or other reproductive health specialist
- Follow-up care after treatment or surgery
- Making lifestyle or dietary changes to improve fertility
- Discussing erectile or ejaculatory concerns
- Counseling about assisted reproductive treatment options
Before making an appointment, patients should make sure the doctor is qualified and that their medical records and test results will be kept private and secure. Online consultation is not a substitute for physical examinations, lab tests, or surgery when they are needed.
Preparing for an Online Doctor Appointment
Before the appointment, patients should:
Ask the following questions:
- What could be causing my infertility concerns?
- Do I need a semen analysis?
- Should I repeat an abnormal semen analysis test?
- Do I need hormone tests?
- Can my medications impact my testosterone production or sperm health?
- Is testosterone therapy safe for me?
- Do I need to see a urologist?
- What lifestyle changes may help?
- What treatment options are available?
- Should my partner see a doctor?
Keep a private space for your consultation.
You should let the doctor know if you feel that your condition may be impacted by:
- Testosterone levels
- Hormone imbalance
- Testicular injury or surgery
- Sexual health or erectile concerns
- Lifestyle or dietary concerns
- Medications or health conditions
- Stress
- Partner's health or infertility concerns
Your doctor may recommend hormone tests, semen analysis, and a reproductive system examination. Patients should ask their doctor whether they need to keep a diary of testicular pain, or other health concerns. It is important to ask whether the semen analysis should be repeated if the results were abnormal.
Summary
Male infertility is a sensitive topic in Nepal, but it is important that men are not ashamed or silent about it. Infertility concerns may involve both partners and should be treated confidentially and with care. Low sperm count, poor sperm motility, hormone imbalances, varicocele, infections, blockage issues, lifestyle factors, sexual health concerns, and other conditions can all contribute to male infertility.
The first step to male infertility treatment is to speak to a trusted healthcare professional. A semen analysis and reproductive system exam can help identify any underlying causes. Some conditions can be effectively treated, while others may require assisted reproductive treatment.
With Upachar Sewa's help, men can begin their journey to better health and fertility with confidence and privacy. Asking for help and support is never a bad thing, and it is the first step to making more positive choices.
