Published Aug 18, 2026 | 7:00 AM ⚊ Updated Aug 18, 2026 | 7:00 AM
Male infertility. Representative image. (iStock)
Synopsis: Men are often tested late in infertility care, even when male factors contribute significantly to the problem. This feature examines how ideas of masculinity, sexual potency and fatherhood shape that delay, why abnormal sperm results can trigger denial, shame and secrecy, and how fertility specialists and a psychiatrist believe earlier education, couple-based testing and psychological support could change men’s infertility journey.
A couple tries to have a child. The woman goes to a gynaecologist, undergoes scans, hormone tests and sometimes months of medication. The man may not be tested at all, or his semen analysis may come much later, even though it is one of the simplest investigations in the infertility work-up.
The assumption behind that sequence is rarely stated aloud: if a couple cannot conceive, something must first be wrong with the woman. The man’s fertility often remains unquestioned, partly because a normal sex life is still treated as evidence that he must also be fertile.
That assumption can take years to unravel. By the time a semen analysis finally reveals a serious problem, the diagnosis may arrive not simply as a medical finding but as a challenge to how a man understands his own body, marriage and masculinity.
Dr Krishna Chaitanya, Scientific Head and Clinical Embryologist at Oasis Fertility, Hyderabad, has spent nearly two decades watching what happens when that number finally appears. He has seen men sit in the consultation room staring at reports showing zero sperm count, some sweating or struggling to process the result, and others walking out of the consultation and never returning.
“I see a lot of people sweating, on the verge to collapse,” he said to South First. “Sometimes they never even come back.”
The delay was not limited to men who avoided fertility clinics altogether. Dr Krishna Chaitanya said that even among patients who eventually reached his clinic, the woman was often the first and sometimes the only partner to seek medical attention.
“For like years the lady has gone through medications, investigations,” he said. “At some point very, very late in the journey is where the semen analysis would be done, and then we realise the whole problem was with the man.”
Dr Madhumitha S, Consultant-Fertility Superspecialist at BirthRight Fertility, Rainbow Children’s Hospital, Chennai, had encountered the same scenario.
“Some men come to us only after two to three years of trying to conceive, because there is often a perception that nothing could be wrong with the male partner and that there is no need for him to undergo testing early,” she said to South First.
The medical reality was more complicated. An ICMR-NIRRCH study conducted across five hospitals between 2022 and 2023 found that, among patients receiving general infertility treatment, female factors accounted for 46% of cases and male factors for 20%. Among the male-factor cases in that cohort, azoospermia, or absence of sperm, accounted for 51%, the largest male-factor category recorded in that group.
The study was not a national prevalence survey, but it offered an Indian clinical snapshot of infertility care in which male factors were far from incidental. The man, however, was often still the last person investigated.
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Part of the delay came from a misconception that had little to do with the complexity of fertility medicine. Men often treated sexual function as proof of fertility, assuming that an erection and the ability to complete intercourse meant their reproductive system was functioning normally.
Dr Krishna Chaitanya spent much of his consultations separating the two. “Potency is being sexually potent and managing to complete the act of sexual intercourse,” he said, “while fertile is being able to conceive and create life and progeny.”
A man who could have an erection and complete intercourse could therefore assume that he had no fertility problem. Dr Madhumitha heard the same reasoning from her patients, who often believed that “a strong erection and ejaculation are proof of their manhood and fertility.” It could be difficult, she said, to explain that normal sexual function did not necessarily indicate normal fertility.
The biology told a different story. Dr Madhumitha explained that testosterone production and sperm production involved different functions within the testes, with Leydig cells responsible for testosterone production and Sertoli cells supporting the developement and growth of sperms. Sexual potency could therefore remain normal even when sperm production was impaired.
The distinction was medically straightforward, but the cultural meaning attached to it was not. A man who had no difficulty with sex had little reason, in his own mind, to suspect that his sperm could be affecting his ability to father a child.
The certainty rarely survived the laboratory report. When the result came back abnormal, men often searched for another explanation, questioning the test itself or pointing to their lifestyle as evidence that nothing could be wrong.
Dr Krishna Chaitanya recalled patients asking how anything could be wrong when they exercised, avoided smoking and alcohol and considered themselves healthy. “Most of them do not want to accept the fact because most of them, you know, are healthy,” he said. “They work out. They don’t have addictions.” Then came the questions: “How? Why did this even happen to me? I don’t smoke. I don’t drink. I hit the gym every day.”
Dr Madhumitha heard variations of the same resistance. “The report might be wrong,” patients told her, while others blamed a recent fever, saying, “I had a fever two days ago, which is why my sperm count is low. I will repeat the test.”
The reactions pointed to the same problem. The semen report was not always being interpreted simply as information about sperm; for some men, it became information about themselves.
Dr Jothi Neeraja, founder of Maarga Mind Care in Bengaluru, described denial as a psychological defence mechanism that gave people time to process an emotionally overwhelming diagnosis.
In India and other cultures, fatherhood could be treated as a natural rite of passage into manhood, Dr Jothi said. Infertility could therefore be experienced as a personal failure rather than a medical condition, while the fear of being judged or shamed could further delay acceptance and medical follow-up.
“Growing up, boys hear that being a ‘real man’ has something to do with strength, virility, fatherhood, sexual prowess,” she said to South First. “Thus, fertility and masculinity are psychologically intertwined, although they are unrelated medically.”
That connection could turn a laboratory finding into a threat to identity. A man was not simply being told that his sperm count was low; he could hear that something was wrong with his ability to become a father, a husband or the kind of man he believed he was expected to be.
The grief nobody called grief
For Dr Jothi, the psychological burden went beyond denial. Infertility could represent a loss even when there was no child to mourn, because a man could be grieving an expected future, an imagined family or the possibility of becoming a father.
“This grief is often invisible and unacknowledged by society, making it even more difficult to process.” Many men did not call that feeling grief because they had been socialised not to appear vulnerable.
The ICMR-NIRRCH study offered a measurable glimpse of the emotional burden. Among husbands undergoing IVF, 35% reported mild anxiety and depression linked to infertility, while another 15% reported moderate levels; among wives, 74% reported some level of anxiety or depression.
The study did not examine why husbands reported lower levels of anxiety and depression than wives. Dr Jothi offered one possible explanation: “The belief that men should always be emotionally in control often prevents them from being able to identify or express their own pain.”
Suppressing that pain could manifest differently, she said, through stress, anxiety, irritability, sleep disturbances or depressive symptoms. A man who appeared composed during fertility treatment could therefore still be struggling with the diagnosis, even if that distress was not openly expressed.
The diagnosis rarely remained with the individual. It moved into the relationship, and sometimes the first response was to decide who should know about it and who should not.
Dr Krishna Chaitanya estimated that three or four out of every 10 patients he saw with zero sperm count asked him not to disclose the result to their wives. “Can you not really tell my wife about this?” he recalled patients asking.
He explained that he could not disclose the diagnosis without the patient’s consent, but treatment could not move forward indefinitely while one partner remained unaware. “Without an egg and sperm, what will I do? What will you do?” he told them. Most eventually agreed to disclose the diagnosis themselves, while the clinic recorded the delay.
It was a form of isolation that could exist inside a marriage. The couple could sit together in the same consultation room while one partner carried information the other did not have.
The pressure did not always originate within the couple. Dr Madhumitha described comments from extended family that could add urgency and guilt to an already difficult decision, including remarks such as, “At least have one child before we grow older.”
Couples could need a year or more to understand their situation and consider treatment options, she said, and needed the space to make those decisions together. Infertility could also bring grief, frustration, disappointment, guilt, anxiety and uncertainty into a relationship, Dr Jothi said, with differences in how partners coped sometimes creating further misunderstandings and conflict.
For Dr Krishna Chaitanya, the solution was not to determine which partner was responsible. “If you both are together on the same page, you’re holding your hands, you want to approach this as a team, come,” he told couples.
But when couples came looking for someone to blame, he believed the problem had moved beyond what a fertility consultation could solve. “If people are wanting to fight and understand who’s the problem here, you need to go to a counsellor or an advocate because I can’t solve your problems,” he said.
The assumptions did not begin in the fertility clinic. They began much earlier, when boys were growing up without meaningful conversations about puberty, reproductive health and what fertility actually meant.
Dr Krishna Chaitanya traced the problem to adolescence, when conversations about reproductive health were often absent from homes. “This whole dealing the men has to start from puberty,” he said. “I don’t really think our fathers have done that, but I make it a point to actually have these conversations with my son.”
He argued that schools also needed to rethink how they approached the subject. “We need to now go beyond just calling it sex education,” he said. “We need to call this as reproductive health awareness.”
Dr Madhumitha also placed the emphasis on adolescence, saying young people needed to learn about their health, including reproductive health, before they reached adulthood and began making decisions about marriage and parenthood. “There should be no shame in talking about reproduction,” she said. “By encouraging open conversations, we can protect young people and guide them towards making better and more informed decisions.”
Online spaces could add another layer to those conversations.
Dr Jothi said some social media content raised awareness, but other narratives reinforced unrealistic ideas about masculinity by linking it to dominance, sexual performance and fertility, potentially making men less willing to seek medical or psychological help because infertility could be perceived as weakness.
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The three specialists pointed to several changes: reproductive health education beginning earlier, evaluation of both partners rather than assuming infertility was primarily a woman’s problem, and psychological support becoming part of fertility care rather than an afterthought.
The ICMR-NIRRCH study showed that infertility affected the wellbeing of both partners, while the clinicians described what happened around those numbers: men questioning results, withdrawing from consultations, hiding diagnoses and struggling to speak about what the diagnosis meant to them.
For Dr Jothi, recognising that emotional burden was an important part of treatment. “Recognizing grief related to infertility and providing appropriate psychological support may be important for emotional recovery and well-being,” she said.
The semen analysis could measure sperm. It could not measure a man’s worth, and the harder task was getting men to separate the two.
(Edited by Fayisa CA)
