For years, infertility was largely viewed as a women's health issue. However, growing scientific evidence is challenging that perception, with fertility specialists now estimating that male factors account for between 40 and 50 per cent of infertility cases in India. In an additional 20 per cent of cases, both partners contribute to fertility challenges, underscoring the importance of evaluating couples together rather than focusing on women alone.
According to the Journal of Human Reproductive Sciences, male partners play a role in roughly seven out of every 10 couples experiencing difficulty conceiving.
The renewed focus comes as India's fertility rate hovers around 2.1 children per woman—the replacement level needed to maintain population stability—but has already fallen below that threshold in several states. Data from the Society for Reproduction and Fertility estimate that between 15 and 20 per cent of Indian couples, or about 27.5 million people, are affected by infertility, with the highest prevalence recorded in urban areas.
Declining sperm health raises concern
Health experts say the growing concern is backed by alarming global trends.
A landmark 2022 meta-analysis published in Human Reproduction Update found that average sperm concentration worldwide declined by approximately 52 per cent between 1973 and 2018, with the pace of decline accelerating after 2000. Although initially considered a problem affecting mainly Western countries, researchers say the trend is now evident across Asia, Africa and South America.
In India, fertility specialists report a noticeable drop in average sperm counts over the past three decades, attributing the decline to a combination of modern lifestyle and environmental factors.
Sedentary living, obesity, diabetes, chronic stress, smoking, excessive alcohol consumption and increasing exposure to environmental pollutants and endocrine-disrupting chemicals have all been identified as major contributors to declining male fertility.
Medical professionals note that many men may experience reduced fertility without obvious symptoms, making a routine semen analysis one of the most effective and accessible first steps in evaluating a couple's reproductive health.
Delayed diagnosis remains a major obstacle
Experts say one of the biggest challenges is that many men delay seeking medical evaluation because infertility is still widely perceived as a threat to masculinity.
The delay can allow treatable conditions to worsen, reducing the chances of successful intervention while adding emotional and psychological strain to couples already struggling to conceive.
One such condition is azoospermia—the complete absence of sperm in semen—which affects about one per cent of all men and between 10 and 15 per cent of infertile men.
Research published in the National Medical Journal of India found that approximately 21 per cent of infertile men had obstructive azoospermia caused by blockages in the reproductive tract. Specialists say many of these cases can be managed through surgical sperm retrieval, provided they are diagnosed early.
Doctors stress that the greatest barrier to treatment is often not limited medical options but the reluctance of men to undergo fertility assessment.
Advances in reproductive medicine
Medical advances have significantly improved treatment outcomes for couples dealing with male infertility.
Globally, the use of in vitro fertilisation (IVF) has expanded dramatically—from about 200,000 treatment cycles in 2000 to more than three million annually—resulting in millions of births since the world's first IVF baby was born in 1978, according to the F&S Reports journal.
For men diagnosed with azoospermia, specialists say even a small number of surgically retrieved sperm can be sufficient to achieve pregnancy through assisted reproductive technologies.
Meanwhile, rapid advances in diagnostic techniques are allowing fertility specialists to identify underlying causes that previously went undetected.
Beyond conventional sperm count analysis, clinics increasingly use the DNA Fragmentation Index to evaluate the genetic integrity of sperm, helping explain repeated miscarriages or unexplained infertility.
Genetic screening has also improved the detection of inherited reproductive disorders, while artificial intelligence is enhancing semen analysis by reducing human error and improving consistency. AI-assisted embryo assessment and time-lapse embryo monitoring are further helping clinicians make more accurate, data-driven decisions during IVF treatment.
A shift toward shared responsibility
Fertility specialists say one of the most important developments is the growing acceptance that infertility should be approached as a shared issue rather than one centred on women.
By evaluating both partners from the outset, doctors can identify male-related factors early, reduce unnecessary and invasive tests for women, and improve the chances of timely treatment.
Experts maintain that breaking the stigma surrounding male fertility and encouraging early, routine testing could significantly improve outcomes for millions of couples hoping to start a family.