Male infertility and the structural failure of reproductive care

As a concept, male infertility has always been shrouded in silence, secrecy, and obliviousness. It still is. 

However, a report published in the medical journal, BMC Women’s Health, male infertility contributes to approximately 50 per cent of the infertility cases globally. Roughly 7 per cent of the male population worldwide is affected by male infertility. 

The occurrence of male infertility has never been rare; it has simply been rendered invisible. Yet, awareness remains largely confined to medical professionals and academic research. Society continues to place the responsibility of fertility on women, while male infertility remains sidelined, despite demanding urgent medical and cultural attention. 

Male infertility in India: Prevalence and trends 

Several studies have confirmed that over the past two decades, men’s sperm count and quality have declined globally, contributing to rising rates of male infertility. 

The Indian Council of Medical Research (ICMR) estimates that male infertility accounts for around 10 to 15 per cent of couples’ infertility in India, informs Poonam Muttreja, executive director, Population Foundation of India. The figure is likely conservative, shaped by limited volunteer participation. 

The phenomenon is anything but new. As early as 2015, a 30-month-long study conducted by the Department of Urology and Anatomy of the All India Institute of Medical Sciences (AIIMS) in New Delhi examined male infertility trends in India.  

As per the study, 83 per cent of the subjects—with a mean age of 31 years—were diagnosed with primary infertility. Assisted Reproductive Technologies (ART) were advised to 71.8 per cent, yet taken up by just 18 per cent.

“The rise in male infertility is primarily driven by modern lifestyle factors such as poor diet, sedentary habits, smoking, alcohol, and chronic stress,” says Dr Madhukar J. Shinde, a fertility specialist at Nova IVF Fertility, Pune.  

Perpetual vulnerability to hormone-disrupting chemicals further compounds the issue, notes Dr Sanjay Prakash J., consulting urologist, microsurgical andrologist, and men’s health expert at Asian Institute of Nephrology and Urology, Chennai. What’s changed is not the biology but the scale and speed at which these risks now accumulate. 

Why infertility in men remains taboo in India 

In India, particularly, reproduction has been predominantly associated with women. Motherhood is integral to womanhood, and not being able to conceive becomes a “women’s issue”. Our social constructs have almost eliminated men from the reproduction conversation and several research papers corroborate this. 

“Since pregnancy and birth occur in women’s bodies, childbirth has been constructed as a female-coded event, while men have been positioned as providers or observers, not embodied participants,” says counselling psychologist and couples therapist, Dr Devanshi Desai. 

Despite fatherhood being rendered a second-tier status in society, fathering a child is, paradoxically, seen as a natural (and obvious) extension of masculinity. “In many cultures, masculinity is measured by virility and the ability to continue the family lineage. Male infertility disrupts this social identity, transforming a medical condition into a deep sense of shame and social failure that enforces a conspiracy of silence,” says anthropologist Shruti Mishra. 

This is where silence takes hold. “Today I got the results: 4M sperms per ml, 13% mobility. Not 100 per cent infertile, but obviously very difficult to get pregnant. The shame and guilt I have are incredible. I feel useless, all I've ever wanted is to be a dad,” shared a user on Reddit. 

Male infertility, therefore, could feel like a threat to the masculine identity. “While fatherhood is [seen as] a public milestone, infertility becomes a private humiliation. Avoidance, denial, and secrecy are common behavioural responses, further intensifying stigma,” adds Desai.

This kind of bias towards male infertility isn’t just deep-rooted in patriarchal cultural norms but further reinforced by the healthcare systems that commercialise fertility solutions for women while offering limited diagnostic focus on men. 

Male infertility care remains less visible in clinical settings, even as women undergo repeated cycles of intervention. “Adding to this is the lack of public education about male reproductive health, and infertility in men remains under-discussed and under-diagnosed,” says Prakash J. 

The ignominy associated with male infertility is reflected in the dearth of male patients at fertility clinics, while women go through endless cycles of IVF. Male infertility care is less visible because it is less commercial and more time-intensive, notes Prakash J. “Improving sperm health often requires lifestyle changes, medical optimisation, or surgery—processes that take 3-6 months to reflect on sperm parameters and expertise rather than quick technological solutions. There is also a shortage of trained andrologists and unqualified practitioners trying to treat male infertility unscientifically.  Oftentimes, male infertility is frequently overshadowed by Assisted Reproductive Technologies that focus on bypassing, rather than treating, the male factor.”

Symptoms and early warning signs 

Male infertility has barely made it to whispers—but it’s about time that changed. Silence can have serious consequences.

“When male infertility is ignored, women often undergo repeated tests and unnecessary invasive treatments. Correctable male factors go untreated,” says Prakash J. “Couples experience emotional strain, guilt, blame, and unnecessary expenses, while men miss early warning signs of broader health issues such as hormonal disorders or metabolic disease. In many cases, couples are denied a chance of their own genetic progeny and are referred directly for a donor sperm. Infertility in men is not just about reproduction and family legacy; it can be an early marker of overall health vulnerability too.”

Male infertility doesn’t always announce itself clearly. “Men may notice warning signs such as reduced sexual desire, difficulty with erections or ejaculation, discomfort or swelling in the testicles, or a history of genital infections,” says Shinde. But sometimes, male infertility might be asymptomatic in nature. Many men perceive themselves as entirely healthy and maintain normal sexual function. However, they only become aware of a problem when pregnancy fails to occur despite regular unprotected intercourse for a year, notes Prakash J. “The usual suspected symptoms are not always present. However, masculinity and erections are not always synonymous with normal fertility, and the absence of symptoms does not necessarily indicate the absence of an underlying issue. A man with normal erections can be infertile, and vice versa—a man with erectile dysfunction can still be fertile.” 

This highlights the importance of routine check-ups to rule out male infertility. In wellness-obsessed urban cultures where blood sugar, VO2 max, and gut health are tracked religiously, fertility still remains a blind spot. 

“Routine semen analysis should be normalised—just like blood pressure or blood sugar testing. Premarital fertility check-ups should be normalised, like an annual master check-up,” cites Prakash J. While semen analysis is still not part of a standard full-body check-up for men in India, the test typically costs between ₹300 to ₹1,500. 

Male infertility: Diagnosis, testing, and treatment 

While the terminology may sound intimidating, the point is simple: male infertility is often diagnosable and, in many cases, treatable. “Men facing fertility concerns should seek evaluation from a qualified andrologist or reproductive urologist—and not rely solely on IVF clinics. Assessment typically includes semen analysis, hormone testing, imaging, sperm DNA testing, and targeted genetic tests when needed,” says Prakash J. “Treatments may involve lifestyle correction, medical therapy to restore hormonal balance, surgery for conditions like varicocele, reconstructive procedures like Vaso-Vasal Anastomosis (VVA), Transurethral Resection of the Ejaculatory Ducts (TURED) or sperm retrieval techniques like Testicular Sperm Aspiration (TESA), and Percutaneous Epididymal Sperm Aspiration (PESA).” Fertility preservation through sperm banking is also a viable option.

How silence reshapes care, blame, and burden

“Workplaces, media platforms, and public health campaigns must break the taboo to include male reproductive and sexual health. Doctors should proactively discuss fertility also with male patients, not only when couples struggle to conceive,” says Prakash J. “The media should give equal importance to topics relating to male reproductive and sexual health just as it does to any cardiac or brain-related issues. Most importantly, men must be reassured that seeking help is not a sign of weakness, but of responsibility.”

Beyond institutions, the immediate social environment matters too. One’s partner, family, and friends often shape whether fertility is met with silence or support. “An infertile man often carries silent grief and fear of social judgment. Cultural expectations discourage emotional expression or help-seeking. This isolation can deeply affect mental health and relationships,” says Mishra. The emotional cost is not abstract. 

“I am a 39-year-old male with low sperm morphology, less than 4 per cent. My wife of 12 years and I had been struggling to conceive naturally for the past four years. Our marriage suffered due to infertility and unresolved family issues that she couldn’t let go of. We explored the option of IVF, but after learning how mentally and physically taxing the procedure can be for a woman, she decided not to proceed and wanted a divorce,” another user on Reddit shared. 

The Established reached out to several individuals experiencing male infertility, but many declined to speak publicly. 

Male infertility, when left unaddressed, often becomes a point of strain rather than shared care. “Partners and family can offer support by openly acknowledging the issue, and reinforcing that seeking help is normal and not shameful. Gentle encouragement, shared decision-making, and emotional reassurance help men feel confident to discuss fertility concerns without fear or embarrassment,” says Shinde. 

Better data collection, including male fertility markers in surveys like the National Family Health Survey, and the routine integration of male assessment in reproductive healthcare must follow, adds Muttereja.

India may prioritise childbearing as a demographic goal, but the responsibility for fertility cannot rest on one gender alone. Fathers cannot remain adjacent figures in reproductive health, present only as providers or spectators. When preventive testing, treatments, and specialised care exist for women and men alike, excluding one side from the fertility discourse is a disservice to all the parties involved.