Condition

Male Infertility

Reviewed by Dr Abhishek Kumar on

Male infertility refers to fertility problems attributable partly or wholly to male factors, such as abnormal sperm production, sperm function, or problems with sperm delivery. It is assessed alongside the female partner's fertility evaluation rather than in isolation.

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Infertility affects an estimated one in six couples worldwide at some point, and a male factor is identified alone or alongside a female factor in roughly half of these couples[1]. Reviews of Indian clinical series describe male factors as a major and rising share of couple infertility seen in practice, which is one reason current guidance favours a semen analysis early rather than after the woman alone has already had extensive testing[3]. That semen analysis, read against the World Health Organization's reference values, is usually the first test done for the man, because it is simple, inexpensive and answers directly whether a male factor is likely[2].

Some symptoms need prompt care: when to seek emergency or specialist care.

How each system of medicine approaches Male Infertility

SystemApproachTypical review period
Modern medicineBoth partners are assessed together. For the man, this may include a history, examination and semen analysis, with hormone tests, imaging or genetic testing added when indicated by the initial findings; treatment is then matched to the cause when one is identified.A semen analysis is not usually repeated sooner than about 3 months after any change, because that is roughly how long a new batch of sperm takes to mature; the couple's overall plan is reviewed every few months against the woman's age and cycle. Supported by clinical guidelines

A structured evaluation of both partners, beginning with appropriate fertility assessment and semen analysis for the man, helps identify treatable causes and guide further management. Evidence for antioxidant and gonadotrophin treatment varies and depends on the underlying cause.

AyurvedaVajikarana approaches fertility in the context of overall health, including factors such as sleep and stress. Any Ayurvedic approach should complement, not replace, appropriate evaluation of both partners.A herbal regimen is typically reviewed at around 12 weeks, matched to the couple's own timeline for trying rather than continued indefinitely. Limited or mixed evidence

The main supporting trial studied ashwagandha in men with low sperm counts and assessed semen parameters rather than pregnancy or live-birth outcomes, so evidence for Ayurvedic treatment of male infertility remains limited.

HomeopathyIndividualised prescribing may consider the man's overall health, stress, sleep and the couple's circumstances, while the homeopathic remedy itself is selected for the individual patient.Reviewed at follow-up over several weeks, with a repeat semen analysis around 3 months out. Insufficient evidence

No clinical trial has established that individualised homeopathy improves fertility or pregnancy outcomes in couples trying to conceive, and the wider evidence base for individualised homeopathy is low certainty.

Modern medicine for Male Infertility

A specific cause, once found, is treated directly. When none is found — the largest single group, sometimes called idiopathic male infertility — options include antioxidant supplementation, gonadotrophin therapy in selected men, or assisted reproduction (IUI, IVF or ICSI) timed to the couple's own fertility window.

  • Antioxidants: A Cochrane review found that antioxidant use may improve some fertility outcomes, including live birth, but the evidence was uncertain and the trials varied in quality[4]. Routine antioxidant treatment should therefore not be presented as established therapy.
  • Gonadotrophins: A Cochrane review found limited evidence that gonadotrophin treatment may improve pregnancy rates in selected men with idiopathic male-factor subfertility, but the evidence was based on relatively few trials[5].
  • A joint decision, not a solo one: fertility planning considers both partners' age, fertility findings, duration of trying to conceive and treatment options. The man's semen results are therefore considered alongside the female partner's assessment rather than in isolation.
  • Lifestyle groundwork: weight, smoking, alcohol and heat exposure are reviewed at the first visit, since they are among the few factors a man can change himself while other results are pending.

Doctors of this system: Sexologist in India

Ayurveda for Male Infertility

Ashwagandha (Withania somnifera) is the most-studied single herb used here, generally paired with Rasayana-style advice on diet, sleep and routine for the man, on the reasoning that his general vitality supports reproductive function; it makes no claim about the woman's side of the work-up.

  • What the trial evidence actually covers: the ashwagandha trial most often cited in this context studied men with a low sperm count, where 90 days of the root extract was linked to improved sperm concentration and motility compared with placebo — it did not study couples or conception rates directly[6].
  • Evidence is limited: this is one relatively small trial, not a body of evidence addressing couple infertility. It also does not establish that an Ayurvedic preparation can correct structural obstruction, genetic causes, or other specific causes of male infertility.
  • Interaction check: any herbal or Ayurvedic preparation should be reviewed alongside the man's current medicines, supplements, and medical conditions and should not delay the couple's fertility evaluation.

Doctors of this system: Ayurvedic Sexologist in India

Homeopathy for Male Infertility

One remedy is prescribed at a time, and the couple's own report of any change, not a lab value on its own, guides whether it is continued, changed or stopped.

  • Evidence is insufficient: a systematic review and meta-analysis of individualised homeopathy found low-certainty evidence across the conditions studied[7]. It did not establish an effect on fertility or pregnancy outcomes in couples trying to conceive.
  • Referral stays part of it: when the female partner's age, medical history, or fertility findings suggest that time is important, the couple should be offered appropriate reproductive-medicine assessment rather than delaying evaluation.

Doctors of this system: Homeopathic Sexologist in India

What is known and what remains uncertain

  • Known: A semen analysis measured against WHO reference values is usually the first and most informative test for the man.
  • Known: In many couples affected by infertility, no specific cause is found on either side, described as unexplained infertility.
  • Known: Reviews of antioxidant and gonadotrophin trials report a possible benefit, though most trials were small and of mixed quality.
  • Uncertain: How much lifestyle change alone improves the chance of conception, as opposed to alongside other treatment, is not firmly established.
  • Uncertain: Whether ashwagandha improves outcomes for couples trying to conceive is untested, since the supporting trial looked at semen parameters alone.

Questions to ask your doctor

  • What tests will I need, and how do they fit alongside my partner's own evaluation?
  • Is there an identifiable cause here, or does this look like unexplained infertility?
  • Which lifestyle changes are worth making, and how soon might they help?
  • When would we consider IUI, IVF or ICSI rather than continuing to try naturally?
  • How does my partner's age affect the timeline for moving between options?
  • Would antioxidant supplements or gonadotrophin therapy be appropriate for me?

Doctors who consult for Male Infertility

  • Dr Abhishek Kumar

    Qualification
    M.B.B.S
    System of medicine
    Modern medicine
    Registration
    Reg. No. 73512, West Bengal Medical Council

  • Dr Ravindra Sharma

    Qualification
    B.H.M.S
    System of medicine
    Homeopathy
    Registration
    Reg. No. H018423, Homoeopathic Medicine Board, Lucknow, UP

Frequently Asked Questions

Is infertility usually the woman's problem?

No. A male factor is found alone or alongside a female factor in roughly half of infertile couples[1], which is why a semen analysis is recommended early for the man rather than only after the woman has been extensively tested.

What is the first test done for the man?

A semen analysis, read against the World Health Organization's reference values for count, motility and shape[2]. It is simple, inexpensive, and usually the result that decides what happens next.

Does the woman's age affect the man's treatment plan?

Yes. Because a woman's fertility declines with age in a way a man's does not to the same extent, the couple's overall timeline — not the man's semen report alone — decides whether to try a slower approach first or move sooner to IUI, IVF or ICSI.

Can lifestyle changes really make a difference?

For some men, yes. Weight, smoking, alcohol and heat exposure are reviewed because they are modifiable, and antioxidant supplementation has been linked to a higher live birth rate in trial data, though the trials were often small[4]. It is one part of a wider plan, not a substitute for finding the cause.

Which system of medicine should we choose?

That is a decision for both partners, discussed at the consultation. Modern medicine has the most trial evidence for identifying and treating a specific cause[4][5]; Ayurveda and homeopathy work on the man as a whole and have far less trial evidence behind them for fertility specifically[6][7].

References

  1. Agarwal A, Mulgund A, Hamada A, Chyatte MR. A unique view on male infertility around the globe. Reprod Biol Endocrinol. 2015;13:37. https://doi.org/10.1186/s12958-015-0032-1
  2. Cooper TG, Noonan E, von Eckardstein S, et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update. 2010;16(3):231-245. https://doi.org/10.1093/humupd/dmp048
  3. Kumar N, Singh AK. Trends of male factor infertility, an important cause of infertility: a review of literature. J Hum Reprod Sci. 2015;8(4):191-196. https://doi.org/10.4103/0974-1208.170370
  4. Smits RM, Mackenzie-Proctor R, Yazdani A, et al. Antioxidants for male subfertility. Cochrane Database Syst Rev. 2019;3:CD007411. https://doi.org/10.1002/14651858.CD007411.pub4
  5. Attia AM, Abou-Setta AM, Al-Inany HG. Gonadotrophins for idiopathic male factor subfertility. Cochrane Database Syst Rev. 2013;(8):CD005071. https://doi.org/10.1002/14651858.CD005071.pub4
  6. Ambiye VR, Langade D, Dongre S, Aptikar P, Kulkarni M, Dongre A. Clinical evaluation of the spermatogenic activity of the root extract of Ashwagandha (Withania somnifera) in oligospermic males: a pilot study. Evid Based Complement Alternat Med. 2013;2013:571420. https://doi.org/10.1155/2013/571420
  7. Mathie RT, Lloyd SM, Legg LA, et al. Randomised placebo-controlled trials of individualised homeopathic treatment: systematic review and meta-analysis. Syst Rev. 2014;3:142. https://doi.org/10.1186/2046-4053-3-142

This information is general and educational. It is not a diagnosis; please discuss your situation with the doctor during your consultation.

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