Fertility assessment is a way to learn more about your fertility and your options.

It is important that man be present for fertility evaluation along with his wife / partner.

More often, a lot of time is spent with the woman before the male partner / husband turns up at the clinic only to find out that he has very low sperm count or some other fertility or sexual problems.

Anyone who has been trying to unsuccessfully to conceive for more than 12 months is advised to check with the fertility specialists to find out if any issues are present.

However, couples need earlier evaluation (after 6 months of trying) and they should not wait long if woman is >35 years, man is >40 years, women have delayed periods, endometriosis, previous ovarian surgery, sexual dysfunction and family history of early menopause.

The sooner you identify and treat these problems, the better your chance of getting pregnant and having a healthy pregnancy

Evaluation of male fertility begins with a thorough history.

Age of the man: Male fertility decreases after 40 years of age. Sperm quality reduces and women may take longer time to conceive. There is increased risk of miscarriage in women if man’s age is > 40 years.

Duration of fertility issues is noted and any prior treatment/ tests are recorded.Fertility declines significantly after 2 years of trying naturallyA thorough sexual history with frequency of sex, erection/ejaculatory problems frequency of sex, fear of having sex and desire is asked for. Having intercourse once in every 2 or 3 days will cover the fertile daysMedical problems like diabetes, hypertension, tuberculosis and endocrine problems like thyroid and prolactin tumors are noted. Childhood history of viral infections, surgeries for congenital hydrocele/hernia are asked for. Injuries to the testis like twisting, cricket ball/ cycle bar trauma are noted. Family history of fertility problems is very significant. History of infertility in siblings is asked for. Occupational history suggestive of increased exposure to heat like welding, truck driving is asked for. Also stress, anxiety and sleep disorders are job related and noted.

Physical examination should include assessment of height, weight, Blood pressure, Thyroid, body habitus and general appearance.Examination of genitals: To know the testicular size, any palpable mass, to check epididymis, feel the vas deferens and to rule out varicocele.

Blood count, lipid profile and diabetic status are assessed. Hormone Assays (if needed): Follicle stimulating Hormone (FSH), Luteinizing hormone (LH), Testosterone, Prolactin, Estradiol, TSH(if needed for some patients).                                                                                    Serologytests are mandatory: HIV, HbsAg, HCV, and VDRL to prevent potential transmission to their offspring’s.

Semen Analysis: Semen analysis is the mainstay and only initial investigation done for men. Though an important test, semen analysis is not always a measure of the fertility potential in the male. The sperm count can be highly variable is even in a normal fertile man.



Lower Reference limit

Semen volume

1.5 ml                                         (1.4–1.7)

Total sperm number

39  million / ejaculate              (33–46)

Sperm concentration

15  million / ml                          (12–16)

Total motility (PR + NP)

40 %                                             (38–42)

Progressive motility (PR)

32 %                                             (31–34)

Vitality (live spermatozoa)

58%                                              (55–63)

Sperm morphology

4 % normal forms                     (3.0–4.0)


Scrotal Ultrasound: to confirm varicocele and rule out any other abnormalities.

Treatment options:

Poor sperm quality can be helped through a change in lifestyle, losing weight by exercising regularly and having healthy food, limiting cell phone exposure, reducing alcohol and quitting smoking.

Daily supplement of antioxidant-rich foods such as vegetables, fruits, whole grains, fish, nuts and seeds can help to improve the semen parameters.

Treatment with medications should be continued for at least 2 to 3 months to notice any improvement in the semen parameters. Hormonal medications are tried to increase the sperm count. Antioxidants help to improve sperm motility and morphology.

Various treatments are also available to treat male infertility. These include

Varicocele surgery: This is done for men with severe grade varicocele with low count, motility and morphology.