Full andrology evaluation — semen analysis to WHO 2021 criteria, DNA fragmentation, hormones, scrotal imaging and genetics — with surgical sperm retrieval pathways for azoospermia.
A male factor contributes in roughly half of all couples with infertility, yet the male workup is frequently a single semen report from a general laboratory. That is not an evaluation. Sperm production responds to treatment over about three months, which makes male factor one of the few areas in fertility where a genuine improvement can be achieved before treatment even begins.
Azoospermia means no sperm are found in a properly centrifuged semen sample. The critical distinction is whether sperm are being produced but cannot get out, or are not being produced in usable numbers. Obstructive azoospermia — after vasectomy, infection, or with congenital absence of the vas deferens — usually has normal testicular volume and normal FSH, and sperm retrieval succeeds in the large majority of cases.
Non-obstructive azoospermia involves impaired production, typically with raised FSH and reduced testicular volume. Retrieval is still possible using micro-TESE, in which the surgeon searches under the operating microscope for the small pockets of tissue still producing sperm. Success is far from guaranteed, and any couple entering this pathway should be told the realistic probability and the plan if no sperm are found — including donor sperm as a considered option rather than an emergency decision on the day.
Varicocele is the commonest correctable cause of male infertility, and repair in appropriately selected men — clinically palpable varicocele with abnormal parameters — improves semen quality and pregnancy rates. Subclinical varicoceles found only on scan generally do not warrant surgery.
The lifestyle advice worth giving is narrow but real: stop smoking and tobacco in every form, cut alcohol, treat obesity, control diabetes, avoid prolonged scrotal heat, and stop anabolic steroids and testosterone supplements, which suppress sperm production and are a common and reversible cause in men who have been prescribed them for gym or energy purposes. Antioxidant supplements have modest and inconsistent evidence and are positioned accordingly rather than sold as a cure.
Standard semen parameters describe how many sperm there are and how they move. They say nothing about the integrity of the DNA inside them. A man with an entirely normal report can have a high DNA fragmentation index, and this is associated with poor embryo development, failed implantation and early miscarriage.
When fragmentation is high, several things can change: treating infection or varicocele, reducing oxidative stress over three months, using shorter abstinence intervals, selecting sperm with PICSI, or in selected cases using testicular sperm, where fragmentation is typically lower than in ejaculated sperm. That is a real and actionable pathway, and it is the reason the test is worth doing before a third failed cycle rather than after.
No. Parameters fluctuate considerably with illness, fever, abstinence period and stress. A repeat sample after a few weeks is standard before any conclusion is drawn.
Often yes. Surgical retrieval finds usable sperm in most obstructive cases and in a meaningful proportion of non-obstructive cases with micro-TESE. Where none is found, donor sperm is discussed with counselling.
Sperm production takes roughly 72–90 days, so any intervention is judged at three months. Repeating a semen analysis after three weeks tells you very little.
45-minute consultation, booked directly with Dr. Sana on WhatsApp. She consults at Apollo Fertility, Hyderabad. No referral needed.