Ghatkopar (East), Mumbai)
Male Infertility
Infertility affects one in six couples – and in approximately half of those cases, a male factor is identified as the primary or contributing cause. Yet male infertility remains heavily underinvestigated, with couples often assuming the problem lies with the woman.
The reality is that with the right evaluation, most male infertility cases have a treatable or manageable cause. At Shree Hospitals, our andrology and urology team provides comprehensive male infertility treatment in Mumbai, from detailed semen analysis through to microsurgical sperm retrieval and varicocele repair.
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Our Approach
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Our Approach In Managing Male Infertility
Male infertility has multiple potential causes – and many are correctable. Our andrology team approaches each couple with a structured, evidence-based evaluation that identifies the specific problem and offers the most targeted solution – surgical, hormonal, or assisted reproductive.
- Comprehensive History & Clinical Evaluation
Our assessment begins with a thorough andrological history:
- Duration of infertility and sexual history - frequency, erectile and ejaculatory function
- Previous pregnancies (current or prior partners) - helps establish time-course and causation
- Medical history - mumps orchitis, sexually transmitted infections, pelvic or scrotal surgery
- Occupational and lifestyle exposures - heat, toxins, anabolic steroids, smoking, alcohol
- Medication history - sulfasalazine, chemotherapy, testosterone supplementation (all impair spermatogenesis)
- Semen Analysis & Interpretation
The cornerstone of male fertility evaluation:
- Semen analysis and sperm count - WHO 2021 reference values: concentration ≥16M/ml, motility ≥42%, morphology ≥4% normal forms
- Two samples 2–4 weeks apart for consistency - significant variability exists between samples
- Detailed motility subclassification - progressive, non-progressive, and immotile fractions
- Sperm DNA fragmentation index - important for unexplained infertility or recurrent miscarriage
- Antisperm antibody testing where indicated
- Hormonal Evaluation
Endocrine causes of male infertility are identifiable and often correctable:
- FSH, LH, testosterone, prolactin, TSH - baseline hormonal profile in all azoospermic and severely oligospermic men
- Elevated FSH with azoospermia - suggests primary testicular failure (non-obstructive azoospermia)
- Low FSH with azoospermia - suggests hypogonadotrophic hypogonadism; highly treatable with gonadotrophins
- Hyperprolactinaemia - identified by MRI pituitary; treated with cabergoline or bromocriptine
- Varicocele Evaluation & Treatment
Varicocele is the most common correctable cause of male infertility:
- Present in 35–40% of infertile men - dilated veins of the pampiniform plexus raise testicular temperature and impair spermatogenesis
- Diagnosed clinically and confirmed by scrotal Doppler ultrasound
- Varicocele repair Mumbai - microsurgical subinguinal varicocelectomy is the gold standard technique; lowest recurrence and complication rates
- Post-operative improvement in semen parameters seen in 60–70% of men within 3–6 months
- Management of Azoospermia
No sperm in the ejaculate requires differentiation between obstructive and non-obstructive cause:
- Obstructive azoospermia (OA) - normal spermatogenesis but blocked ductal system; treatable surgically
- Vasoepididymostomy or vasovasostomy for post-vasectomy reversal and epididymal block
- Non-obstructive azoospermia (NOA) - impaired spermatogenesis; sperm retrieval for IVF/ICSI
- TESA PESA sperm retrieval - PESA (percutaneous epididymal) for OA; TESA (testicular) or micro-TESE (microsurgical extraction) for NOA
- Medical & Hormonal Treatment
Targeted pharmacological therapy for identified endocrine or immune causes:
- Gonadotrophin therapy (FSH + HCG injections) for hypogonadotrophic hypogonadism - restores spermatogenesis in 70–90% of cases
- Clomiphene citrate or letrozole for relative hypogonadism - improves spermatogenesis and testosterone
- Antioxidant supplementation (vitamin C, E, CoQ10, lycopene) - evidence-based support for idiopathic oligospermia
- Azoospermia treatment Mumbai - individualised based on FSH level, testicular volume, and genetic assessment
- Assisted Reproductive Technology (ART) Partnership
When semen parameters cannot be adequately corrected:
- Intrauterine insemination (IUI) for mild oligospermia with good motility
- IVF with ICSI - a single sperm injected directly into each egg; successful even with very few motile sperm
- Sperm cryopreservation - prior to chemotherapy, radiotherapy, or vasectomy reversal
- Co-ordinated care with our IVF partner team - male factor evaluation integrated into the couple's fertility plan
How To Identify Male Infertility?
Male infertility has no external symptoms in most cases - it is identified during the investigation of a couple's inability to conceive. However, some signs may point to an underlying cause:
Clinical Signs Suggesting Male Factor:
- Failure to conceive after 12 months of regular, unprotected intercourse (or 6 months if partner is over 35)
- Previous testicular surgery, trauma, or orchitis - all affect spermatogenesis
- Small testicular volume - a key clinical indicator of impaired sperm production
- Varicocele - may cause a visible or palpable "bag of worms" in the scrotum, typically on the left
- Absence of the vas deferens - congenital bilateral absence (CBAVD) associated with CFTR mutation
- Ejaculatory dysfunction - retrograde ejaculation (urine is cloudy post-orgasm), absent ejaculation, or haemospermia
Investigation Triggers:
- Abnormal semen analysis - low count, poor motility, or abnormal morphology on standard testing
- Partner's investigation revealing normal fertility despite failed conception
Treatments For Male Infertility At Shree Hospitals
Microsurgical Varicocelectomy
Subinguinal microsurgical ligation of varicocele veins - the gold standard technique; improves semen parameters in 60–70% of men and restores natural conception potential in many couples.
TESA / PESA / Micro-TESE Sperm Retrieval
Minimally invasive surgical sperm retrieval from the epididymis (PESA) or testis (TESA, micro-TESE) for men with azoospermia - sperm used for IVF/ICSI with high fertilisation rates.
Vasectomy Reversal (Vasovasostomy/ Vasoepididymostomy)
Microsurgical reconnection of the vas deferens following vasectomy - success rates of 70–90% for vasovasostomy within 10 years of vasectomy. Vasoepididymostomy for epididymal block.
Gonadotrophin Therapy (FSH + HCG Injections)
Hormonal treatment for hypogonadotrophic hypogonadism - stimulates the testes to produce testosterone and sperm. Highly effective in this specific cause of azoospermia.
Top Urologists in Mumbai
Dr. Shyam Mohan
Robotic Urological Surgery, Uro-Oncology
Dr. Alap Mehendale
Urologist, Andrologist, Kidney Transplant Surgeon
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1800-268-4000
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Important FAQs: Male Infertility
When should a man get a fertility evaluation?
A couple should seek evaluation after 12 months of regular, unprotected intercourse without conception (6 months if the female partner is over 35). Male evaluation should happen simultaneously with female evaluation - not as an afterthought. A semen analysis and sperm count is the simplest, most informative starting point and can be arranged without a referral at Shree Hospitals.
Can varicocele treatment alone lead to natural conception?
Yes - in many couples, varicocele repair Mumbai produces sufficient improvement in semen parameters to achieve natural conception without assisted reproduction. Studies show natural pregnancy rates of 30–40% within 12 months of microsurgical varicocelectomy. The younger the couple and the milder the semen abnormality before surgery, the better the prognosis for natural conception.
What is the difference between TESA and micro-TESE for sperm retrieval?
TESA (Testicular Sperm Aspiration) involves needle aspiration of testicular tissue - quick and minimally invasive, used for obstructive azoospermia. Micro-TESE (Microsurgical Testicular Sperm Extraction) is performed under an operating microscope, identifying and selectively extracting sperm-producing tubules - used for non-obstructive azoospermia. Micro-TESE achieves sperm retrieval in 40–60% of NOA patients where standard TESA would fail. Our TESA PESA sperm retrieval team performs both techniques based on individual patient evaluation.
Is azoospermia curable?
That depends on the cause. Obstructive azoospermia - where spermatogenesis is normal but the ductal pathway is blocked - is often surgically correctable. Azoospermia treatment Mumbai for non-obstructive azoospermia (impaired spermatogenesis) focuses on hormonal stimulation or sperm retrieval for ICSI rather than natural conception. Even with the most severe testicular failure, micro-TESE finds usable sperm in approximately 50% of men.
Does male infertility mean low testosterone?
Not necessarily - and this is a common misconception. Testosterone is produced by Leydig cells, while sperm are produced by Sertoli cells - the same testes but different cell types regulated by different hormonal signals. Men with severe oligospermia or azoospermia often have normal or even supranormal testosterone levels. Conversely, men taking exogenous testosterone supplements frequently develop azoospermia because externally administered testosterone suppresses the pituitary signals needed for sperm production.
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