In this episode of The Care Circle podcast powered by Motherhood Hospitals, host Sneha delves into the often-overlooked topic of male infertility. Joined by Dr. Beena Muktesh, Clinical Director, IVF at Motherhood Fertility & IVF, the conversation explores how male fertility has evolved over the years, the factors affecting sperm health, and the latest testing and treatment options. Dr. Beena shares insights on conditions like azoospermia and oligospermia, explains when and how men should get tested, and provides practical advice on lifestyle changes, fertility preservation, and assisted reproductive technologies. The episode highlights the importance of early testing, accurate diagnosis, and approaching fertility as a team.

Here are the key points you shouldn’t miss from this episode:

• Male infertility accounts for nearly half of all fertility challenges, yet social stigma and misconceptions often delay testing.
• Semen analysis is the most important test for male fertility, but it must be done in a quality IVF or fertility lab to get accurate results.
• Conditions like azoospermia (no sperm) and oligospermia (low sperm count or poor quality) are treatable, and men can still become fathers through advanced techniques like IVF, ICSI, TISA, and micro-TISA.
• Lifestyle factors, late nights, junk food, alcohol, smoking, excessive cycling, tight underwear, and prolonged computer use, can negatively affect sperm quality and should be addressed.
• Men’s fertility declines with age, impacting both sperm quality and the probability of healthy offspring.
• Early fertility checks, lifestyle improvements, and sperm or embryo freezing are recommended, especially for those planning to delay parenthood.
• Donor sperm is a safe, viable option if all other methods fail; men can still have children with their partner’s eggs and donor sperm.
• Fertility should be approached as a team effort, with both partners involved from the start.
• Awareness and timely action can save couples years of stress, financial burden, and emotional strain.

Dr Beena Muktesh, Clinical Director–IVF, Motherhood Fertility & IVF, Gurugram

0:06 – Intro: Male infertility and why it’s rarely discussed
0:28 – Guest introduction: Dr. Bina Muktesh, IVF expert with 40+ years of experience
1:05 – How male fertility has changed over the years
1:35 – Persistent mindset: Why families still assume infertility is a female issue
2:12 – Hesitancy in testing: Lack of awareness and social stigma
3:14 – Understanding male infertility: Types and causes
4:18 – Azoospermia and oligospermia explained
5:34 – Can men with these conditions become fathers? Advanced technologies explained
7:30 – Treatment options based on sperm quality and quantity (IUI, IVF, ICSI)
9:20 – Who should get sperm testing: baseline fertility check recommendations
10:21 – AMH test for men? Importance of lab quality and accurate semen analysis
12:44 – Evolution of sperm testing and additional parameters like Y-chromosome deletion and DNA fragmentation
14:15 – Lifestyle impact on sperm health: sleep, diet, exercise, alcohol, smoking, and work habits
15:19 – Fertility check for men planning to delay children
16:03 – Common myths: protein powders, tight underwear, alcohol, late nights, and age
17:22 – Case study: Couple with three failed IUIs due to male infertility
18:42 – Importance of early and accurate testing
18:50 – Care Circle rapid-fire: myths, advice for couples, and career highlights
20:04 – Expert advice: semen analysis, lifestyle, fertility preservation, and donor sperm
22:20 – Closing: Encouragement, team approach, and reassurance for men facing fertility challenges
22:53 – Outro: Summary and encouragement to test early and seek expert care

Snehaa (0:06) When a couple struggles to conceive, the first question is usually, What’s wrong with her? But the truth is, in nearly half the cases, fertility issues are linked to the man, too. It’s just not talked about enough.  Hi everyone, welcome to the Care Circle, a podcast series by Motherhood Hospitals.

I’m your host, Sneha, and today we are breaking the silence around male infertility. We will be talking about what affects sperm health, how testing has evolved, and most importantly, what can be done when challenges show up.  Joining us is Dr. Beena Muktesh, Clinical Director, IVF, from Motherhood Fertility and IVF, a highly respected fertility expert with over 40 years of experience in reproductive medicine.

Someone who has witnessed the entire landscape of fertility care evolve, and who has helped many couples achieve their dream of parenthood. Dr. Beena, welcome to the Care Circle, and we are so glad to have you here. 

Dr. Beena (1:00) Thank you, Sneha. Thank you very much for inviting me. 

Snehaa (1:03) Let’s start with the first question. With your four decades in fertility care, you have seen the landscape evolve dramatically. If we focus on men, how has male fertility health changed over the years? 

Dr. Beena (1:15) Yeah, it has changed a lot, because you know, earlier the lifestyle was much, much better. Now, because of the decline in lifestyle, the late nights, computers, and a lot of other reasons because of, we are finding a lot of males coming with low fertility, and age is also very important. So, all these things affect fertility a lot.

Snehaa (1:35) That’s really encouraging, Dr. Beena, but even today, in so many families, people still assume the issue is with the women. Why do you think that the mindset has not changed? 

Dr. Beena (1:45) See, initially, long back, maybe about 20-25 years back, they used to think it is only because of the females that a couple is having infertility, and that is deeply engraved in their psyche, and they still think that in the last, when everything is okay from the female side, then only the men will check. So, that is very important.

They need to change their mindset and come forward to check the male fertility as well.

Snehaa (2:12) That’s such an important point, Dr. Beena, you just said, and when it comes to testing, are men simply hesitant, or is it that they don’t even realise they should be tested early? 

Dr. Beena (2:21) See, firstly, they think they are alright, they shouldn’t be anything because they are producing semen, that means they are alright, it’s not that there may be something wrong with their semen, maybe sperms are not there, or they are very few in number. So, they think that since they are producing semen, they must be alright.

One is this. Second is that, you know, as I told you earlier, also, because of the mindset, the females only have infertility issues. That is why they also think that they don’t, and then, of course, a little bit they are hesitant also to come to a fertility unit and get the semen checked because of many reasons, maybe a little shy or something, and most importantly is the knowledge.

They don’t have the knowledge that that could also be the sole responsibility of males if they don’t have a child. Maybe sperms are not there, maybe there is very less in quantity, and the quality is also not that good. So, that awareness needs to be created amongst them.

Snehaa (3:14) That’s an important point, doctor. So, before we dive into the solutions, I want to go a little deeper into the basics. Like, we keep hearing the term male infertility, but what does that really include? Are there any different types of problems men face today? 

Dr. Beena (3:28) See, male infertility means that a lady or the couple is not able to conceive because of a male issue. Now, male issues could be of many types. One is that there are no sperm at all. When the sperm are not there, of course, the lady cannot conceive.

Second, maybe a very, very poor quality of sperm. If they have a very poor quality of sperm and the count is too less to reach the egg, or maybe the morphology or the structure of the sperm is not good enough to fertilise and make a baby, and maybe motility is too less. So, there are many kinds, you know, if we really look into the problems, there are a lot of problems which can come, and because of that, they may have a fertility issue.

So, the semen analysis is a very, very important parameter, which will tell us that there is a problem of male infertility also. 

Snehaa (4:18) Understood, doctor. In fact, doctor, you said something about there is no sperm in the semen at all, and the sperm count is lower than normal.

So, there are some terms like, you know, azoospermia and oligospermia. And, you know, these terms also sound a little scary, doctor. Can you explain what these two terms really mean and whether men with these conditions can still become partners? 

Dr. Beena (4:41) Yes. See, in males, azoospermia means there are no sperm in the semen. Semen may be looking twice, it must be looking, okay, they are producing 2 ml or 3 ml of semen,  but maybe there are no sperm in it. When we test microscopically, maybe there are no sperm at all.

Then we call them having azoospermia. Now, the term oligospermia is the term which we use to see the sperm quality and quantity as well. So, together, if the count is less, if the motility is less, if the morphology is not up to the mark, viability is not there, then we call this one terminology that is called oligoteratazoospermia.

But separately, there are also like motility is less, there is a terminology, if the count is less, there is a terminology. But no need to go into details of all that. But I think there is a terminology when sperm quality is poor.

Snehaa (5:34) And doctor, can men with these conditions still become fathers?

Dr. Beena (5:39) Definitely. See, first of all, let’s take azoospermia. In azoospermia, when there are no sperms, apparently, there may be that there are no sperms. But maybe the testes are producing sperm. So, the technology nowadays is so advanced that we can even extract sperm from the testes of the male and fertilise with the eggs taken out by means of IVF, and then they can have a pregnancy. One is this, and there is another advanced way. 

Sometimes one testicle produces sperm, but it is being produced in one corner of the testes. If we just put a needle and try to extract, nothing will come out. We’ll think that probably testes also do not have any sperm. But when we open it with the help of a microscope and under the microscope, we open the testes, and there may be one portion of the testes which is still producing sperm. So, we can extract sperm from there and impregnate the female or the wife. So, that is also a very good technology which is coming up, and by means of which a male can become the biological father of a child.

If we take the oligospermia, most probably, most of the time it is genetic, but sometimes there are a lot of factors that also affect it. Lifestyle, as mentioned before, includes a lot of exercises, as cycling, which compresses the testes, and there may be oligo-teratospermia. Then there may be some kind of late-night drinking, smoking, and eating outside, which you can call it as junk food and no exercise. Lack of all these things may give rise to oligoteratosis spermia, or count and mortality may be reduced because of that, and subsequently male fertility. 

Snehaa  (7:24) So, doctor, you mean to say that men with all these conditions can still become fathers. So, technology has evolved, right, doctor? 

Dr. Beena (7:30) Yes, see what happens is once we know what the quality and quantity of the sperm are, we can make a proper decision about what should be the treatment. If the sperm quality and quantity are slightly deteriorated, then we can do an IUI for those patients, wash the sample, maybe the sample becomes a little better, and then we can use it and put promptly when ovulation takes place in the female, which we do by doing a follicular monitoring, and we can insert those sperms. 

This is when there is a little bit of a problem in the semen, and then if it is serious in the sense that the morphology, which means the structure, the structure of the sperm is not all right, then we do IVF ICSI. In that case, the husband’s semen is also washed, and then we pick up those good sperms from the semen and do ICSI, which is a very good process.

 So, even when the sperm is of low quantity, quality is not that great, morphology is not good, even if they have got infection in the semen, then also we can pick up those good quality sperms and insert them by the means of ICSI, and females can become pregnant with that. Normally, it would not have been possible because the motility is less, the sperm cannot reach the egg, maybe the structure is not good, but here we pick up the well-structured sperm only, so pregnancy can take place. 

So, normally it would not have been possible, but with this technology, it is possible, and as I told you before, also if there is azoospermia, we can extract directly from the testes and make the female pregnant with the help of IVF ICSI, and that is called TISA and PISA, which is called testicular sperm aspiration and microtISA. If we do it with the help of a microscope, then we call it microtISA. 

Snehaa (9:10) That’s really reassuring because hearing zero sperm or no sperm can be very overwhelming, doctor, but it sounds like science has an answer for most of the scenarios. And who should go in for the sperm testing? Should every man who is planning a family get it done, or only if there’s been trouble conceiving? 

Dr. Beena (9:30) See, as I see the lifestyle of the people, it is compulsory for them to go for a fertility check. What I mean by a fertility check is whenever they get married or they want to plan a baby, they should get their baseline fertility checked. In females, there are certain tests, but we are not talking about female fertility. In men, the semen test is the most important.

So, in the fertility check, they should come to know that what is the status of their semen. If it is really poor, then they can make an informed decision. What should they do if their sperm quality is that bad? Maybe coming years, they will not have sperm at all, maybe it deteriorates further. So, should they plan, or should they freeze their semen, or should they make an embryo and freeze embryos even if they don’t want pregnancy now? So, it is important to check semen analysis, and it is a part of the fertility check for males. 

Snehaa (10:21) Also, doctor, my next question is, we have been hearing a lot about the AMH test. In fact, the media has also been writing a lot about AMH testing. Is there a male version of the AMH test? We hear so many women talking about, you know, egg count. Is there a sperm count number that men should know? 

Dr. Beena (10:39). See, sperm count first, and the most important is where the semen analysis has been done. If it has been done in a local laboratory, that is not going to give us the correct parameters. Why am I saying this? Because once they take a semen sample and keep it outside, the sperm quality is going to deteriorate. So, it has to be tested immediately in a good IVF or fertility unit first. And second is that they see it under a low microscope. So, when they check it under a low microscope, most of the time they are not able to pick up the abnormalities in the sperm. So, they will give a picture as if 50% sperm are normal. But the same people, when they come to an IVF lab and they check, then we say maybe 2% or 3% or maybe 1%, they are surprised why our count was so good. 

But they didn’t realise that that was in a normal lab where they are not able to pick up the parameters which we exactly want. They are not able to pick up the normal sperm and tell you what exactly is the normal sperm count is. So, that is most important that they should do it in a good laboratory where the semen is checked under a high microscope. So, a single parameter of semen checking, if done in a good laboratory, is a good indication of having male infertility or not. 

The rest of the things, like you know, if they’re not able to produce, they’re not able to have intercourse, that comes in sexual things. If they’re able to produce, they can make a baby; they can become the father of a baby. So that we are not covering. But the semen analysis is the only good parameter which will tell us about male fertility. 

Snehaa (12:11) That’s really helpful to know, Dr. Beena. I think people often oversimplify it to just a good or a bad count. Now, with so many possible issues, does that mean that the type of tests also varies depending on the condition? 

Dr. Beena (12:25) No condition. We will only come to know when we do a semen analysis, no? Maybe there are sperm or not, or maybe there are what kind of parameters we can see. So, I think sperm analysis is good enough to know about the kind of fertility they have. 

Snehaa (12:44) And Dr., over the years, like even from the time you started your practice, how much has sperm testing evolved? 

Dr. Beena (12:51) See, there are many more tests for sperm, which we are doing. Like when if we get an azoospermia patient, like suppose they don’t have any sperm at all, then even if we have to take out the sperm from the testes, we need to check their Y chromosome, which is called Y-chromosome deletion. If we are having some deletion in the Y chromosome, then even if we take out the sperm from the testes, maybe we will not get any. So, that is also important before going in for a biopsy of the testes or taking out sperm. So, this test is important. Second is DNA fragmentation. So, that DNA fragmentation means the sperm are fragmented. So, such sperm are not able to cause pregnancy. This DNA fragmentation, if it has a high percentage of DNA fragmentation, means sperm quality is really poor.

If they are borderline, then with the help of, you know, exercises and diet, and regularity in their lifestyle, they can still improve. But if the DNA fragmentation is very high, which could be because of diabetes in the male or any other medical conditions, or maybe a really poor child smoking, drinking, all these things can give rise to, and particularly smoking, which is really bad for sperm. So, that will give us high DNA fragmentation, though we can still do ICSI for those patients, but we may not get good embryos from this kind of sperm. 

Snehaa (14:11) Understood, doctor. It’s a very important point that you projected now. So, doctor, let’s talk about the lifestyle aspect as well. The long hours, the late-night work schedule, the junk food, and the constant travel. Is modern living quietly sabotaging male fertility? 

Dr. Beena (14:25) Definitely. You know, it’s, as I told you, awareness. Busy people have got lifestyle which is not too good, still they can improve, you know. Suppose they have got lifestyle, like they have to work late nights, they can get a proper sleep in the morning. Still, if they are just engaged in other tasks, then it becomes difficult for them to get a proper sleep. They can cut down on alcohol and smoking, which is in their hands. They can improve their lifestyle by doing that. Computers and all, they should take a break from it. They should not continuously sit on the computers and, you know, keep doing mobiles and all. They can keep mobiles and computers a little away so that they can do so. Exercises in moderation, not too much of proteins and steroids in the gyms and all, which is also not too good, and too much cycling also is not recommended. So, they can definitely, in spite of being very busy, they can definitely improve their lifestyle if they really wish to. 

Snehaa (15:17) That’s good to know, doctor. Even, in fact, doctor, we also speak about egg freezing for women. Do you think men should also go for routine fertility checks, especially if they plan to delay having children? 

Dr. Beena (15:28) Yes, that’s what I mentioned earlier also. A fertility check for males typically includes a semen analysis. They should definitely do it, and that will tell us whether they need further investigations or not. So, the fertility check package, which we have in our hospital, basically is semen analysis, the MH and age, of course, we know the patient, and the third is the enteral follicle count. These three make a complete package of fertility tests, which everyone, whether they want pregnancy now or not, can at least they will know the status of their fertility, which is very important.

Snehaa (16:03) That’s a smart way to look at it, doctor. Now, for the classics: protein powders, alcohol, tight underwear, late nights. Are these just myths, or do they actually affect sperm health? 

Dr. Beena (16:15) Yes, definitely, it does affect. Too much protein is not good because it has to be metabolised in the body itself, and it disturbs the rest of the functions also. Similarly, even the semen quality also. Tight underwears, there is no oxygenation. See, God has made testes outside the body with the purpose that they should remain cool. That is why it can produce sperm. If somebody wears very tight underclothes, there is no oxygenation, and the scrotum is pressed. So, that is also not too good. So, all these things do matter for, you know, having poor-quality sperm. 

Snehaa (16:47) Now, coming to age, Dr. Veena, can men really father children at any age? Is it a myth or a fact? 

Dr. Beena (16:53) See, earlier, they used to think that they could have children at any age, but nowadays, it’s not like this. The fertility goes down with age in males as well because one is that the quality doesn’t remain, and there is a high probability of having abnormal children because of the ageing, male sperm. Quality and quantity also deteriorate with age. That is why it is said that if they want to have children, they should have them at an appropriate age.

Snehaa (17:21) Understood, doctor. In fact, doctor, once you told me about a couple who went through three failed IUIs before discovering the real issue was male-related. Could you walk us through what exactly happened in that case? 

Dr. Beena (17:32) Yes. See, there was a couple who came to me from Nepal, and they said that they had done three IUIs at different places, and they are not getting any results. And they were thinking everything is good because we are okay, our tubes are patent, our ovaries are all right, and semen is also okay. So, when we did semen analysis in our lab, we found that only 1% sperm were morphologically normal. Such people who got less than 1% or 1% need IVF ICSI only. So, the three times they have done IUI were a waste. So, we did an IVF ICSI on them and they conceived, they stored their embryos also, and finally they came for the second child for the second time also. They produced one more child, and they were happy with two children. If they had known that their sperm was not that great, they would have gone for IVF ICSI earlier. It’s just a false belief that their sperm are normal because they did it in a normal laboratory, and I told you the importance of having it done at a good laboratory. 

Snehaa (18:39) This is a very interesting story, doctor, that you have told. This story drives home the importance of early and accurate testing. The right diagnosis can save couples years of stress and expense. Time for a quick Care Circle rapid fire. First thing that comes to your mind, one myth about male infertility you wish should disappear forever. 

Dr. Beena (18:59): That it’s only females because of them; the infertility is there. Men can also be.

Snehaa (19:04) Your go-to advice for any couple walking into your clinic for the first time? 

Dr. Beena  (19:08) First, I would say they should come as a couple, a unit. Second, they should definitely bring all the reports done so far. Maybe we are able to pick up something which is very important.

Snehaa (19:17) My third and last rapid fire question, doctor, to you is a moment in your career that still gives you goosebumps. 

Dr. Beena (19:23) You know, a couple came to me who were trying for 17 years and at the verge of disappearing their fertility, rather, you know, very, very poor ovarian reserve, and we did an IV for that patient, and fortunately, we got one or two eggs. Maybe I remember two eggs. We fertilised and they got pregnant after 17 years, which was amazing. I still remember how the patient was crying and saying, Oh, we are not able to conceive. We’ve tried for so long, and finally they got pregnant with the help of ICSI and other supportive medicines.

Snehaa (19:58) Love that, Dr. Beena. Thank you for sharing, and that’s a wrap on our rapid fire. You absolutely nailed it. Before we wrap up, Dr. Beena, if you had to give just one piece of advice to men when it comes to protecting and improving their fertility, what would it be? 

Dr. Beena (20:13) First of all, as I mentioned many times that they should do their fertility check. Semen analysis should be done in a very good laboratory, maybe a fertility unit where they can see semen under a very high microscope. They should have an improved lifestyle to maintain their fertility. In case they feel that they are not able to have children because of some other reason, at least they should get the embryos frozen by doing IVF ICSI on their wife’s eggs with their sperm and store them. 

Maybe they want to use it later. They can do it and don’t get disappointed even if you have azoospermia. We have many ways to do it. Even testicular biopsy, we are not able to take out any sperm. 

There is another way called PISA-TISA. We can take out, extract sperm from there, and you can become the biological father of a child, and you know, never think that fertility is only because of females. It is always and always could be both of you, maybe you only. So, take care of all this. Bring all your reports, whatever you have done, so that we know the pattern, whether you are having a deteriorating sperm count or it is the same, because then we can store your sperms also. In case suppose we find that because for any reason, your semen quality and quantity are deteriorating from day to day, then we can freeze a couple of them so that we can use them later on, and that’s the most important thing I would like to say. 

Never get disappointed that they can’t become the father of a child if sperm are not there. Another important thing is never to hesitate to take donor sperm in case if you just don’t have sperm, and even PISA-TISA doesn’t help you. Basically, it’s your child, it’s wife’s eggs and sperm, donated sperm. You will have a baby and love your baby as your own, even if it is from donor sperm. There are very nice donor sperms available, and a very good sperm count; you can go ahead with that also. Never hesitate to do that. That’s my advice to you.

Snehaa (22:20) Thank you, Dr. Beena, for sharing such valuable insights and breaking the silence around male infertility and helping couples see that no matter the challenge, there is a path forward.

Dr. Beena (22:29) Yeah, sure. Thanks a lot. Your questions were also very interesting, and I think it will benefit most of the people who are still in some kind of doubt, what they should do, what they should not do, and I’m sure that was an amazing discussion. 

Snehaa (22:42) Whether you are a couple just starting your journey or already in the middle of it, remember that testing early, seeking the right care, and approaching fertility as a team can make all the difference. You have been listening to The Care Circle, your very own expert-led safe space. We will be back soon with more honest, thoughtful, and empowering conversations that put you, your health, your journey, and your voice at the centre of care. Until next time, stay healthy, stay kind, and take care.