By Dr. Shweta Agarwal, MBBS, DGO Medically reviewed by Dr. Shweta Agarwal, MBBS, DGO Last updated: June 2026
Information on this page is educational and does not replace a medical consultation. Outcomes depend on individual clinical factors.
Aansh Hospital & IVF Center is a government-registered Level-2 ART clinic (Reg. No. MH/AC/2024/15441/L2/Chandrapur/132), part of a chain of fertility centers serving Vidarbha and northern Telangana, with our headquarters and in-house embryology lab in Chandrapur. Our government ART registration covers the full range of regulated fertility diagnostic and treatment services.
Male fertility is one of the most myth-laden areas of reproductive medicine. Some of these myths arise from embarrassment and the reluctance to discuss the topic openly. Others come from outdated assumptions that have been superseded by decades of clinical research. And some are simply cultural beliefs that persist because no one has clearly explained what the evidence actually shows.
In this post I want to address the most common myths I encounter in clinic — phrased the way patients and their families actually say them — and set out what the evidence shows instead. The Hindi and Marathi phrase most often used is पुरुष बांझपन (purush baanjhpan); the fact that it carries social stigma is itself one of the myths we need to dismantle.
Myth 1: "Infertility is almost always the woman's problem"
Fact: Male factor is involved in approximately half of all cases of couple infertility — either as the primary cause or as a contributing factor alongside a female-side finding.
This is the single most consequential myth in fertility care, because it leads to a pattern where the female partner undergoes months of investigation and treatment while the male partner is not evaluated at all. Clinical guidelines from the World Health Organization and major international reproductive medicine bodies consistently place male factor at around 40–50% of infertility presentations, either alone or combined. In a proportion of couples, no cause is found in either partner (unexplained infertility) — but male-side investigation is part of a thorough workup from the outset.
A semen analysis is a simple, non-invasive test. It is almost always the first investigation recommended when a couple has not conceived after a reasonable period of trying. It makes clinical and practical sense to evaluate both partners early, rather than treating the female partner in isolation and discovering a significant male factor months later.
Myth 2: "If a man can have sex and ejaculate normally, his fertility is fine"
Fact: Erectile and ejaculatory function are controlled by neurological and vascular mechanisms that are entirely separate from sperm production. Normal sexual function tells us nothing at all about sperm count, motility, or morphology.
Sperm are produced in the testes over a cycle of approximately 70–74 days. The quality and quantity of the sperm produced depends on testicular function, hormonal signalling, temperature, and a range of other factors — none of which are related to sexual function. A man can have no physical difficulty with intercourse and simultaneously have a very low sperm count, non-motile sperm, or no sperm at all in the ejaculate.
This is precisely why a semen analysis is necessary. There is no symptom, no physical sign visible from the outside, and no aspect of sexual function that reliably predicts the findings of a semen analysis. The only way to evaluate sperm is to examine them under a microscope in a laboratory. Understanding what a semen analysis measures is the first step toward an accurate clinical picture.
Myth 3: "Male infertility means he is not masculine / it reflects his virility"
Fact: Male infertility is a medical condition. It has no relationship whatsoever to masculinity, libido, sexual desire, physical strength, or any other attribute of manhood.
Sperm production is regulated by hormones produced in the pituitary gland (FSH and LH), which signal the testes to produce sperm. Conditions that affect this system — genetic variants like Klinefelter syndrome, hormonal imbalances, varicocele, previous infections, or obstruction — have nothing to do with personality, behaviour, or any social construct of masculinity.
The conflation of fertility with virility is a cultural overlay, not a medical one. It causes real harm: it delays men from seeking evaluation and treatment, it generates shame where none is warranted, and it can damage relationships when the underlying issue is a manageable medical condition. I see this pattern regularly in clinic, and it is one of the most important conversations we have.
A man with azoospermia and a normal testosterone level can have the same libido and sexual function as a man with a normal sperm count. The two are simply not the same system. Male infertility is a medical diagnosis, approached the same way as any other diagnosis — with investigation, explanation, and a treatment plan.
Myth 4: "You can tell sperm count from how semen looks — more / thicker / clearer means more sperm"
Fact: Semen appearance, volume, colour, and consistency provide no reliable information about sperm count, motility, or morphology. Only laboratory analysis does.
This myth persists partly because it seems intuitively logical — if there's more fluid, surely there are more sperm? In reality, sperm make up a very small fraction of the total semen volume. The majority of semen is secreted by the seminal vesicles and the prostate, not by the testes. A man can produce a large-volume, normal-looking ejaculate with no sperm at all (azoospermia), and conversely, a small-volume sample can contain a normal sperm count.
Even highly experienced embryologists and andrologists cannot estimate sperm count from visual inspection of the sample. The only valid measurement is a count performed using a haemocytometer or computer-assisted sperm analysis (CASA) system under a microscope — which is what happens during a semen analysis in an accredited laboratory.
Myth 5: "Age doesn't affect men the way it affects women"
Fact: Male age does have a real, measurable effect on sperm quality — though the pattern differs from the sharper age-related fertility decline seen in women.
Female fertility is strongly age-dependent because women are born with a fixed number of eggs and that pool diminishes over time. Men continue producing sperm throughout their adult lives, which is why the age effect is more gradual and less absolute. However, research shows that as men age, sperm DNA integrity tends to decline, morphology can worsen, and there is some evidence of increased DNA fragmentation rates with advancing paternal age.
This does not mean that older men cannot father children — many do, naturally and with assisted reproduction. It does mean that paternal age is a legitimate clinical variable, particularly in the context of repeated IVF failures, recurrent miscarriage, or unexplained infertility, where a sperm DNA fragmentation test may be informative. The conversation about age and fertility should include both partners.
Myth 6: "Tight underwear and laptop heat are the main causes of male infertility"
Fact: Heat is a real but minor, modifiable risk factor. The major causes of male infertility are medical — varicocele, hormonal imbalances, genetic conditions, and obstructive problems — and cannot be resolved by changing underwear.
The testes sit outside the body in the scrotum because sperm production requires a temperature slightly below core body temperature. Scrotal temperature elevation — from whatever source — can temporarily suppress sperm production. This is the basis for the concern about tight underwear, prolonged sitting, laptops on the lap, and hot baths.
In clinical practice, however, these factors are rarely the primary cause of significant male infertility. When I see a man with severe oligospermia or azoospermia, the likely explanations are varicocele (enlarged veins in the scrotum, which is the most common identifiable and treatable structural cause), hormonal dysfunction, a genetic variant, or obstruction — not underwear choice. Lifestyle modifications are generally advisable as adjuncts to treatment, but they should never delay a proper medical evaluation and they do not replace it.
If you have been told to "just change underwear and wait" without a semen analysis and clinical workup, that advice is incomplete. See a specialist. The male infertility conditions page outlines the full range of causes and what investigation looks like.
Myth 7: "Nothing can be done if sperm count is very low or there are no sperm"
Fact: A very low sperm count does not preclude biological fatherhood. Even azoospermia — no sperm in the ejaculate — may allow biological fatherhood through surgical sperm retrieval combined with ICSI, depending on the underlying cause.
This is one of the most important myths to correct, because it leads men to give up before they have been properly evaluated. The treatment pathway depends entirely on the cause:
- Low sperm count (oligospermia): Depending on severity and cause, options include IUI, IVF, or ICSI. If the cause is hormonal (such as hypogonadotropic hypogonadism), hormone therapy can sometimes improve sperm production substantially.
- Obstructive azoospermia (sperm are produced but blocked): Surgical sperm retrieval — PESA or TESE — can usually obtain sperm from the epididymis or testis for use with ICSI. The success rate of retrieval in obstructive cases is high.
- Non-obstructive azoospermia (production itself is impaired): Micro-TESE — microsurgical testicular sperm extraction — can find sperm in a proportion of these cases, even when the standard semen analysis shows none. The likelihood depends on the underlying genetic and hormonal findings. Sperm retrieval options are explained in detail on the treatment page.
Not every case will have a successful outcome, and I never make guarantees — outcomes depend on individual clinical factors. But "nothing can be done" is almost never the accurate medical position before a thorough evaluation has been completed.
Myth 8: "Ayurvedic remedies and home treatments reliably cure male infertility"
Fact: There is currently no high-quality clinical evidence that any Ayurvedic preparation, herbal supplement, or home remedy reliably corrects the underlying causes of male infertility — varicocele, obstructive azoospermia, hormonal failure, or genetic conditions.
Some antioxidant supplements have been studied as adjuncts to treatment, with mixed evidence and modest effect sizes at best, and should only be considered on a doctor's advice. These are different from unregulated preparations that claim to correct infertility.
The risk of relying on unproven remedies is not simply that they don't work — it is the time lost. Female fertility is time-sensitive (particularly for women over 35), and spending a year on unproven treatments while a correctable male factor goes untreated is a clinical cost. The appropriate response to a concern about male fertility is a semen analysis followed by a specialist consultation. After a proper diagnosis, any adjunct treatments (including evidence-based supplements if relevant) can be discussed in context.
If you have used or are considering such treatments, I do not dismiss this — but I would strongly encourage getting a semen analysis first so that we know what we are actually dealing with.
The constructive message: what to actually do
If you or your partner has a concern about fertility — whether you have been trying to conceive and not succeeding, or whether one or both of you simply wants to know where you stand — the evidence-based path is straightforward:
- Both partners are evaluated. Female evaluation and male evaluation happen together, from the beginning, not sequentially.
- The first male investigation is a semen analysis. It is simple, non-invasive, and provides the most important information in a single step. Book a fertility assessment to get both evaluations in one appointment.
- If the semen analysis is abnormal, a repeat is done to confirm. One result does not make a diagnosis.
- Further investigation follows the finding — hormonal panel, scrotal ultrasound, genetic tests, or sperm DNA fragmentation testing as clinically indicated.
- Treatment is matched to the diagnosis. There is no generic "male fertility treatment" — ICSI, IUI, surgical retrieval, hormone therapy, and lifestyle modification are each appropriate for different clinical situations.
To speak with Dr. Shweta Agarwal about a male fertility concern, or to arrange a semen analysis at our in-house andrology lab, contact us on +91 80056 85160 or WhatsApp. We offer consultations in Marathi, Hindi, and English. Answers in the language you are most comfortable with — including discussing पुरुष बांझपन openly and without judgment — are always available.