Published: 8 October 2026
Medically reviewed by Dr. Pranay Shah, MS (ObGy), Director & Chief Fertility Consultant, Wellspring IVF & Women’s Hospital, Ahmedabad
Last medically reviewed: 8 October 2026
A male factor is involved in roughly half of couples who cannot conceive: male factors alone account for about 20 to 30 per cent of cases and combine with a female factor in a further 20 to 30 per cent. That is a statement about couples, not about men. The proportion of men who are themselves infertile is a different and much smaller number — around 4.5 to 12 per cent in the regions where it has been measured, and unmeasured at national level in India.
Almost every argument about male infertility statistics is really an argument between those two numbers. One describes how often a man’s fertility contributes to a couple’s difficulty; the other describes how many men have a fertility problem at all. They are not interchangeable, they are not the same order of magnitude, and confusing them produces both false reassurance and unnecessary alarm. This article separates them, sets out what the evidence actually supports, and explains what follows for a couple deciding who gets tested and when.
What does “how common” actually mean here?
Two distinct questions hide inside the phrase. The first is an attribution question: of couples presenting with infertility, in what share is a male factor part of the explanation? The second is a prevalence question: of all men of reproductive age, what share are infertile? The first is measured in fertility clinics; the second requires a population sample. They answer different needs and they produce very different figures.
Attribution | Prevalence | |
|---|---|---|
The question | Among infertile couples, how often is a male factor involved? | Among men generally, how many are infertile? |
Where it is measured | Fertility clinic populations | General population samples |
Typical published figure | About 50% involve a male factor | About 4.5–12% of men, depending on region |
What it is useful for | Deciding whom to investigate | Health-service planning and trend analysis |
Common misreading | “Half of all men are infertile” | “Male factor is rare, so test the woman first” |
Table 1. Two different questions that both get answered with the words “how common is male infertility”.
What proportion of infertility is due to male factor?
The most widely cited synthesis is Agarwal and colleagues (2015), published in Reproductive Biology and Endocrinology, which reports that around 50 per cent of infertility cases are due to female factors alone, 20 to 30 per cent to male factors alone, and the remaining 20 to 30 per cent to a combination of male and female factors. Adding the male-alone and combined categories gives the familiar figure: a male factor is present in roughly 40 to 60 per cent of infertile couples, which is where “about half” comes from.
It is worth knowing what that figure is not. The World Health Organization’s infertility fact sheet, last updated on 28 November 2025, states that infertility may occur due to male, female or unexplained factors and lists the causes in each reproductive system — but it does not publish a proportional split between them. When a website attributes “50 per cent” to WHO, the attribution is wrong even though the number is defensible. The figure comes from the clinical literature, and it is a range rather than a constant.
The range matters clinically. It moves with the population studied, with how “male factor” is defined — an abnormal semen parameter is not the same as demonstrated infertility — and with how thoroughly the male partner was investigated in the first place. In settings where men are evaluated late or superficially, male factor is systematically under-counted, which is precisely the pattern seen across much of India.
How common is infertility overall?
The WHO fact sheet defines infertility as the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse, and reports that approximately one in every six people of reproductive age worldwide experience infertility in their lifetime. That is a lifetime prevalence figure covering both sexes, not a current point-prevalence and not a male-specific figure — another number that is frequently repurposed to mean something it does not.
What do we actually know about male infertility in India?
Less than most published claims imply. India has no national male-factor prevalence estimate derived from a population sample. The Agarwal synthesis is explicit that its regional calculations exclude Asia because of under-reporting, so figures quoted for North America, Australia or Central and Eastern Europe cannot be transferred to an Indian population.
What does exist is clinic data. Kaushal and colleagues (2020), writing in the National Medical Journal of India, prospectively enrolled 447 infertile men at a dedicated andrology clinic in a tertiary public hospital over 30 months; 426 completed evaluation, with a mean age of 31 years. About 83 per cent had primary infertility, approximately 40 per cent had oligo-, astheno- or teratozoospermia, and approximately 40 per cent had azoospermia, of whom 21.1 per cent had obstructive azoospermia. Only 24.4 per cent of patients went on to receive the treatment they were advised, with a pregnancy rate of 36.8 per cent among those who did.
Those numbers are valuable, and they must be read with their selection in mind. A tertiary andrology referral clinic sees the concentrated end of the spectrum — an azoospermia rate near 40 per cent is a statement about who reaches that clinic, not about Indian men. The finding that generalises is the last one: fewer than a quarter of men diagnosed with a treatable problem actually received the treatment advised. The bottleneck in Indian male infertility is not diagnosis. It is what happens after the diagnosis.
Should the male partner be tested first?
Neither partner should be tested “first”. Both should be assessed at the same time. NICE guideline NG257, published in March 2026 and replacing CG156, recommends at 1.1.1 that couples who experience problems in conceiving be seen together, because both partners are affected by decisions about investigation and treatment; and at 1.16.5 that where a woman has not conceived after one year of unprotected vaginal sexual intercourse, both partners be offered further clinical assessment and investigation.
The practical case for simultaneous assessment is stronger than the courtesy argument. Semen analysis is quick, inexpensive and non-invasive; the corresponding female workup involves blood tests timed to the cycle, imaging and sometimes a surgical procedure. Sequencing the invasive investigation ahead of the simple one is inefficient in every direction. It also risks the outcome seen repeatedly in Indian practice, where a couple completes months of female investigation and treatment before anyone examines the semen — by which time the woman is older, the couple is poorer, and the answer was available at the start.
In much of India the default assumption still places responsibility with the woman. Correcting that is not a matter of fairness alone; it is the single change most likely to shorten time to diagnosis. Understanding how male infertility is investigated alongside female fertility evaluation is what a couple is entitled to expect from a first consultation.
What does the first male test involve?
The first test is a semen analysis, performed against the reference values in the WHO laboratory manual for the examination and processing of human semen, 6th edition (2021). NG257 recommends at 1.17.3 that where a first semen analysis is abnormal, a repeat confirmatory test be offered, and at 1.17.4 that the repeat ideally be undertaken about three months after the initial analysis, or sooner where the deficiency is severe. Where two analyses are abnormal, 1.17.5 recommends physical examination of the scrotum and testes and consideration of serum testosterone and gonadotrophin measurement.
A single abnormal result is therefore not a diagnosis. Sperm production runs on a cycle of roughly three months, and a recent fever, illness, or a short abstinence interval can move the numbers substantially. Our guide on how to read a semen analysis report explains what each parameter measures and where the common misreadings occur.
Is male infertility increasing?
The honest answer is that sperm counts have measurably fallen and that this is not the same finding as male infertility becoming more common. Levine and colleagues (2023), in Human Reproduction Update, reported a meta-regression of samples collected worldwide and found that mean sperm concentration among unselected men declined by 51.6 per cent between 1973 and 2018, with a 62.3 per cent decline in total sperm count, and that the rate of decline roughly doubled from 1.16 per cent per year after 1972 to 2.64 per cent per year after 2000.
That is a serious finding from a large body of data, and the authors themselves call for research into its causes. It is also frequently over-read. What follows below is the distinction that most reporting collapses.
What the analysis measured | What it did not measure |
|---|---|
Mean sperm concentration and total sperm count in unselected men over time | Whether the rate of male infertility has risen over the same period |
A population average, drawn from pooled study samples | Any individual man’s fertility, which a population mean cannot predict |
A statistical trend across five decades | The cause of that trend, which remains unestablished |
Table 2. What the sperm-count meta-regression establishes, and what it does not.
A falling population mean is compatible with a rising number of men below the fertility threshold, but it does not by itself demonstrate one, and the analysis was not designed to test it. The reasonable clinical position is that the trend warrants attention and further study, and that it is not a basis for telling any individual man that his fertility is worse than his father’s would have been. His own semen analysis answers that question; the meta-regression does not.
When should a couple seek evaluation?
The one-year rule is the general standard, but it is not universal. NG257 recommends earlier referral at presentation where either partner has a known or suspected cause of infertility, or where the woman is aged 36 or over. Waiting a full year is the wrong advice for a couple in which the woman is in her late thirties, or in which either partner has a relevant history.
- Twelve months of regular unprotected intercourse without conception, in a couple where the woman is under 36 and neither partner has a known risk factor.
- At presentation, without waiting, where the woman is 36 or over.
- At presentation where the man has had undescended testes, testicular surgery or trauma, mumps orchitis after puberty, chemotherapy or radiotherapy, a known genetic condition, or a previous fertility problem.
- Promptly where there is a testicular lump or swelling, marked testicular asymmetry, absent or greatly reduced ejaculate volume, or symptoms suggesting a hormonal disorder — these need assessment on their own merits, independently of the fertility question.
- At presentation where the woman has irregular or absent periods, known tubal disease, endometriosis, or previous pelvic surgery or infection.
Frequently asked questions
What percentage of infertility is due to male factor?
A male factor is present in roughly 40 to 60 per cent of infertile couples. Agarwal and colleagues (2015) report male factors alone in 20 to 30 per cent of cases and a combination of male and female factors in a further 20 to 30 per cent. The commonly quoted “about 50 per cent” is the midpoint of that combined range. WHO does not publish a proportional split of its own.
Should the male partner be tested first?
Both partners should be assessed together rather than in sequence. NICE guideline NG257 recommends seeing couples together and offering both partners assessment and investigation after one year without conception. Because semen analysis is quick and non-invasive, delaying it while the woman completes cycle-timed blood tests and imaging adds months without adding information.
Is male infertility increasing?
Sperm counts have fallen measurably — Levine and colleagues (2023) report a 51.6 per cent decline in mean sperm concentration between 1973 and 2018 — but that is a population average, not a measure of how many men are infertile. No study has yet established that the rate of male infertility has risen in step, and the cause of the sperm-count trend remains unestablished.
How common is male infertility in Indian men?
There is no national prevalence figure for India derived from a population sample, and international regional estimates exclude Asia. Indian clinic-based studies describe the pattern of abnormalities among men who reach andrology clinics, but those populations are heavily selected and cannot be read as community prevalence.
Does one abnormal semen report mean I am infertile?
No. Sperm production runs on an approximately three-month cycle, and a recent illness, fever or short abstinence interval can alter results significantly. NG257 recommends a repeat confirmatory test, ideally about three months after an abnormal first analysis. A diagnosis rests on two abnormal analyses together with examination, not on a single report.
Speaking to a fertility specialist
If you and your partner have been trying to conceive for a year, or you have a history that makes earlier assessment sensible, a semen analysis is a reasonable and undramatic first step to take alongside your partner’s evaluation rather than after it. You can speak to our team about arranging both, or discuss your individual situation with a fertility specialist at Wellspring IVF & Women’s Hospital, Ahmedabad.
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References
- World Health Organization. Infertility — fact sheet. Updated 28 November 2025.
- World Health Organization. WHO laboratory manual for the examination and processing of human semen, 6th edition. Geneva: WHO; 27 July 2021.
- National Institute for Health and Care Excellence. Fertility problems: assessment and treatment. NICE guideline NG257. London: NICE; March 2026. Updates and replaces CG156.
- Agarwal A, Mulgund A, Hamada A, Chyatte MR. A unique view on male infertility around the globe. Reproductive Biology and Endocrinology. 2015;13:37. doi:10.1186/s12958-015-0032-1
- Levine H, Jørgensen N, Martino-Andrade A, Mendiola J, Weksler-Derri D, Jolles M, Pinotti R, Swan SH. Temporal trends in sperm count: a systematic review and meta-regression analysis of samples collected globally in the 20th and 21st centuries. Human Reproduction Update. 2023;29(2):157–176. doi:10.1093/humupd/dmac035
- Kaushal R, Gurnani N, Kumar M, Dada R, Kumar R. Male infertility in India: demographics, aetiology and outcomes of standard clinical practice. The National Medical Journal of India. 2020;33:340–343.
