Kalpesh Kapadia: A Man’s Semen Analysis May Be the Most Under-Ordered Health Test in India
Kalpesh Kapadia, Consultant UroAndrologist at Pratham IVF and Urology Clinic, shared on LinkedIn:
“A Man’s Semen Analysis May Be the Most Under-Ordered Health Test in India.
We treat it as a fertility test. It is closer to a general health report.
The 2023 meta-regression in Human Reproduction Update found mean sperm concentration fell roughly 50% between 1973 and 2018 – and it was the first analysis with enough power to detect the same trend in men from Asia, South America and Africa. The decline is not a Western phenomenon anymore.
Three things I see repeatedly in clinic in Ahmedabad:
- The male partner is evaluated late. Couples often arrive after months of female-factor work-up, when a semen analysis is cheaper, faster and non-invasive. Male factor contributes to a substantial share of infertility. It should be assessed in parallel, not after.
- A large part of what we find is modifiable. Obesity, tobacco, occupational heat exposure, poor sleep and untreated varicocele account for a meaningful proportion of low counts. Varicocele remains the most common correctable cause.
- Reference limits are being read as pass/fail. WHO 2021 lower reference limits are 16 million/mL and 39 million total.
These are the 5th percentile of a fertile population – not a diagnosis line. Intra-individual variation is wide, and a single sample should not drive counselling. Two samples, minimum.
There is a broader signal here worth naming. Falling sperm counts track with obesity, insulin resistance, low testosterone and cardiovascular risk. A poor semen report in a 30-year-old is often the first written evidence that his metabolic health is drifting – years before anything else flags it.
That makes this a men’s health issue, not only a reproductive one.
If you counsel young men in any capacity: normalising a semen analysis is a low-cost intervention with an unusually high information yield.
Dr. Kalpesh K. Kapadia, Uroandrologist · Pratham IVF and Urology Clinic, Ahmedabad.”
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