Steroids, Sperm Count Decline, and Stigma: India Faces Silent Male Infertility Crisis

Time of India

25-04-2025

New Delhi: Male infertility is quietly escalating into a public health crisis in India, yet remains among the most under-discussed medical conditions in the country. With traditional masculinity still tied to physical strength and social expectations, the subject of male reproductive health is too often buried under layers of stigma, misinformation, and silence.
Startling data reveal that only 25 per cent of Indian men meet normal semen parameters—meaning 75 percent face issues related to semen volume, sperm count, motility, or morphology. Male-factor infertility accounts for nearly 40–50 percent of all infertility cases in India, supported by studies from the
Indian Society for Assisted Reproduction (ISAR)
and National Medical Journal of India. These findings emphasise the critical need for a shift in focus towards male infertility, as it is a significant contributor to the overall infertility rates in the country. This concern takes on added urgency as the country observes
National Infertility Awareness Week
, aiming to shed light on the challenges of infertility and the importance of inclusive reproductive health conversations.
'The conversation around infertility still centers heavily on women. We urgently need a shift toward inclusivity and science-backed awareness,' says Dr. Prachi Benara, Senior Consultant and Centre Head at
Birla Fertility
& IVF.
"One of the most alarming contributors to declining sperm health is the unregulated use of anabolic steroids and gym supplements. In the race for rapid muscle gains and social media-worthy physiques, many young men are unknowingly compromising their fertility," Dr. Benara added. Even a few months of steroid use can bring sperm count down to zero.
'Most over-the-counter supplements in India don't disclose their ingredients properly. Many men fall prey to quack advice or misguided gym trainers,' she warns. Worse, some men unknowingly take testosterone injections, which can shut down natural sperm production.
Beyond supplements, several other lifestyle factors are contributing to the decline: tobacco use, poor diet, high BMI, sedentary work, and increased age. While women face a biological clock, men experience a more gradual reproductive decline called andropause. Studies show sperm quality begins to significantly deteriorate after the age of 40—a challenge for many urban men delaying parenthood.
Data Deficit and Diagnostic Gaps
Despite the growing threat, India lacks comprehensive data on steroid-linked infertility. Most men don't disclose supplement use unless directly asked, making it difficult to trace the root cause of fertility issues. However, experts believe early testing—especially semen analysis—is crucial.
Clinicians assess four key parameters: volume, count, motility, and morphology. Ideally, a sample should have more than 1 ml of semen, over 16 million sperm/ml, 40 percent motility, and a morphology score above four percent. Yet, only 1 in 4 Indian men meets these benchmarks.
The good news: recovery is possible. If steroid use is discontinued within a year, many men show significant improvement in sperm quality within six months, she stated.
Another hidden aspect of male infertility is the issue of non-consummation of marriage, often due to psychological conditions like vaginismus or erectile dysfunction. 'Up to 90 percent of such cases improve with conversation and counseling alone,' Dr. Benara adds. At Birla Fertility, initial consultations last up to an hour and prioritize mental health and emotional well-being before recommending diagnostics or IVF.
'Many couples don't need IVF right away. What they need first is someone to listen—without judgment,' she says.
With India's Total Fertility Rate (TFR) dipping to 1.99—below the replacement level—the implications of untreated infertility loom large. However, the rise of technology and affordability is bringing hope.
Today, an IVF cycle costs ₹1.7–1.75 lakh, down from ₹2.5–3 lakh, and EMI options are widely available. Some employers have even started including IVF in insurance plans. Advanced technologies like AI-assisted lab procedures and microfluidics are enhancing outcomes. While CRISPR and genome editing are not yet used in Indian IVF, DNA-quality assessments are emerging as the next frontier.
The Road Ahead: Replace Silence with Science
India is at a crossroads. Without proactive steps, the socio-economic fallout of untreated infertility could mirror aging societies like Japan and South Korea. Between the ages of 35 and 50—coincidentally peak career years—many Indians are also at peak fertility risk.
Without proactive steps, the socio-economic fallout of untreated infertility could mirror aging societies like Japan and South Korea. Between the ages of 35 and 50—coincidentally peak career years—many Indians are also at peak fertility risk.
'This conversation needs to evolve—from one filled with fear and shame to one grounded in empathy, education, and empowerment,' says Dr. Benara.
The stigma must end. Science must speak. And the silence around male infertility must finally be broken.