PCOS and Male Factor Infertility: How Often They Overlap

How Often Does Male Factor Infertility Occur Alongside PCOS?

Male factors contributed wholly or in part to 45.1% of infertility cases in the population data behind the World Health Organization’s 2026 infertility guideline — female factors alone accounted for 30.6%, both partners together for 26.3%, and male factors alone for 18.7% (WHO Guideline Development Group for Infertility, 2026). Those figures describe infertility in general, not PCOS specifically, and that gap is the actual problem: PCOS content and male-factor content sit in separate corners of the internet, as though a couple could only ever have one explanation on the table at once.

A 2025 case-control study looked at that overlap directly. Among 187 male partners of women with anovulatory PCOS, 22.5% had at least one semen parameter classified as pathological and a further 51.3% as borderline, compared with 13.2% pathological and 44.7% borderline among 76 male partners of women being treated for tubal-factor infertility instead (Aschauer et al. 2025). The gap between the two groups was statistically significant (p = 0.027), and both groups were drawn from women already carrying a diagnosed female-side cause of infertility — the PCOS group’s male partners were not screened out for looking healthy on paper going in; they were tested the same way as the comparison group, and came back worse.

A widely cited older estimate — drawn from Sharlip et al. and repeated across the male-infertility literature since — puts male factor alone at 20–30% of all infertility cases and combined male-and-female factor at another 20–30%, against roughly 50% attributed to female factor alone (Agarwal et al. 2015). The exact split shifts depending on which population and which decade a given study draws from, but every version of it agrees on the same structural point: a meaningful share of couples — cited most often somewhere between one in five and one in four — have a contributing factor on both sides at once, not one factor that explains everything. This page sits alongside the rest of the PCOS fertility coverage on this site, which mostly answers questions that assume the female side is the whole story; this one does not make that assumption.

You may also see PCOS written as polyendocrine metabolic ovarian syndrome (PMOS), the name a 2026 global consensus of more than 50 organisations gave the same condition (Teede et al. 2026). Nothing about the mechanism changed — only the label did — and this article uses PCOS because that is still the term most readers search.

What Does a Semen Analysis Actually Measure?

A standard semen analysis reports on concentration, motility and morphology — the same measurements a study of more than 4,500 men across 14 countries used to build the reference values labs still use today (Cooper et al. 2010). It also records semen volume, total sperm number, and vitality (the percentage of sperm that are alive). None of it requires a procedure on either partner — one sample, examined in a lab, usually with results back within a few days.

These figures are the fifth percentile drawn from men whose partners had already conceived within 12 months of trying — not the midpoint of a healthy population, and not a line separating fertile men from infertile ones.

Are WHO Reference Values a Pass/Fail Line?

No — the reference values above are population percentiles, not a diagnostic threshold, and that distinction is one of the most consistently misread facts about a semen analysis. By definition, roughly 5% of the men whose data built the concentration figure — men whose partners had already conceived within a year — had a sperm concentration below 15 million per millilitre. A result under a reference value describes a man who falls outside the typical range of that fertile reference group, not a man who cannot father a child, and a result above every reference value does not guarantee a pregnancy in any given cycle either.

That is a fact about how the numbers were built, not an invitation to read a specific result: what any individual value means for one couple’s actual chances is a question for whoever ordered the test, not something a general article can resolve from population percentiles alone.

Why Does a Semen Analysis Get Deferred When PCOS Is Already the Diagnosis?

Nearly one in four male partners in the PCOS group above — 22.5% — had a pathological result, close to double the rate in the control group, yet the authors of that same 2025 study note that current PCOS-specific guidance gives no clear instruction on when a semen analysis should happen relative to starting ovulation-induction treatment. The 2023 international PCOS guideline does list semen analysis among the baseline tests a fertility work-up covers, but it appears as one line inside a longer list built around the female diagnosis, not as a standalone recommendation with its own timing rule (Teede et al. 2023).

The newer 2026 WHO infertility guideline is more explicit about the general principle: it states that female evaluation “should proceed regardless of semen analysis outcome,” and directs clinicians toward assessing both partners in parallel from the first visit rather than testing one only after ruling out the other (WHO Guideline Development Group for Infertility, 2026). Applied to a couple where PCOS is the presenting diagnosis, that same parallel principle runs in both directions: a known female-side cause is not, on its own, a reason to postpone the male partner’s evaluation.

In practice, a diagnosis that already has a name and a treatment plan is an easy place for attention to settle, and a semen analysis is easy to schedule “later” precisely because it asks nothing of the person who has already been told what the problem is. The baseline work-up guidance covered elsewhere on this site lists semen analysis among the tests a specialist typically orders as a set at the first visit, rather than one at a time as each prior result comes back.

Most of the conception-rate numbers people search for with PCOS assume anovulation is the only variable in play — the actual PCOS conception rates from named cohorts are built on exactly that assumption, and it holds for the majority of couples. It is simply not guaranteed to hold for every one of them, which is the entire argument for checking rather than assuming.

What Predicts Abnormal Semen Quality in These Couples?

Male body mass index and smoking status predicted a pathological semen result in the 2025 case-control study — at adjusted odds ratios of 1.478 and 6.228 respectively — while no characteristic of the female partner reached statistical significance as a predictor (Aschauer et al. 2025).

That finding matters for how a couple frames the conversation. A female partner’s PCOS phenotype, insulin resistance, or androgen levels did not predict what her partner’s semen analysis would show in this study. The male partner’s own body mass index and smoking status did. Put plainly, there is no version of “her PCOS is severe, so his numbers are probably fine” — or the reverse — that this data supports. The two are separate biological questions with separate risk factors, evaluated with separate tests.

What Happens After Both Partners Are Evaluated?

The 2023 international PCOS guideline frames a baseline work-up as three things done together, not in sequence: confirming ovulation status, checking tubal patency, and a semen analysis for the male partner, before treatment planning begins in earnest (Teede et al. 2023).

Which combination of findings points toward which treatment path is a decision a fertility specialist makes with both partners’ results in hand — not a sequence a general article can specify in advance. A work-up completed on both sides up front exists precisely so that decision gets made once, with complete information, instead of being revisited every few months as each new result trickles in. How intrauterine insemination performs specifically in PCOS and how a specialist actually weighs IUI against IVF are both covered in full elsewhere on this site; both discussions assume a completed work-up on both sides as the starting point, not a substitute for it.

Who This Combined-Factor Picture Does Not Describe

77.5% of the male partners in the case-control study above had no pathological semen finding at all, and most PCOS-diagnosed couples will never need this article to describe their situation beyond “this test is worth doing.”

The study behind most of the numbers here compares two groups already attending an infertility clinic — both groups were, by definition, already having some difficulty conceiving — so its rates describe couples already mid-work-up, not a general population of women with PCOS trying to conceive for the first time. The actual rate of male-factor coexistence across every PCOS diagnosis, including couples who have not struggled at all yet, is very likely lower than the clinic-referred numbers above.

None of this means insulin resistance or androgen levels in a female partner cause abnormal semen parameters in her partner — the study found no such link, in either direction. And it does not mean every couple needs specialised andrology testing beyond a standard semen analysis. It means a single, one-sample test is worth doing alongside the female work-up rather than skipped or delayed — a far smaller ask than it sounds, and a far cheaper one than months of ovulation-induction cycles aimed at only half of a two-part problem.