Tuberculosis can silently damage male fertility: Experts explain symptoms, sperm health risks and why early treatment matters

Tuberculosis is usually discussed as a disease of the lungs. Cough, fever, weight loss and weakness are the symptoms most people recognise.

But doctors say the infection does not always stay limited to the lungs. In some men, tuberculosis quietly reaches the reproductive organs and begins affecting fertility long before the condition is detected.

This form of the disease is known as genitourinary tuberculosis. It can involve the testicles, epididymis, prostate or urinary tract. Because the symptoms may appear mild or confusing, many men do not realise that the infection is slowly harming sperm health.

Fertility specialists warn that delayed diagnosis may lead to long-term complications.

Yet the good news remains simple: when tuberculosis is identified early and treated fully, many men recover normal reproductive function.

Tuberculosis is caused by the bacterium Mycobacterium tuberculosis. The infection spreads through airborne droplets when a person with active TB coughs or sneezes.

According to India’s Ministry of Health and Family Welfare, TB can affect several organs beyond the lungs, including the kidneys, bones and reproductive system. Government health data under the National TB Elimination Programme (NTEP) highlights that extrapulmonary tuberculosis forms a significant portion of TB cases in India.

When TB bacteria reach the male reproductive organs, they can cause inflammation, swelling and tissue damage. This may slowly begin interfering with sperm production and movement.

Fertility specialists say tuberculosis can damage the reproductive system in several ways.

“In males, genitourinary TB may remain undetected for months, as symptoms are often mild. Common signs include pain or swelling in the testicles or scrotum, difficulty urinating, blood in semen or urine, and sometimes low-grade fever or weight loss. If untreated, TB can cause scarring, blockages, and inflammation in reproductive organs, reducing sperm count, motility, or even causing infertility. TB in men can affect sperm production and transport. Infections in the epididymis or testicles can lead to scarring, obstructing sperm flow. Even after the infection is treated, some men may experience reduced fertility. Couples trying to conceive may require assisted reproductive techniques like IVF to achieve pregnancy. Early intervention can prevent permanent damage and improve outcomes,” said Dr Sandeep Talwar, Fertility Specialist, Nova IVF Fertility, East of Kailash, Delhi NCR.

The epididymis, a narrow tube that stores and carries sperm, is particularly vulnerable to TB infection. If scarring blocks this pathway, sperm may not reach the semen even when production inside the testicles is normal.

One reason genitourinary TB often escapes attention is that its symptoms resemble other common conditions.

Doctors say these symptoms should never be ignored, especially in countries like India where TB remains widespread.

The Central TB Division of the Government of India reports that India accounts for a large share of global TB cases. Early screening and treatment remain key priorities under national health programmes.

Recognising these symptoms early allows doctors to begin treatment before permanent reproductive damage occurs.

Diagnosis of genitourinary tuberculosis usually requires a combination of medical tests. Fertility specialists evaluate both infection and sperm health.

“Diagnosis involves urine tests, semen analysis, ultrasound of the reproductive organs, and sometimes biopsy or culture to detect TB bacteria. Standard TB treatment with antibiotics is highly effective if followed completely. Men diagnosed early often regain normal reproductive function. Fertility assessment after treatment will help to identify any lasting issues and decide if IVF or other interventions are needed. Hence, men with TB who wish to embrace fatherhood should seek timely TB treatment and stay in touch with the fertility consultant. The fertility expert will guide you toward fulfilling the dream of fatherhood,” explained Dr Sandeep Talwar.

These tests help identify whether sperm production has been affected or whether scarring has created blockages.

Once the infection is controlled, doctors may reassess fertility through semen analysis and imaging tests.

In many fertility conversations, the focus often shifts quickly toward female reproductive health. Experts say this can delay diagnosis in men.

“Many couples tend to focus only on female fertility, but male factors play an equally important role. Tuberculosis in men is often overlooked and can silently affect sperm production or block sperm transport, reducing the chances of natural conception. Screening both partners for infections before planning a pregnancy is essential. If TB is detected and treated early, it can prevent permanent damage to the reproductive system. Once the TB infection is managed, then only start your IVF procedure to conceive without any challenges. But simultaneously keep a watch on females age as well,” said Dr Beena Muktesh, Clinical Director-IVF, Motherhood Fertility & IVF, Gurgaon.

Medical experts say couples planning pregnancy should consider complete health screening. This approach helps detect hidden infections, hormonal problems or structural issues affecting fertility.

The most reassuring aspect of tuberculosis is that it remains a treatable disease.

Standard TB therapy includes a combination of antibiotics taken over several months under medical supervision. When patients follow the treatment schedule carefully, the infection can be cured.

For men who wish to become fathers, early treatment may prevent long-term reproductive damage. In cases where fertility remains affected, modern reproductive technologies such as IVF can still help couples conceive.

Awareness about tuberculosis must therefore include its lesser-known effects, including reproductive health.

This article includes expert inputs shared with TOI Health by:

Dr Beena Muktesh, Clinical Director-IVF, Motherhood Fertility & IVF, Gurgaon.

Dr Sandeep Talwar, Fertility Specialist, Nova IVF Fertility, East of Kailash, Delhi NCR.

Inputs were used to explain how tuberculosis can silently affect the male reproductive system, the symptoms men should watch for, the potential impact on sperm health and fertility, and why early diagnosis and timely treatment are crucial.