Semen abnormalities and associated factors among men seeking fertility services in Eastern and Central Uganda: a multicentre cross-sectional study

BACKGROUND: Male-factor infertility contributes substantially to the burden of infertility, yet evidence on semen abnormalities and their associated factors in Uganda remains limited. This study assessed the prevalence, patterns, and factors associated with abnormal semen values among men seeking fertility services in Eastern and Central Uganda. METHODS: A cross-sectional study was conducted among 155 men attending Jinja Regional Referral Hospital, Kayunga Regional Referral Hospital, and Healingway Diagnostic and Fertility Centre between September 2025 and January 2026. Semen analysis was performed using World Health Organization criteria. Factors associated with abnormal semen values were assessed using bivariable and multivariable logistic regression analyses. RESULTS: Overall, 52 of 155 participants had at least one abnormal semen parameter, giving a prevalence of 33.5% (95% CI: 26.5-41.4). The prevalence did not differ significantly across study sites (p = 0.841). Teratozoospermia (42.3%) and asthenozoospermia (38.5%) were the most common abnormalities, followed by hypospermia (26.9%), necrozoospermia (25.0%), oligozoospermia (23.1%), and azoospermia (23.1%). Hypertension (AOR = 5.23; 95% CI: 1.10-24.93), diabetes mellitus (AOR = 4.82; 95% CI: 1.85-12.57), medication use (AOR = 2.73; 95% CI: 1.11-6.71), history of mumps infection (AOR = 5.29; 95% CI: 1.25-22.31), and occupational hazard exposure (AOR = 4.23; 95% CI: 1.60-11.13) were independently associated with abnormal semen parameters. CONCLUSIONS: Approximately one in three men seeking fertility services in Eastern and Central Uganda had at least one abnormal semen parameter, with abnormalities in sperm morphology and motility being the most common findings. Hypertension, diabetes mellitus, medication use, history of mumps infection, and occupational hazard exposure were associated with abnormal semen parameters. Assessment of medical conditions, previous infections, medication use, and occupational exposures may therefore be useful when evaluating men presenting with infertility.