Sperm Health

Attention men: According to the American Urological Association, "male factors" play a part in up to 50% of all cases of infertility. And 30% to 40% of cases involve men exclusively. So, it's important to find out what you can do to maximize your sperm health.

A wide range of factors can impact sperm viability. Age, high temperatures, lifestyle choices (smoking, drinking, recreational drugs), toxic chemicals, illnesses and medications can all play a role.¹ However, many of these factors are within your control, and more than half of all cases of male infertility can be treated successfully. Here's a brief overview of what reproductive specialists look for as well as some tips to boost your sperm health.

Semen analysis

Semen analysis (sperm analysis or sperm count) is the main test for male fertility. For best results, it should be performed at least 2 times over a 2- to 3-month period.

Semen analysis has 4 main components: 

• Semen volume. Usually 2 to 6 milliliters of semen are collected (about 1 teaspoon or less).
• Sperm concentration (sperm count). Twenty million or more sperm per milliliter are considered normal.
• Motility. Motility means the percentage of moving sperm. Ideally, sperm will move at good speed in straight lines.
• Morphology. Sperm structure and appearance is called "morphology." Irregular or abnormally shaped sperm are less likely to be fertile.

For a man to be considered fertile, the rule of thumb is that his sperm count should be at least 20 million per milliliter, with at least 60% having normal shape and good forward movement. Still, with assisted reproductive technology (ART), conception is possible below these limits.

If you're scheduled for semen analysis, refrain from ejaculating for 2 to 4 days before providing the sample. If you collect the sample at home, keep it at room temperature (roughly 70 degrees). Don't refrigerate it or try to keep it at body temperature. If you plan to provide the sample at the clinic, you'll have a private place in which to do so.

The mental challenges

Fertility problems can be difficult for a couple to face. The subject can give rise to frustration, embarrassment, anger and even shame. At the same time, confronting infertility can draw out strengths that a couple never knew they had.

Men and women tend to respond to infertility differently (and often separately). But even if each of you could tough it out alone, you'll almost certainly do better if you face the challenges together. Keep the lines of communication open — with your partner, your primary care physician and your urologist (male reproductive specialist).

You might find that you'd like more help. Some couples find support groups helpful. Others benefit from counseling, such as individual or couples therapy. At particularly high risk for infertility-related stress are people in unstable marriages, people facing tough decisions involving ART or people with a history of major depression, anxiety, chemical dependency or childhood abuse.

Tips for sperm health

If semen analysis shows that you might have fertility problems, there are things you can do to improve your sperm health. You might be thinking, "Hey, it takes only one." But in reality, sperm tackle the job of conception like a team sport. You need to have plenty of them — healthy and speedy ones to boot. If you have fertility problems, Mark Perloe, M.D., medical director for Georgia Reproductive Specialists in Atlanta, says: "First, consult a urologist to see what might be wrong. If it's a varicocele [a group of swollen veins in the scrotum that can raise temperatures enough to impair sperm production], that can be corrected surgically. If it's an infection, there are antibiotics."

There are also steps you can take on your own:

• Avoid smoking, excessive alcohol and recreational drugs.They harm your fertility and are bad for your overall health as well. "Our single biggest recommendation to patients is, 'Stop smoking.' The good news is that such damage is reversible," Perloe says.
• Get regular exercise. Being a couch potato (or having a sedentary job) hurts your fertility. Sitting too much can raise the temperature of your testicles enough to affect sperm production. On the other hand, regular and even quite strenuous activity isn't likely to impair your reproductive health.
• Watch your weight. Being overweight (or underweight) affects hormone production, which can reduce sperm counts and increase the risk of irregular sperm. Obese men are at higher risk for infertility.
• Stay out of the sauna. Sperm are heat-sensitive. So, it's wise to avoid hot tubs, whirlpools, saunas and steam rooms. More than 30 minutes of exposure to water temperatures of 102 degrees could lower sperm counts.
• Cut your stress. Though experts agree that stress doesn't cause infertility, it may contribute by affecting hormones involved in sperm production. Seek healthy ways of reducing thestress of infertility treatment (as well as the general stress in your life). Occasional out-of-town adventures together, nights out and walks in the park can help the two of you keep stress in check.
• Get your vitamins. A daily multivitamin provides selenium, zinc and folic acid — all of which are important for sperm health. Sperm are also vulnerable to oxidants (unstable oxygen molecules that damage cell membranes). As a result, "antioxidant support can sometimes be beneficial," Perloe says. He recommends "vitamin C or vitamin E — though there aren't any specific grounds for preferring one product or combination over another."
• Choose your best time. Sperm counts are generally highest early in the morning. And since sperm are affected by temperature, their numbers tend to be higher in winter and lower in summer.
• Cut back on biking. Bicycle riding appears to be harmful, especially for more than 30 minutes at a stretch using hard, narrow, racing-style seats and wearing tight bicycle shorts. The jarring impacts may produce genital numbness and potentially harm the nerves and blood vessels of the male reproductive system. To lower your risk, shorten your trips, replace your narrow bike saddle with a wider one and wear looser, padded shorts. You might also adjust your seat so that it points slightly downward.
• Debriefing time? You've heard it before: Tight underwear impairs male fertility — or not. MayoClinic.com says there's "no scientific proof that briefs, athletic supporters or tight trousers adversely affect fertility, even if worn daily." But in certain circumstances, Perloe says they might play a role. "I wouldn't recommend that men get rid of their briefs across the board," he adds. "There's really no good data for a link to male infertility. But if semen analysis showed that a patient's fertility was compromised, I still might suggest switching to boxers."

When more aggressive steps are needed

Sometimes, more serious interventions are needed. Available therapies include hormone manipulation, microsurgical repair of reproductive blockages or varicoceles, artificial insemination and even surgical harvesting of sperm. Some treatments are noninvasive, meaning that they involve no surgery at all. And when surgery is required, it's generally done on an outpatient basis with no hospital stay.