Fertility is a couple's issue. Problems with sperm are a common reason couples have trouble conceiving, and many men never think to get checked. The good news is that testing is simple, and some causes can be improved or treated.
How sperm are made
Sperm are made in the testes. They then mature and are stored in the epididymis, a coiled tube behind each testis. During ejaculation they travel through the vas deferens and mix with fluid from other glands to form semen.
Male factors are common. Cleveland Clinic notes that the male partner is the cause in about half of infertility cases, which is why both partners should be tested from the start.
Making mature sperm takes about 3 months. Healthy changes you start today may only show in a semen test around 3 months later.
Semen analysis explained
A semen analysis is the main test of male fertility. It looks at the amount and quality of semen and sperm. You usually avoid ejaculation for 2 to 7 days beforehand, then give a sample by masturbation into a clean container.
| What is measured | What it means |
|---|---|
| Volume | How much semen is produced |
| Count and concentration | How many sperm in total and per millilitre |
| Motility | The share of sperm that move well |
| Morphology | The share of sperm with a normal shape |
| pH, white cells, liquefaction | Signs of infection or other problems with the fluid |
Sperm quality varies from day to day. One abnormal result is not a diagnosis; your doctor may ask for a second sample a week or two later.
What can harm sperm
Several everyday factors are linked to poorer sperm. Most are within your control, which makes them a good place to start.
- Stop smoking, including avoiding second-hand smoke
- Keep alcohol within low-risk limits (UK advice: no more than 14 units a week, spread over 3 or more days)
- Tell your doctor about all medicines and supplements you take
- Spend long periods in saunas or hot tubs
- Use anabolic steroids or hormone supplements to build muscle
- Start testosterone treatment without discussing fertility plans first
Long-term misuse of anabolic steroids can reduce sperm count and movement. Taking testosterone, even for low testosterone, can also affect fertility, so mention any plans for a baby before starting.
Varicocele
A varicocele is a swelling of the veins that drain the testis, a little like varicose veins in the leg. It can be linked to a gradual fall in sperm and testosterone production. Many men have no symptoms.
- Found in about 15% of men in general, and in up to 40% of men seen for infertility
- Treatment may be considered for pain, reduced semen quality, or a shrinking testis
- After repair, semen is usually rechecked at 3 to 4 months, because sperm take about 3 months to develop
Other causes doctors look for
Beyond lifestyle and varicocele, several medical conditions can affect a man's fertility. Your doctor will ask about your health history and may examine you or order blood tests to look for them.
- Damage to the testes from infection, injury, surgery or cancer treatment
- Ejaculation problems, where semen does not come out normally
- Hypogonadism, meaning low testosterone production
- A previous vasectomy
Sometimes no clear cause is found. In the UK, unexplained infertility accounts for around 1 in 4 cases, and couples can still be offered treatment.
Treatment options
Treatment depends on the cause. Cleveland Clinic groups the options into four broad types, and many men need only the first.
| Approach | Examples |
|---|---|
| Lifestyle | Healthy weight, fruit and vegetables, regular exercise, managing stress, stopping tobacco and alcohol |
| Medicines | Hormone treatment when hormone levels are out of balance |
| Surgery | Varicocele repair, vasectomy reversal, unblocking procedures, surgical sperm retrieval |
| Assisted reproduction | IVF with ICSI, where a single sperm is injected into each egg |
Cleveland Clinic lists the tests that guide these choices: semen analysis, blood tests for hormones and genetic causes, imaging such as ultrasound, urine tests and sometimes a testicular biopsy.
- Keep vaccinations up to date
- Limit exposure to hazardous chemicals at work
- Use recreational drugs
- Expose the testicles to heat for long periods
Age matters for men too, though later than for women. ASRM notes that in the mid to late 40s, sperm changes can reduce fertility and are linked to genetic and developmental problems in children.
Sperm take about 3 months to develop, so healthy changes made today show up in a semen test a few months later.
When men should get tested
Testing the male partner early saves time. A semen analysis is quick and non-invasive, and it is usually done alongside the woman's first tests rather than after them.
- Know the timelineSee a doctor after a year of trying, or after 6 months if the female partner is 35 or older.
- Book a semen analysisFollow the lab's instructions on abstinence and how to collect and deliver the sample.
- Review the results with a doctorAbnormal results may lead to a repeat test, an examination, or blood hormone tests.
- Discuss optionsDepending on the cause, options range from lifestyle changes and treating a varicocele to IVF with ICSI, where a single sperm is injected into each egg.
When to see a doctor
- You have been trying for a year without pregnancy, or 6 months if your partner is 35 or older
- You notice a lump, swelling or ongoing pain in the scrotum
- You have had testicular injury, surgery, infection or cancer treatment
- You have problems with erection or ejaculation
- You use or have used anabolic steroids or testosterone
Questions & answers
Does one bad semen result mean I am infertile?
No. Sperm quality varies, so doctors often repeat the test before drawing conclusions.
How long before lifestyle changes help?
Sperm take about 3 months to develop, so improvements usually need around 3 months to show in a semen test.
Can low sperm count still lead to pregnancy?
Often there are options. Depending on the cause, treatment or IVF with ICSI may help; your doctor will explain what fits your situation.
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Sources
- Infertility: Causes — NHS
- Infertility — NHS
- Semen Analysis — MedlinePlus (U.S. National Library of Medicine)
- Male Infertility — Cleveland Clinic
- Varicocele — UNC Department of Urology
- Does My Age Affect My Fertility? — ASRM ReproductiveFacts.org