When it comes to fertility, men are frequently overlooked and underappreciated as part of the conception equation. The American College of Obstetricians and Gynecologists (ACOG) states that male factor infertility is the cause of infertility in 40–50% of couples. Though some have argued the percentage is lower, male fertility is usually easy to test, and often a lot can be done about it.
Sperm quality is a top factor for male fertility. Sperm quality is not just about how many sperm you produce, but also how well they move, how healthy they are, and how compatible they are with the egg. There are several tests that look at sperm quantity and quality.
Number One: How semen analysis measures sperm quantity and quality
Several tests can measure different aspects of sperm quality. Some of them can be done at home with a kit, while others require a visit to a laboratory or a clinic.
A semen analysis is a test that can provide a basic overview of sperm quantity and quality, but it may not detect all the possible problems that can affect fertility. This test usually consists of figuring out several semen variables, such as:
- Sperm count: How many sperm are present in a given volume of semen. A normal sperm count is usually between 15 million and 200 million sperm per milliliter of semen. A low sperm count (oligospermia) can reduce the chances of fertilizing an egg, while a very low sperm count (azoospermia) means that no sperm are present at all.
- Sperm motility: This test measures how well the sperm can swim and move towards the egg. Normal sperm motility is usually above 40%, which means that at least 40% of the sperm can move forward in a straight line. Low sperm motility (asthenozoospermia) can lower fertility, as fewer sperm can reach and enter the egg.
- Sperm total motile count: This number results from the volume of the ejaculate times the number of the sperm per milliliter of ejaculate times the percentage that are motile. The WHO cutoff is 15 million total motile sperm, so 95% of men will have more than 15 million total motile sperm. What is also relevant about this number is that approximately 1 sperm per 10 million total motile sperm will find an egg after intercourse. If a man has 200 million total motile sperm, then 20 should find an egg. If a man has 1 million total motile sperm, then this means that 1 sperm may find an egg per year. Hence, the lower the counts, the lower the likelihood of pregnancy.
- Sperm morphology: This test measures how normal the shape and structure of the sperm are. Normal sperm morphology is usually above 4%, which means that at least 4% of the sperm have an oval head, a long tail, and no defects. A low sperm morphology (teratozoospermia) can affect the function and viability of the sperm. Though most morphology problems are also associated with an abnormal total motile count, rare conditions such as postpubertal mumps can lead to meaningful morphology issues despite a normal total motile count.
- Other characteristics: pH, volume, color, viscosity, infections, antibodies and more can point to other problems with sperm, as well as to why.
A poor semen analysis can indicate problems with the production or delivery of sperm. It’s important to consult with a fertility specialist who can guide you through the results of a semen analysis and give you recommendations about your specific circumstances.
Number Two: Additional tests that analyze sperm quality (directly or indirectly)
Additional tests may be required to further investigate sperm quality, such as:
- Genetic tests: These tests can identify chromosomal abnormalities or gene mutations that can cause infertility or increase the risk of miscarriage or birth defects.
- Hormone tests: These tests can measure the levels of hormones that are involved in sperm production and function, such as testosterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol.
- Urinalysis after ejaculation: This test can detect retrograde ejaculation, a condition where semen flows back into the bladder instead of out of the penis. Men with a history of poorly controlled diabetes or neurologic or spinal cord injury are among those with the highest risk for this condition.
- Testicular biopsy: This test can obtain a tissue sample from the testicles to examine sperm production and quality under a microscope.
- Anti-sperm antibodies test: This test can detect the presence of antibodies (from the immune system) that can attack and damage sperm. This is most common after vasectomy reversal or rare testicular injuries.
- DNA fragmentation test: This test can measure the amount of DNA damage in sperm, which can affect their ability to fertilize an egg and produce a healthy embryo. Smoking and toxin exposures can increase fragmentation.
- Epigenetic test: This test can measure the changes in gene expression that can affect sperm function and embryo development.
Number Three: Factors that affect sperm quality
There are many factors that can affect male fertility and sperm quality. Some of them are modifiable, which means that you can change them by adopting a healthier lifestyle or seeking medical treatment from a fertility specialist. Others are non-modifiable, which means that you cannot change them but you can still manage them or seek alternative options. Here are some of the most common factors:
- Age: As men get older, their sperm quality tends to decline. This is due to several reasons, such as hormonal changes, genetic mutations, oxidative stress, and environmental exposure. The decline in sperm quality can start as early as 35 years old and accelerate after 40 years old and lead to lower fertility and higher miscarriage rates.
- Lifestyle: Your lifestyle choices can have a significant impact on your sperm quality. Some of the factors that can harm your sperm include smoking, alcohol consumption, drug use, obesity, stress, lack of exercise, poor diet, and exposure to heat or radiation. Though many talk about tight underwear, that remains controversial; however, excessive sauna/hot tub use or use of old laptops where the heat vent blows directly on the lap can be more meaningful.
- Medical conditions: Some medical conditions can affect your sperm production or function. Some of them include varicocele (enlarged veins in the scrotum), infections (such as chlamydia or gonorrhea), hormonal imbalances (such as low testosterone or thyroid problems), genetic disorders (such as Klinefelter syndrome or cystic fibrosis), autoimmune disorders (such as antisperm antibodies), and cancer or its treatment (such as chemotherapy or radiation).
- Medications: Some medications can interfere with your sperm quality or quantity (as well as erectile function and ejaculation). Some of them include antibiotics, antidepressants, antihypertensives, anti-inflammatories, steroids, and recreational drugs.
Number Four: How to improve your sperm quality
If you want to improve your sperm quality, there are some steps that you can take. Here are some of them:
- Consult a specialist: If you have any medical condition or medication that may affect your fertility, talk to a specialist about possible treatments or alternatives. Your doctor may also recommend some tests to check your sperm quality and identify any underlying issues.
- Adopt a healthier lifestyle: As noted above, quit smoking, limit alcohol intake, avoid drug use, maintain a healthy weight, manage stress levels, exercise regularly, and eat a balanced diet rich in antioxidants and omega-3 fatty acids. However, lifestyle changes won’t unblock the vas deferens, cause missing support cells to regrow (such as with Sertoli-only syndrome), or fix female problems (such as ovarian failure, fibroids, endometriosis, etc.), so there are some meaningful limits to what lifestyle change can improve for fertility.
- Undergo surgery to correct any anatomical problems or blockages. Consult a specialist to determine your specific needs.
As sperm quality is just one factor of many affecting fertility, a specialist might suggest using assisted reproductive techniques (ART) such as intrauterine insemination (IUI) or in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI). However, sometimes simple steps are available—the critical thing is to understand where one’s sperm counts are and why so as to channel energy effectively.
Ultimately, sperm quality testing is critical for evaluating male fertility and reproductive potential. Semen analysis can quickly identify many male reproductive problems and guide effective treatment.
If you are struggling to make sense of the complicated world of fertility, reach out to an expert today. Don’t suffer in silence. Get answers. Get peace.
