About one-third of the time, if a couple is having trouble getting pregnant, the problem may have to do with sperm. For this reason, your doctor will usually order a semen analysis for your male partner. Your partner will be asked to produce a fresh semen sample, usually by masturbation. A small part of the sample will be examined under a microscope in a clinical laboratory to gather more information about the quantity and quality of sperm in the entire ejaculate. Results from the analysis are helpful for your doctor to decide whether intercourse, insemination or in vitro fertilization (IVF) would be the best course of treatment. The information from the semen analysis will usually include the following information:
Normal ranges for semen characteristics have been established by the World Health Organization. For any single semen analysis, some results may fall within normal ranges, and others may be considered abnormal. For instance, a man may have a normal sperm count but a very low sperm motility. That means that he has plentiful sperm numbers, but the sperm have poor swimming ability.
If your partner’s sperm sample is sub-optimal, your fertility doctor might ask about lifestyle factors that can affect sperm quality. Testicles are kept outside the body in the scrotal sac, rather than deep inside the body, to keep them cooler than the internal body temperature. Cooler temperatures are ideal for optimal sperm production and quality. Exposure to sustained high-heat conditions can negatively affect sperm quality. Frequent use of a hot tub, wearing tight pants, occupations such as welding or fire-fighting, and even high body temperatures brought on by a recent fever can reduce sperm quality temporarily.
Certain medications, over-the-counter or prescribed, can also reduce sperm quality. One class of medications to control high blood pressure-- called calcium-channel blockers-- reduce the fertilizing ability of sperm by impacting cellular receptors on the sperm without noticeably affecting most semen analysis results.
Taking anabolic steroids or supplemental testosterone can reduce sperm count to zero, a condition called azoospermia. If your doctor prescribes androgen therapy, he or she should monitor for any effects on semen count by ordering semen analysis labs.
Although most classes of antibiotics do not harm sperm production, Sulfasalazine, used to treat ulcerative colitis, has been shown to decrease human sperm concentration and motility. These effects are not permanent, but patients who are concerned about fertility can use an alternative antibiotic, 5-amino salicylic acid which does not affect semen parameters.
Some classes of medications used to treat depression can also affect sperm quality. One side-effect of many anti-depressants is that the hormone prolactin is increased, which suppresses sperm production, but the effect is reversible. Epilepsy medications, such as valproate, oxcarbazepine, and carbamazepine, disturb the normal hormonal balance. Some studies suggest a correlation with the use of these medications and morphological (shape) defects in sperm.
Chemotherapy agents used to treat cancers generally have a negative effect on both sperm quality and quantity. Patients anticipating chemotherapy are urged to bank semen samples for future use if they are able to before treatment begins.
Because medications can cause problems with sperm count and quality, it is important to discuss all medications and supplements that you are taking with your doctor. It is often possible to use alternative prescribed medications that are more fertility-friendly. Most medication effects and lifestyle effects on sperm are reversible. Because it takes approximately 74 days for each batch of sperm to be made, a repeat semen analysis three months after negative factors have been addressed may show an improvement in sperm count and quality.
Some sperm factors are more serious and non-modifiable, including being born with undescended testicles and having surgical correction late (sperm germ cells would have been damaged) and mumps orchitis, which can usually can be traced back to mumps in childhood.
Some couples choose to use herbal or dietary supplements to improve sperm quality because they want to try a natural alternative. Though natural, these alternatives may be neither safe, nor effective. Compared to FDA-approved prescription medications, very little research to prove effectiveness and safety for supplements is available. Even for prescription medications, fertility effects are generally not as well-studied, because most of the research on new drug safety is focused on life-threatening, not fertility, side effects. Frequently, the only information about a drug’s effect on fertility may be from animal research studies, which may or may not be similar to side effects the drug might cause in humans.
Discuss the use of any alternative supplements with your doctor, because the FDA applies only very limited regulation to supplements. Supplements do, however, have the same potential for side effects and drug interactions as prescription drugs. Keep in mind that even if a supplement were able to improve sperm, because of the time frame for new sperm to be produced, it will take the better part of three months to improve sperm quality. Be aware also that as you are delaying other types of proven treatments, your ovaries are aging.
Take all these factors into account when deciding what methods to try, but if in doubt, ask your doctor if it’s a good idea for you to try supplements and treatment at the same time, so that if the treatment doesn’t work, you might have improved your sperm quality for the next round of treatment.