One in three couples have trouble getting pregnant due to sperm problems. Sperm factors that can impact fertility include sperm count, motility and morphology. In many cases, male fertility obstacles can be overcome naturally or with treatment.
First, to learn more about your male partner’s sperm quantity and quality, your doctor will order a semen analysis when you’re trying to conceive. Your partner will be asked to produce a fresh semen sample, which will be examined under a microscope in a clinical laboratory.
Some sperm factors are more serious and non-modifiable. For instance, sperm germ cells could have been damaged if a man was born with undescended testicles and had surgical correction too late. A man's sperm count may also decline if they have mumps orchitis, a condition that causes swelling in the testicles and can usually be traced back to mumps in childhood.
But most other factors are reversible. It takes approximately 74 days for a man to develop each batch of sperm. Therefore, a repeat semen analysis three months after negative factors have been addressed may show an improvement in sperm count and quality.
Below, we will examine the characteristics of sperm and lifestyle factors, medications, supplements and medical treatments that can affect their quality. In another blog post, we discuss your treatment options.
Know the characteristics of sperm that affect fertility.
Results from a semen analysis will help your doctor determine whether your partner's semen have a good chance of conceiving with intercourse or if he might need the help of treatments such as insemination or in vitro fertilization (IVF).
The information from the semen analysis will usually include the following:
► Sperm count: The number of sperm in the ejaculate.
► Sperm motility: The percentage of sperm that are swimming.
► Sperm progression: How well the sperm are swimming, whether they are swimming rapidly, or slowly; in a straight line, or in a circular motion; or just barely twitching.
► Sperm morphology: The shape of the sperm and what percent of the sperm have an abnormal head, tail, or middle section.
Normal ranges for semen characteristics have been established by the World Health Organization1. For any single semen analysis, the results can be mixed, with some traits falling in the normal range and others in the abnormal. For instance, a man may have a normal sperm count but very low sperm motility.
It might be your lifestyle.
If your partner’s sperm sample is sub-optimal, your fertility doctor might ask about lifestyle factors that can affect sperm quality. For example, 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. 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.
Check your medications.
Certain medications, over-the-counter or prescribed, 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 of the effects on sperm from medication and lifestyle are reversible.
Some medications that can affect your sperm count or quality include:
► Calcium-channel blockers — a class of medications to control high blood pressure — has been known to reduce the fertilizing ability of sperm by impacting cellular receptors on the sperm without noticeably affecting most semen analysis results2.
► Anabolic steroids3 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. Azoospermia has been treated by a 3-month regimen of human chorionic gonadtropin (hCG) and human menopausal gonadotropins (hMG)3.
► 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. The side effects appeared to reverse after more than two months of non-use4. Although these effects are not permanent, patients who are concerned about fertility can use an alternative antibiotic, 5-aminosalicylic acid5.
► Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) have been blamed for male factor infertility (MFI), but studies have not yet found a definitive link between male infertility and SSRIs. Subjects taking SSRIs have self-reported a change in erectile function or difficulties with ejaculation2.
► Epilepsy medications, such as valproate, phenytoin, and carbamazepine, disturb the normal hormonal balance. Some studies suggest a correlation with the use of these medications and morphological (shape) defects in sperm, reduced motility and lower sperm count2.
► 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 begins2.
Do dietary supplements help?
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, there is very little research to prove effectiveness and safety for supplements. Even for prescription medications, fertility effects are generally not as well-studied. Most of the research on new drug safety conferns life-threatening side effects. The only information about a drug’s effect on fertility may be from animal research studies.
The FDA applies very limited regulation on supplements, so be sure to discuss the use of alternative supplements with your doctor. Supplements have the same potential for side effects and drug interactions as prescription drugs. Keep in mind that even if a supplement was able to improve sperm, it would take about three months for those improvements to show.
Take all these factors into account when deciding what methods to try. When in doubt, ask your doctor if it’s a good idea for you to try supplements and treatment at the same time. That way, if the treatment doesn’t work, you might have improved your sperm quality for the next round of treatment.
If sperm issues persist, see our next blog post about treatment options that can help.
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5: Zelissen PM, van Hattum J, Poen H, Scholten P, Gerritse R, te Velde ER. (1988) Influence of salazosulphapyridine and 5-aminosalicylic acid on seminal qualities and male sex hormones. Scandinavian Journal of Gastroenterology. https://www.ncbi.nlm.nih.gov/pubmed/2907823