In reproductive health, a lot of emphasis is placed on ovulation, egg quality and a receptive endometrium, but you can’t make a baby without sperm. It’s estimated that almost 35 to 50 percent of infertility or sub-fertility cases are due to male factor infertility, which includes issues of sperm production and quality. The frustrating part is that essentially you won’t know there’s a problem with sperm until you have your sperm tested. You should have a good idea that there are no sexual function issues—the ability to get and maintain an erection and then ejaculate—but just because you can successfully ejaculate that doesn’t mean your swimmers are strong.
Testicles have two functions: to produce a hormone called testosterone and to generate sperm. Issues with sperm production and quality can happen for many reasons including hormonal issues, active infections, past injury and steroid use. Sperm is continuously being produced and its lifecycle is about three months, but sperm are notoriously sensitive to environmental stressors and experience micro-damage from inflammation, cellular oxidative stress or exposure to other toxins. Luckily, they are also responsive to an optimal environment of essential nutrients, minerals and vitamins.
Sperm motility test
Sperm must make its way up the vagina, through the cervical mucus, beyond the uterine cavity and through the fallopian tubes to fertilize the eggs. You need millions of motile sperm at the start of the journey to ensure some will make it to their destination.
An important screening test for male infertility is a sperm motility test since the motile sperm concentration (TMC) is a critical parameter when analyzing semen. The test will flag low motile sperm concentration and motility, which lets you know whether the sperm are strong enough swimmers. While your doctor can order this test, you can also do one in the comfort of your home.
Unfortunately, many couples and prospective parents only find out they have a significant male factor component to their infertility once they undergo a semen analysis at their doctor’s office. A simple screening test at home can save valuable time.
Hormone factors in male infertility
As mentioned, testicles produce sperm and testosterone. This function relies on two hormones, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) that come from the pituitary gland. (Yes, these are the same hormones that help ovarian follicles grow and trigger ovulation.) In male fertility, LH is used by the Leydig cells to make testosterone, while FSH is used by Sertoli cells to allow proper testicular function. Together, they help make testosterone and ensure sperm cells mature properly.
Will more testosterone make me more fertile?
Testosterone can increase sex drive (libido) and energy, but it also helps ensure that testicular cells are working properly so they can make sperm and allow the release of mature sperm cells—it’s an important piece of the fertility puzzle. But more testosterone will not make you more fertile. In fact, too much testosterone can cause infertility (as seen in males who take testosterone-replacement therapy (TRT) or other anabolic steroid treatments (AST)).
High testosterone levels send a feedback signal to the pituitary glands and stops them from sending out more LH and FSH. Since these hormones are critical for making sperm, that excess testosterone halts the sperm-making machine, leaving you shooting blanks. Depending on the frequency and duration of use of TRT or AST, it can take months to years to get this system back online and it often requires alternate hormone therapy to do so (like HCG treatment that acts to stimulate the testicles).
Testicular health in male fertility
Since the testes (A.K.A., testicles) are where sperm are made, anything that injures or damages them will affect male fertility. This includes impact injuries (often from sports or biking), infections, chemotherapy and radiation, and varicoceles.
What is a varicocele?
Varicoceles are a common, treatable, cause of male infertility that may occur in about 35 to 40 percent of male-factor infertility cases. They happen when the blood vessels that return blood from the testicles get leaky valves and there is a back-up, which causes the veins to enlarge.
Varicoceles can go unnoticed without any symptoms, or they may cause a dull, aching sensation, pain, swelling, or small lumps in the scrotum. The presence of varicoceles are associated with increased oxidative stress and inflammation. It’s thought that the negative impact is due to pooling of blood near the testicles that may slightly raise their temperature—testicles need a lower temperature for optimal performance). To diagnose, you’ll need a physical exam and a scrotal ultrasound with a urologist. Depending on the degree of varicocele, it may require surgical or microsurgical treatment, which can help restore fertility.
Oxidative stress and male infertility
Oxidative stress happens when there are too many free radical particles without antioxidants to keep them in check and de-activate them. These free radicals are by-products of normal cell metabolism, but we also accumulate them from air pollution, inflammatory foods, infections and testicular overheating. Having high amounts of free radicals without antioxidant support leads to cellular damage—in this case to testicular and sperm cells, their energy-making mitochondria, and their DNA. Adding antioxidants to your diet, or supplementing your diet with them, can help keep free radicals in check.
Things that affect male fertility
Both hormonal and testicular factors can affect sperm production and quality, but there are other genetic, dietary, lifestyle, and environmental factors that play a role:
- Sleep deprivation: Not getting enough Zs can decrease testosterone and sperm motility and cause higher amounts of sperm DNA damage.
- Cigarette smoking: The hundreds of damaging chemicals in cigarettes, including carbon monoxide and hydrogen cyanide, can cause low sperm counts, poor motility and cause major DNA damage and mutations.
- Cannabis: Chronic cannabis use has been linked to low sperm counts and poor motility and research suggests that cannabis might also interfere with the sperm’s ability to fertilize an egg. In couples trying to conceive, when the male partner used cannabis weekly, there was a greater risk of pregnancy loss compared to those who did not use cannabis.
- Obesity: Having excessive amounts of adipose (fat) tissue in your body increases the activity of an enzyme called aromatase which converts testosterone to estrogen. That means a greater risk of having low testosterone and high estrogen—a combination that can cause low sperm production and less motile sperm. Obesity is also associated with increased inflammation and oxidative stress which can cause damage to sperm DNA and mitochondria.
When to test your sperm
Traditionally if you have been trying to conceive for 12 months without success (or six months if you and your partner are older than 35), it’s best to test your semen and find out if those sperm are functioning. This recommendation to wait before testing also has to do with the fact that you need a physician to order these tests. But with the availability of screening at-home sperm tests, it’s recommended to test even at the start of your journey. If any abnormalities are detected, you can connect with a doctor for a full comprehensive male assessment which would include a full semen analysis.
New sperm are produced frequently, but if any abnormalities are found, it often takes a minimum of three to six months to correct any issues. Your best insurance policy for male fertility is to get tested early and to improve diet and lifestyle factors that can impact sperm production and quality, including incorporating a prenatal that supports sperm health into your daily routine.
Indications that you may have a testicular injury
- Most assaults on sperm are microscopic, but there are a few major red flags to look for that could indicate male infertility and should prompt you to have testing done.
- Testicular pain and/or swelling
- Significant testicular injuries that may have required medical attention
- Multiple concussion history (since the glands that make LH and FSH hormones required to make sperm are tucked under the brain)
- Erectile dysfunction
- Use of testosterone replacement therapy (TRT) or other anabolic steroid treatments (AST)
Other factors that can commonly cause male infertility
- Recurrent infections
- Cannabis use
- Diets high in processed foods, fast foods, fried foods, refined sugars artificial sweeteners
- Testicular overheating (from siting or driving longer than 20 minutes at a time, working in a hot environment or wearing occupational clothing that causes overheating)
- Exposure to harmful chemicals such as fertilizers, pesticides, synthetic fragrances, air pollution, plasticizers, and solvents