Male Fertility: What a Semen Analysis Says and What Improves It
Infertility is still treated culturally as a female problem. In reality a male factor contributes in roughly half of cases, either alone or alongside a female factor, and the first test is simple, cheap and non-invasive. It should be done early, not after months of investigating one partner.
When to investigate
- After twelve months of regular unprotected intercourse without conception
- After six months if the female partner is over 35
- Immediately if there is a known risk factor: undescended testes, previous chemotherapy or radiotherapy, testicular surgery or injury, varicocele, mumps orchitis after puberty, known genetic condition, or anabolic steroid use
Preparing for the test
- Abstain for two to five days, not longer. Very long abstinence reduces motility
- Collect the whole sample, since the first fraction carries most of the sperm
- Keep it at body temperature and deliver it within an hour
- Avoid lubricants unless they are sperm-friendly
- Postpone the test for two to three months after a significant fever or illness, because sperm production takes roughly 70 to 90 days and a fever today shows up in the result three months later
- Always repeat an abnormal result after about three months before concluding anything, because variability is high
Reading the result
Reference values are the lower limits seen in men who achieved pregnancy within a year, not a sharp line between fertile and infertile.
- Volume: 1.4 mL or more
- Concentration: 16 million per mL or more
- Total count: 39 million or more per ejaculate
- Total motility: 42 per cent or more
- Progressive motility: 30 per cent or more
- Normal morphology: 4 per cent or more
- Vitality: 54 per cent or more
Terms you may see: oligozoospermia for low count, asthenozoospermia for low motility, teratozoospermia for abnormal shape, oligoasthenoteratozoospermia for all three, and azoospermia for no sperm at all.
A morphology figure of 4 per cent sounds alarming and is normal. The criteria are strict, and human sperm morphology is naturally highly variable.
Azoospermia needs further work to separate obstructive causes, where production is normal but the pathway is blocked and sperm can often be retrieved surgically, from non-obstructive causes, which require hormonal and genetic assessment including karyotype and Y chromosome microdeletion testing.
Things that genuinely reduce sperm quality
Heat. The testes sit outside the body because sperm production requires a lower temperature. Hot tubs, saunas, prolonged laptop use on the lap, tight underwear and occupational heat exposure all measurably reduce quality. These effects are reversible.
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Smoking, which reduces count, motility and DNA integrity.
Alcohol in excess.
Anabolic steroids and testosterone, which suppress sperm production, sometimes severely and sometimes for a long time after stopping. This is one of the most important and least known facts in this area: taking testosterone is close to a male contraceptive.
Obesity, which lowers testosterone and raises scrotal temperature.
Varicocele, dilated veins around the testis, present in a notable proportion of men with infertility. Repair benefits selected men, particularly with a clinically palpable varicocele and abnormal parameters.
Certain medicines, including some antidepressants, alpha blockers, finasteride, sulfasalazine, chemotherapy and long-term opioids.
Heavy cycling, with long hours of saddle pressure.
Infections including untreated sexually transmitted infections.
Environmental exposures: pesticides, solvents, heavy metals, and heat in industrial settings.
Poor sleep and chronic stress, which affect the hormonal axis.
What helps
- Stop smoking and reduce alcohol
- Lose excess weight
- Keep the testes cool: loose underwear, no hot tubs, laptop off the lap
- Exercise moderately; extreme endurance training can reduce quality
- Eat a diet rich in antioxidants, with vegetables, fruit, nuts and fish
- Manage sleep and stress
- Review every medicine and supplement with a doctor
- Stop any anabolic steroid, and seek specialist advice, since recovery can take many months
- Treat varicocele if clinically indicated
- Antioxidant supplements have mixed evidence; some trials show modest improvement in parameters, with less clear effect on live births
- Timing matters more than frequency. Intercourse every one to two days across the fertile window, which is the five days before and the day of ovulation, is optimal. Saving up by abstaining for long periods reduces quality
Hormone testing
Worth doing where count is low, where there are symptoms of testosterone deficiency, or where sexual function is impaired: testosterone, LH, FSH, prolactin. A raised FSH with low count suggests primary testicular failure; low LH and FSH suggest a pituitary cause.
Sperm DNA fragmentation
A newer test assessing genetic integrity rather than counting and measuring. It may be informative in recurrent pregnancy loss, repeated failed IVF, or unexplained infertility, but it is not a routine first-line test and interpretation is still evolving.
About the emotional side
Male infertility is associated with significant distress that men rarely discuss. The framing of fertility as a female matter leaves men both undertested and unsupported. Being tested early is practical, not an admission of anything, and it frequently shortens the path for both partners.
The short version
Get a semen analysis early rather than last, prepare for it properly, and repeat any abnormal result after three months before drawing conclusions. Heat, smoking, excess weight and above all anabolic steroids or testosterone are the modifiable factors that matter most, and sperm made today reflects conditions of three months ago.