Male infertility accounts for at least a third of infertility cases. In an additional third, problems with both the man and the woman play a role. In most cases, male infertility is due to issues with the sperm, such as low sperm count or poor sperm quality. In about 10-15% of men, there is no sperm at all in his semen. And unfortunately, there are few outward signs of sperm issues.
Most men don’t know they’re infertile until they struggle to get a partner pregnant. Here’s what you need to know about sperm count and quality, and its correlation with pregnancy success.
Sperm Count and Quality: The Basics
For a man to impregnate his partner, healthy sperm must fertilize the egg. The egg must then travel to the uterus and implant itself in the lining. While the man’s job is done after fertilization, issues with sperm can affect every aspect of pregnancy and fertility. For example, genetic mutations on sperm may increase the risk of miscarriage, or make it more difficult for an egg to implant in the uterus. In most cases, however, the primary way sperm affects fertility is via fertilization. Issues with sperm make it much more difficult for sperm to fertilize an egg.
The simplest way to assess sperm quality and the count is via a semen analysis. This is a simple test that only requires a man to ejaculate into a cup. A lab can then analyze the semen and the sperm it contains. A semen analysis reveals a lot about a man’s fertility.
Your doctor will pay careful attention to:
- Sperm count/concentration: Sperm count is a measure of how many sperms are present in each milliliter of semen. A healthy sperm count is 15 million or higher. While it’s possible to impregnate a partner with lower numbers, a lower sperm count makes it more difficult for sperm to travel to the egg. Some men have no sperm in their semen, which makes pregnancy impossible.
- Sperm motility: Sperm motility is a measure of your sperm’s ability to move and swim. In a healthy semen sample, 50% or more sperm are active. When this percentage lowers, the odds of successfully swimming to the egg diminish.
- Sperm morphology: Morphology is a measure of how healthy your sperm look -- whether they are shaped normally, and of typical size. Normal semen should contain at least 4% normal shaped sperm.
- Semen volume: The amount of semen a man produces can affect fertility. Men who produce very little semen also produce less sperm -- and fewer healthy sperm -- each time they ejaculate. Healthy ejaculation should contain at least 1.5 milliliters -- roughly half a teaspoon. Anything less could point to a problem with the prostate, meaning that the body is not manufacturing sufficient semen, or possibly that there is a blockage in the seminal vesicles.
- Semen liquefaction: This is a measure of how long before semen becomes liquified. Healthy semen comes out thick, then slowly liquefies. Liquefaction should take about 20 minutes. If it takes longer or does not liquefy, it could be a sign of a problem.
- Chemical composition of semen: Your doctor will assess the pH of the sperm, which is a measure of its acidity. Healthy pH is between 7.1 and 8.0. Low pH means the semen is acidic, while a higher pH means the semen is too alkaline. In either scenario, the change in pH may decrease the chances of pregnancy, or make it more difficult for sperm to move. Your doctor will also look at other chemical components of sperm, such as fructose. Healthy seminal vesicles produce fructose. Low or no fructose may mean there is an obstruction somewhere.
Your doctor should discuss the meaning of each variable, and be able to answer questions about how each factor influences the chances of a successful pregnancy. For example, a moderately low sperm count in an otherwise healthy man might not explain infertility or might make pregnancy take longer to achieve. But very few or no sperm may completely eliminate the chances of a pregnancy.
How Long Does it Take for Sperm to Reach the Egg?
There’s a lot of variation in how long it takes sperm to reach an egg. Very fast sperm can reach the egg in an hour, while slower sperm may take several days. Because an egg only lives 12-24 hours, the faster sperm have an advantage, especially if a couple has sex on the day of ovulation.
However, sperm can live 5-7 days in a woman’s reproductive tract. This means that sperm that enters the woman’s body before ovulation may actually have a better chance of fertilizing an egg. In fact, research has shown that the best day to get pregnant is actually the day before ovulation. Couples who have sex every other day leading up to and immediately after ovulation may have the best chances of pregnancy, since ejaculating more frequently may diminish sperm count.
Signs of Healthy Sperm: How to Tell if a Man is Fertile
There’s no surefire way to measure a man’s fertility without fertility testing, including semen analysis. Men who seem very healthy may have very low sperm counts, while men in relatively poor health may have very healthy sperm. So don’t try to assess fertility based on a man’s health, appearance, or sexual performance.
Some warning signs may indicate a potential problem. A man is more likely to be infertile, or to have low fertility, if:
- He has a history of erectile dysfunction
- Ejaculation or urination is painful
- There is blood in the semen, or the semen is an unusual color
- The volume of semen the man ejaculates is very low
- The man smokes or uses illegal drugs
- The man is in poor health, especially if he has diabetes or cardiovascular health conditions
Odds of Pregnancy
Many men with infertility are actually subfertile. This means that there is still a chance of getting a partner pregnant, but the odds are reduced. For example, a man with a sperm count that is lower than normal may still be able to get his partner pregnant. It may take longer, though, and if the woman has fertility issues, the odds of pregnancy will be much lower.
When a man’s fertility is suboptimal, a doctor may focus on improving the woman’s fertility, or recommend measures to improve the man’s health.
If a man has no sperm, cannot ejaculate, or has very few healthy sperms, then he will not be able to get his partner pregnant. Treatment for this form of infertility varies, but may include:
- Surgery to correct anatomical issues.
- Treatment for underlying health issues. For example, cardiovascular health issues may cause severe erectile dysfunction.
- The use of donor sperm.
- The use of artificial reproductive technologies such as intrauterine insemination (IUI) or in vitro fertilization (IVF).
There is no one-size-fits-all treatment, so talk to your doctor and ensure you have a comprehensive diagnostic workup. The odds of pregnancy vary with the diagnosis, and with other factors -- notably the woman’s fertility.
Mutual Infertility: How Problems With the Woman Compound Sperm Issues
For a pregnancy to happen, both men and women must be reasonably healthy. The effects of issues with sperm depend partially on the overall fertility profile of the woman. For example, if a woman has polycystic ovary syndrome (PCOS) and only ovulates every 60 days, her chances of pregnancy are already reduced. If the man also has a low sperm count, these factors together can interact and greatly lower the odds of a successful pregnancy. Helping the woman ovulate more frequently may help. Conversely, if a woman ovulates regularly and is healthy but her partner has a modestly low sperm count, there may still be fairly good odds in favor of pregnancy.
This interaction between the health of the two partners is critical to understanding fertility. Fertility does not happen in a vacuum. So it’s important to test both the man and the woman. In some cases, a doctor may even want to test how their bodies interact, by taking a sample from the woman’s vagina shortly after the couple has intercourse. This can show how the woman’s body responds to the man’s sperm. Sometimes incompatible pH levels attack otherwise healthy sperm, or otherwise reduce the chances of pregnancy.
You may be surprised to learn that treatment for sperm issues often begins with treating the woman. This is because it’s not always possible to treat sperm issues, especially when they are not caused by an anatomical problem. By optimizing the woman’s fertility, a fertility specialist can improve the chances of pregnancy, even with unhealthy sperm.
Is it Possible to Improve Sperm Quality?
Sometimes a problem with sperm stems from an anatomical issue. For example, prostate disorders can affect sperm count and quality. Varicocele, a bulging vein in the testicles, can block sperm. This may lower sperm count and affect sperm quality. Treating a varicocele may immediately improve fertility.
So it’s important to not only diagnose the symptoms -- issues with sperm -- but also to diagnose the underlying cause of low sperm count.
But what if a doctor can’t determine why a man has low sperm count?
Spend a few minutes online and you’ll find dozens of products that purport to improve sperm quality and increase the odds of a pregnancy -- vitamins, supplements, foods, smoothies, and more. The truth is that nothing is scientifically proven to immediately improve sperm quality. Doctors don’t fully understand why some men have sperm issues and others don’t.
In some cases, better health may improve sperm quality. Therefore, exercise, eating better, and managing stress may help. If you smoke or use illegal drugs, quit. Certain medications may also affect sperm quality, so talk to your doctor about any and all drugs you use, and avoid the unnecessary use of prescription or over-the-counter drugs. For example, if you take medication to help you fall asleep but no longer struggle with insomnia, you may benefit from stopping the medication.
Some research also suggests that supplements may improve sperm health. For example, antioxidants such as vitamin C may correct some sperm issues. While the preliminary research is promising, there is no guarantee that these supplements will work. And like all medication, supplements are not safe for everyone. So talk to your doctor before trying any fertility supplements.
When to See an Infertility Specialist for Signs of Infertility
The struggle with getting pregnant can range from frustrating to heartbreaking. In the early months, you may monitor for every potential sign of pregnancy, begin planning the baby’s nursery, or help your partner shop for maternity clothes. After several months of trying, you may begin to lose hope. Infertility can affect your relationship, your sense of self, even your job. But there is hope. The right fertility specialist can help you determine the cause of infertility and chart a course to a healthy, happy pregnancy.
So when should you see a specialist? We recommend seeking help if:
- The man has severe erectile dysfunction that makes it difficult or impossible for him to ejaculate.
- The man has a very low volume of sperm.
- There is a swelling or lump on the penis or testicles.
- The man is over 40 or the woman is over 35, and you have tried for longer than 6 months to get pregnant.
- The man is under 40 and the woman is under 35, and you have tried for longer than a year to get pregnant.
- The woman has had more than two miscarriages in a row.
- The woman has very irregular menstrual cycles, PCOS, or knows that she does not ovulate on a regular basis.
- Either partner has a previous history of infertility, even if it was with a different partner.
- The woman is over 40 and the couple wants to have a baby.
- Either partner has a chronic medical condition or a condition that is linked to lower fertility.
The Center of Reproductive Medicine, in Houston, Texas, helps people just like you become parents. We know how painful this journey can be, and we ensure you never walk it alone. We’re here for you. Don’t give up hope. An expert can help. Give us a call today!