• TheGyn Guru

Male infertility (AKA bad sperm)

Bad baby batter? Funky spunk? Shooting blanks?


So what if his sperm ain't the best? It seems like this is every man's greatest fear, but there are many things that can be done to improve sperm quality and achieve pregnancy.



How does he get a semen analysis?


One of the most important things we will do as part of a basic fertility evaluation is a semen analysis. You should call your OBGYN or primary care doctor for a referral to good fertility clinic.


There are at-home sperm tests you can buy, but they are NOT reliable. So your partner will need go to the fertility clinic himself and leave his sample for a proper evaluation. (Or you can make the appointment for him and just tell him you're going for ice cream and let it be a surprise.)


This is by no means a painful test... awkward perhaps, but certainly not painful. So you will not feel sorry for him. When he goes to the fertility clinic, he will be put in a clean private room, "read" a magazine and ejaculate into a cup. Compared to the blood work and ultrasounds that the woman will need to do, it doesn't sound too bad right?




When we evaluate sperm, we look at 3 main components:


1 - Count - we like at least 15 million sperm


2 - Motility - we like at least 40% to be good swimmers


3 - Morphology - we only need like 4% to be normally-shaped.






Morphology is the most common abnormality, but if the man has a high count, it doesn't matter too much.


People sometimes worry that abnormal sperm will cause an abnormal baby, but the problem is an abnormal sperm can't fertilize an egg, so that's the issue.







So what if the sperm ain't the best ?


It seems like this is every man's greatest fear (along with the common cold), which is why it's like pulling teeth to get them to go get the (not-painful) semen analysis done. But there are some options to improve sperm quality...


1 - Focus on getting healthier through better diet (that always means actually eating some vegetables), moderate exercise, and lose some weight if needed.


2 - Stop smoking and/or using excessive alcohol, pot, or any other drug use.



3 - Keeping the boys cool..


Fun fact: the testicles are on the outside of the male body so that they can remain a degree cooler to produce good quality sperm. If the scrotum gets too warm, if can affect sperm quality. You'll hear advice about keeping the testicles cool a lot, but don't obsess over it. It's not likely that tight underwear, hot tubs, saunas, or any intermittent exposure to warmer environments would cause true long-term sperm issues. Sure, he shouldn't sit in a hot tub all day, but don't obsess over the temperature of his scrotum at all times. Studies really haven't shown that these behaviors make any difference in sperm quality over time.




4 - He should see his primary care doc for a physical. He should have bloodwork done to check for any underlying medical conditions. His doc can review any medications he is taking to be sure they're OK. They can discuss any erectile dysfunction or performance issues as well.



5 - He may need a referral to see a Urologist for an evaluation. They may do some hormonal tests to see if there is anything that can be treated with medications. They may do an exam and/or ultrasound of the testicles to see if there are any structural issues that can be surgically repaired.






6 - You will most likely also be referred to an REI (Reproductive Endocrinologist and Infertility specialist, AKA fertility specialist) sooner rather than later. The REI will then have a few options as well...


  • The REI doctor may recommend some supplements and/or medications he can take. It all depends on the reason for a low sperm count, but there may be medications that can help.


  • Sometimes insemination, or IUI (intra-uterine insemination) is your best option. We can concentrate the good sperm and make sure you get it when you need it.


  • If there really isn't much sperm to work with, then IVF (in-vitro fertilization) may be your best option. For IVF, we can selectively pick out only the best sperm, and we really only need a few.


  • Donor sperm. In extreme cases of male infertility, we may recommend donor sperm. This is also easier and cheaper than IVF if that's not an option for you. You can actually buy sperm online. (It may be the one thing Amazon doesn't have.) Your fertility clinic would make sure you get it from a reputable source. Patients will sometimes ask if they can use a friend, but it is likely better for you in the long run to use an anonymous donor. The sperm you purchase will have been tested for STDs, and you can know genetic traits, and any medical or family history that may be important for your child in the future.



So don't despair. If the results from his semen analysis were less than perfect, it's not hopeless. It's worth it for him to get a full evaluation and see what can be done. There are always options and many different paths to choose on the journey to parenthood.








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