The Facts About Male Fertility

It's been estimated that approximately 13 percent of couples who want to get pregnant are unable to, with male fertility issues accounting for about one-third of instances where couples cannot conceive. Also, research indicates that sperm counts among American males have decreased by almost 60 percent in the past 38 years.

If you and your partner have been unsuccessful in trying to get pregnant for more than a year, then you both should consider fertility testing.

Male fertility testing is a straightforward process. You provide a sperm sample that's evaluated for its overall health, which will indicate if sperm number, shape and mobility play a role in your inability to conceive.

Overview of male fertility

Sperm health is the most common factor in male fertility problems. Your sperm health is determined by several elements, including the quantity of sperm in your ejaculate, the motility (or mobility) of your sperm and the structure (or shape) of your sperm.

The amount of semen in a single ejaculation contains a lot of sperm, but there may not be enough sperm to ensure fertility. If your ejaculate has a minimum of 15 million sperm per milliliter, then you are considered fertile.

If your ejaculate contains fewer than 15 million sperm per milliliter, conception will be significantly more difficult. And if there are no sperm at all in your ejaculate—this affects about 1 percent of the entire male population—then you will not be able to impregnate your partner.

The sperm in your ejaculate needs to cover a relatively long distance to reach your partner's egg. Sperm travels through the vagina to the cervix, on to the uterus and then to the fallopian tubes. Even if tests reveal you're fertile, a minimum of just 40 percent of your sperm will be moving and capable of making the journey to the fallopian tubes.

The shape and appearance of the sperm in your ejaculate are other key contributors to your overall fertility. If your sperm are healthy, they will have oval-shaped heads and long tails, which are necessary for good motility. The higher percentage of sperm in your ejaculate that has a normal structure, the more likely they will be able to fertilize your partner's egg.

Any aberration in your sperm count, motility or structure can decrease your ability to conceive.

What affects male fertility?

Many medical conditions can affect your fertility, including:

• Ejaculation issues
• Functional issues
• Infections
• Autoimmune diseases
• Tumors
• Congenital conditions
• Hormone imbalances
• Defective sperm transport tubes
• Chromosome defects
• Sexual dysfunction
• Medications
• Celiac disease
• Previous vasectomy or testicular, rectal or scrotal surgeries
• Medical treatment that included radiation
• Cancer treatment that included radiation and/or chemotherapy

Your diet is important

Although diet alone is not responsible for declining sperm counts, it is considered to be a contributing factor. Foods that may negatively impact your fertility have become a fixture in the typical American diet, but if you want to have children, you may need to consider making some changes.

Added sugars have become a staple of the American diet, never more so than with sodas and energy drinks. Drinking a soda may make you feel more energetic, but at the same time, your sperm may become more lethargic and exhibit less motility. Added sugar is found in almost all processed foods, so switching to a diet that includes little to no processed food—centered on chicken, fish, legumes, whole grains, vegetables and fruit—can help your fertility.

If you're overweight, your fertility may also be adversely affected because the extra pounds you're carrying decrease the quality of your semen. Being overweight has several direct impacts on your fertility:

• Testosterone production is reduced, and estradiol levels, which can lower your sperm production, increase.

• Higher blood glucose (sugar) levels create insulin resistance, and when you become insulin-resistant, your body produces fewer sex hormones.

• Extra fat can make your scrotal temperature rise, and that can lead to sperm dying.

Alcohol, drugs and more

Another lifestyle factor that can affect your fertility is drug and alcohol use.

If you choose to drink alcohol, do so sparingly, with no more than one to two drinks a week. Heavy drinking—for men, that's defined as 15 or more drinks a week—can lower testosterone levels, which in turn decreases sperm production and can also cause erectile dysfunction (ED).

Fertility can be affected by both prescription medications and recreational drugs. For example, calcium channel blockers, which are used to treat hypertension, have been linked to lower sperm production. Also, certain antihistamines can reduce ejaculation effectiveness, and using anabolic steroids can decrease your fertility. Marijuana and cocaine can also damage sperm production.

Exposure to environmental hazards and toxins, such as pesticides, insecticides, herbicides, lead, mercury, radioactive substances, heavy metals, benzene and boron, can also impact your fertility.

Can you feel the heat?

Too much heat is a lifestyle factor that can affect your fertility, as the optimal temperature for mature sperm production in your scrotum is a few degrees lower than your normal body temperature. However, there are several things you can do to lower your scrotal temperature so that mature sperm production is not inhibited.

One of the most important factors is the type of underwear you wear. Boxers are best as they create space for your testicles to be away from your body. If you wear briefs, everything gets scrunched up together and your scrotal temperature will be warmer than it should be for optimal fertility.

If part of your regular exercise routine includes running or cycling, make sure you let everything cool down afterward. This does not mean you cannot exercise, but it does mean you should include a cool-down period afterward so your testicles have time to get back to their optimal temperature.

Also, repeated exposure to the high water temperatures in hot tubs and Jacuzzis is damaging to fertility.

If you spend hours playing games or working on your computer while it's on your lap, know that this will increase the temperature of your testicles. The best advice is to walk away from your laptop for a few minutes every hour and try to cool down before your next session.

Age is another factor that affects a man's fertility. While there are men in their 70s and 80s who have fathered children, they are few and far between. Statistics indicate that if you are 40 or older, you and your partner may experience difficulty getting pregnant because sperm production naturally decreases with age.

Determining whether you are fertile

If you and your partner are unable to get pregnant after one year of unprotected sex, then you should both start investigating possible causes by scheduling appointments with medical sexual health specialists.

You will want to see a urologist who specializes in fertility and your partner will want to see an OB-GYN. A good strategy is to attend each other's appointments so that you can both ask questions and fully understand all the issues.

You should prepare for your urology appointment by ensuring you have complete medical records, from birth until present-day, for you and your partner. While most current medical records are electronic, you both may have had illnesses, chronic diseases and surgeries before electronic records were kept, so you need to make sure you have them all recorded. Do not ejaculate two to five days before your first appointment with your urologist, since you may need to provide a semen sample during that appointment.

Then, your urologist will examine your genitals to check for anything abnormal, such as swelling, tenderness or hard lumps. In addition to taking a semen sample, your urologist may carry out bloodwork to check the levels of your fertility hormones. In some cases, your bloodwork will also be used for genetic testing.

Be prepared for your urologist to ask for an ultrasound to be done on your genitals, especially if the physical examination shows possible abnormalities in your testicles. The ultrasound examination is used to rule out benign problems as well as more serious issues, such as cancerous tumors.

Once your urologist gets the results from your semen sample, your bloodwork and, if necessary, your ultrasound, then they will be able to assess your fertility. If you have any problems, your physician will advise you on the next steps to take to address them.

What are your options?

If your fertility problems are medical or hormonal, you and your partner have several options:

• Artificial insemination
• In vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT)
• Intracytoplasmic sperm injection (ICSI)
• Hormone therapy
• Surgery

Many of these procedures involve time and a lot of money, so you and your partner should discuss how much you are willing and able to invest in getting pregnant. You should also be aware that there can be an enormous emotional toll on both you and your partner, especially as many of these procedures can fail multiple times before they are successful.

There are also what could be considered among the optimal techniques to improve fertility that don't cost: monitor ovulation, have sex every other day when ovulating and use a lubricant that doesn't interfere with sperm motility.

Of course, if you are committed to having children, there are options other than having biological children, including adoption and foster parenting. A good strategy is to discuss this as a secondary plan so you have something to fall back on if the medical procedures prove unsuccessful.

And if you don't want kids...

If you decide that you don't want to have biological children, then you should consider having a vasectomy, a surgery that prevents sperm from getting into semen by cutting and tying off each of your vas deferens—the tubes that are part of your ejaculatory duct.

If you decide to have a vasectomy but then change your mind later, you can have an operation to reverse the procedure but there is no guarantee you will be able to conceive. The more time that passes between your vasectomy and your vasectomy reversal, the lower the chances you will be capable of impregnating your partner.

One way to increase your chances of conception after a vasectomy is to freeze your sperm and store it beforehand. Your frozen sperm can be defrosted and used for in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT).

And since even after a vasectomy your body still produces sperm, it can be removed directly from one of your testicles and used in IVF or GIFT.

Fertility resources

If you and your partner are struggling with fertility, you may need extra support. Ask your urologist for recommendations for infertility counselors if both of you are more comfortable with individual counseling.

Infertility counselors are therapists who specialize in helping individuals with fertility issues work through the emotional and mental aspects of the process of trying to get pregnant.

If you and your partner prefer support in a group environment, your urologist can give you the names of fertility support groups in your area. These support groups may be divided into just men or just women, but they should have support available for both of you. A few quick searches online will also reveal any such groups in your area.

Here's a great place to start: Resolve is a national organization that offers comprehensive support to couples who are experiencing fertility issues.

There is help and hope if you have fertility issues, no matter what the outcome of the procedures and treatments. If you and your partner are committed to having children and have the support of loved ones and family, you will find a way.