How can I tell if my sperm is okay?
A semen analysis is the initial baseline to check a person with sperm’s fertility. A semen analysis will examine ejaculate based on semen volume, sperm cell count, concentration, motility, and morphology, per the World Health Organization criteria. In other words, a semen analysis allows a man to assess the quality of his sperm at any given time.
“Checking sperm” is not a phrase thrown around much, nor is it common in infertility conversations to have the male partner checked first. By current cultural standards, the female partner assumes the issue lies with her, and then must undergo a series of invasive, uncomfortable tests to assess her fertility, including multiple blood tests and transvaginal ultrasounds.
On the other hand, male fertility testing is simple: a sperm sample can be produced to be measured by an embryologist, who will compare several parameters of sperm health against those of the average man, and then, if more intensive testing is needed, give a referral to an andrologist or urologist who can give blood tests or testicular exams.
You’re only “infertile” if you’re trying to conceive
That said, it is important to note that this will not confirm that a person with sperm is “infertile” - you can have low sperm count, odd morphology, etc. and not experience infertility. The guidelines of what is considered “normal” are based on huge datasets of many thousands of men, but no one factor is necessarily going to prevent conception. A lower score on these parameters doesn’t preclude the possibility of children, but it will make conception more difficult.
Even though few data are collected on the quality of the individual sperm cells that result in successful natural conception, it is accepted that the "normal" looking sperm would be the one resulting in fertilisation and a healthy pregnancy. If there are problems with the sperm such as genetic issues then even if the egg is fertilised, the resulting embryo will likely be miscarried or result in other birth defects.
Since this is such a taboo, esoteric subject, lots of myths about sperm testing are thrown around.
Here are a few that we are busting right open:
Myth 1: There’s no male equivalent of a gynaecologist
Andrology is the area of medicine dealing with the male reproductive system and urological problems found only in men and people with sperm. Andrology is the direct equivalent of gynaecology, but due to a variety of cultural reasons, is not widely recognised as its own distinct speciality.
Andrologists are a subspeciality of urology, which is a medical field focused on the urinary tract in both biological sexes and the male reproductive system, which shares some of the same equipment.
There is a reason you may not have heard of this, alarmingly there are only 1,328 urologists for the entirety of the UK. That’s only 15.5% of the slightly more than 8500 gynaecologists in the UK, and the number shrinks to mere hundreds of andrologists to serve the whole country by various counts. For some suggestions on why this might be the case can be found here.
Myth 2: Semen and sperm are the same thing, or, my sperm is what it is - just all sperm!
What is often referred to as sperm is called the “ejaculate.” It is made up of sperm cells and three types from 3 sources:
the vas deferens (sperm fraction)
the seminal vesicles
The sperm cells from the vas deferens, a sperm reservoir in the testicle, make up just 1-10% of the total volume of the ejaculate, and are not visible to the naked eye.
The seminal vesicle fluid makes 70-80% of the total semen volume, containing primarily fructose, the base form of sugar that serves as the food/energy that sperm cells need to travel to its destination upstream. It also contains proteins, ascorbic acid, amino acids, phosphorus, potassium, l-carnitine, among other nutrients, which are often recommended as supplements to improve sperm quality. The final 10-20% is from the prostate and contains acid phosphate, calcium, citric acid, magnesium, and zinc.
Zinc stabilises the DNA within the sperm, and provides semen its colour and taste. The prostatic specific antigen that the prostate releases liquifies the semen and allows the sperm to swim freely. This mixture of semen then exits the penis during ejaculation.
Myth 3: Every ejaculate creates new sperm
Most men produce millions of new sperm every day. However, these new sperm take about 74 days to mature and be ready for fertilisation. As the sperm mature, they are released via ejaculation. At any given time, the sperm ejaculated is showing the health of a person over the last 3 months.
Myth 4: My sperm count is set and permanent.
Semen quality is based on both genetic and lifestyle factors, and is affected by what the person with sperm is getting up to. Per the myth directly above, most men produce millions of new sperm every day, but these new sperm take about 74 days to mature and be ready for fertilisation. But along that maturation journey, external forces such as poor diet, lack of exercise, exposure to heat, recreational drugs, and cigarette smoke, reduce sperm parameters such as count, morphology, and motility.
Thankfully, the lifestyle factors that can negatively impact sperm quality can generally be improved!
For example, if men get more exercise, and give up a few vices e.g. lay off the booze, stop smoking, or reduce exposure to high heat via saunas, spas, grills, or long drives, results of higher sperm count and quality are often seen as early as 3 months later.
Conversely, men or people with sperm who have previously had sperm tests done while healthy will not necessarily have the same result in the future if previous vices are resumed or other health issues arise (including infections).
Myth 5: Blue balls is caused by too much sperm which makes men infertile
Blue balls, the state of not ejaculating once aroused, is not actually a medical diagnosis. The concept of “blue balls” is often a manipulative tactic used by men to convince a partner to have sex, claiming that if they do not achieve orgasm/ejaculation, their testicles will swell to the point of excruciating pain due to there being too much semen in their bodies. As myths 3 and 4 explained, the body manages sperm production carefully and there is no evidence that an overproduction occurs or would cause harm.
The closest actual medical diagnosis that could be mistaken for “blue balls” is “epididymal hypertension,” which is essentially the expansion and contraction of the blood vessels of the penis and testicles, similar in feeling to the loss of circulation in any other part of the body. If the testicles and scrotum actually turn blue, it is likely indicative of a serious medical condition like testicular torsion or testicular cancer, rather than simply not ‘getting off.’
A notable exception: According to a 2017 study, Normal to High sperm count men should not abstain from ejaculating for more than a week for conception purposes, as sperm quality in terms of motility and vitality decreases significantly as abstinence period lengthens.
Myth 6: higher semen volume means higher fertility
Semen and sperm are like squares and rectangles: sperm is a component of and is in semen, but semen itself is not entirely composed of sperm. Nearly all of the components of semen are protective fluids and enzymes that ensure the sperm themselves are protected for as long as possible.
While more semen may mean that sperm have a greater chance of reaching an egg, about 200 to 500 million sperm cells are contained in any given sample of ejaculate, regardless of semen quantity; an ejaculate of 1mL will, on average, contain around the same amount of sperm as a 5mL ejaculate, all other things being equal. The number of sperm released during any given ejaculation and the amount of semen produced will also vary based on a number of factors, anything from hydration to diet to atmospheric levels of pollution. Volume does not dictate the amount of sperm cells reaching an egg.
A semen analysis will show whether a given ejaculate is within the normal volume standards set by the WHO. If volume is less than expected, please consult your doctor.
Myth 7: COVID negatively effects fertility
Nicki Minaj claimed during the COVID-19 pandemic that the virus negatively impacted her male cousin’s reproductive health (tweetstorm here) by claiming that the COVID-19 vaccine caused him to become impotent, leading to the dissolution of his marriage. However, in a retrospective study looking at rates of conception of IVF patients with fathers who had been diagnosed with COVID-19, there was no significant decrease in successful conceptions. No other studies have shown that COVID-19 has reduced fertility for men.
Myth 8: Men don’t have a fertility cliff
False! Sperm quality decreases markedly throughout a person with sperm’s life. Yes, you may say, “well the world’s oldest father was able to sire a child at 96 years old!” From their early thirties onward, men tend to lose their fertility; by the early forties, men tend to be less than half as fertile as they were in their twenties. It may take significantly longer for men over age 45 to father a child; the likelihood of taking two or more years to conceive is 13 times higher than in comparison to the same man at age 25 (too long to be #ttc!).
Men over the age of 35–40 typically experience a decrease in sperm health, which leads not only to difficulties with conception, higher rates of miscarriage, but also health risks for the foetus and ultimately the child born. Sadly, men over age 35 are almost 30% more likely to fertilise an egg that spontaneously miscarries between six and twenty weeks of pregnancy.
Unfortunately, things only get worse with age, pregnancies that involve a male over the age of 45 see an increased risk of birthing complications, and their offspring have an increased risk of adverse birth outcomes, which means any pregnancy fathered by a father over 50 would be classified as high-risk for both foetus and mother. DNA fragmentation increases with paternal age, which negatively affects the likelihood of conception and live birth.
Genetic disorders become more common in children of older fathers, as the genetic material contained in the sperm becomes more degraded as a result of the natural ageing process. Physical and mental conditions also become more common among children of older parents; conditions such as leukaemia, Downs syndrome, genetically-based autism, or schizophrenia increase in occurrence in children fathered by men over 40, though are not guaranteed.
While it is still possible for someone to father a child successfully over ages 30-40, and many people in the UK are waiting to have children later in life for a variety of perfectly valid reasons, there is a significantly higher chance of complications with conception and pregnancy, a chance which increases with age, which is part of why those looking to start a family at any age should consider checking their sperm health. Once the issue is identified, many cases of male infertility are treatable.
Myth 9: STIs cause infertility
Having a sexually transmitted infection can affect fertility at the time of trying to conceive if it is not properly treated. If, for example, someone has an untreated case of syphilis or chlamydia and does not seek treatment for it, the infection can result in infertility through damage to the testicles and the rest of the reproductive system. However, if these common infections are treated properly and in time, there should be very little chance of infertility resulting from having previously had such an infection.
Myth 10: Boxers vs. Briefs? Underwear doesn’t matter
The great boxers versus briefs debate remains raging and boxers may be the winner.
A study examining people with sperm experiencing infertility did find that men who reported most frequently wearing boxers had higher sperm concentration and total count, and lower Follicle Stimulating Hormone (which promotes sperm production) levels, compared to men who did not. Another study found, however, that underwear had no effect on testicular function.
The brief version of the anti-briefs hypothesis is due to the assumption that briefs cause the male genitalia to sit closer to the body which raises the temperature of the testicles and could start killing the very sensitive sperm cells. It is the case that testicles constantly exposed to higher temperatures will produce fewer viable sperm. However, the effects of what sort of clothing you wear on your fertility are not as great as other things that may affect your sperm health, such as smoking, alcohol/drug usage, or exposure to chemicals which prevent the creation of healthy sperm.
Despite the careful research into busting the myths above, research on male fertility is so nascent that myths are constantly being busted, and conflicting reports constantly come out. We at Jack Fertility hope to ensure that the most up-to-date research is available for you. Please reach out if you have any questions or would like to collaborate on further research or myth-busting activities! And sign up for more information as we bring our tests to home.
This post was reviewed for scientific accuracy by Maryam Rahbar, MSc, DPhil (pending), Chief Scientific Officer at Jack Fertility, December 2022.