Male Fertility: Semen Analysis and How to Improve Sperm Health

A male factor plays a part in 30-40% of couples' fertility problems, and in about 20% it is the only cause. That's why a semen analysis is one of the first steps in any fertility workup: it's cheap and simple, and the result points you in the right direction. This guide covers how your partner can get ready before you start trying.

Semen analysis is the first test in a male fertility evaluation. WHO lower reference limits (2010/2021):

• Volume: ≥1.4 ml
• Concentration: ≥16 million/ml
• Total sperm count: ≥39 million
• Motility: ≥30% progressive (swimming forward)
• Morphology (shape): ≥4% normal forms (Kruger strict criteria)
• pH: ≥7.2
• White blood cells: <1 million/ml

Before the test: 2-7 days without ejaculating (fewer or more days can skew the result), no fever or major stress in the 3-5 days before, no hot baths or sauna for a week before, and no alcohol for 3-7 days before. If the result is abnormal, repeat the test 2-3 months later, because it takes about 72-90 days to make new sperm.

Types of abnormal results:

• Oligospermia: low sperm concentration
• Asthenospermia: low motility
• Teratospermia: abnormal shape
• Azoospermia: no sperm in the sample (obstructive or non-obstructive)
• OAT: all three together, a common abnormal pattern

Evidence-based ways to improve sperm quality (stick with the changes for at least 3 months, one full sperm cycle):

• Lifestyle: quit smoking (it increases sperm DNA damage), keep alcohol under 14 units (about 8 US standard drinks) a week, no recreational drugs, and get 7-9 hours of sleep
• Weight: aim for a BMI of 19-25; both obesity and being very underweight can harm sperm
• Exercise: regular and moderate; extreme endurance training (marathons, triathlons) can lower sperm count
• Heat: cut back on hot baths, saunas, hot tubs, and resting a laptop on your lap, because testicular temperature matters

Nutrition:

• Mediterranean-style diet: randomized studies have linked it to better sperm parameters
• Antioxidant-rich foods: berries, dark leafy greens, dark chocolate, walnuts
• Zinc (oysters, pumpkin seeds): supports testosterone
• Selenium (Brazil nuts, fish): sperm motility
• Folate + B12: DNA integrity
• Lycopene (tomatoes): anti-inflammatory

Supplements (moderate to good evidence):

• CoQ10 (200-400 mg/day): randomized studies show better motility and count
• L-carnitine + acetyl-L-carnitine (3 g/day): some of the best evidence for motility
• Vitamin C + E + selenium: lowers oxidative stress
• Zinc (25-50 mg/day): if levels are low
• Vitamin D: correct it if levels are low
• Omega-3 (1-2 g/day): supports cell membrane health

Ask a doctor about dose and duration before starting any of these. Taking high-dose zinc for a long time can cause copper deficiency.

Medical causes your doctor may check:

• Varicocele (enlarged veins in the scrotum): found in about 15% of men; in some cases, treating it can improve sperm parameters
• Hormone problems (FSH, LH, testosterone, prolactin tests)
• Genetic causes (Y chromosome microdeletion, karyotype; checked in severe OAT or azoospermia)
• Infection (semen culture)
• Blockage (ejaculatory duct obstruction)

Environmental factors to avoid: pesticides, heavy metals (lead, mercury), endocrine-disrupting chemicals (BPA, phthalates), long stretches of laptop heat, tight clothing, and long use of heated car seats (they raise scrotal temperature). Swap plastic food containers for glass, and choose organic when you can.

When IVF or IUI is needed: ICSI (intracytoplasmic sperm injection, where a single sperm is injected into each egg) is the main treatment for severe male factor infertility. With azoospermia, sperm can sometimes be retrieved directly from the testicle (TESE or micro-TESE) and used for ICSI. How often this works varies widely: retrieval is usually possible when the cause is a blockage, and much less certain when the testicles make very little sperm. A urologist or fertility specialist can tell you what is realistic in your situation. Fertility medicine has come a long way, so a difficult result is a starting point, not the end of the road.