Sperm health and male fertility

A semen analysis measures more than how many sperm there are. It also looks at how the sperm move and their shape. A clinician needs to explain what the results mean. A result that needs follow-up doesn’t on its own mean someone can’t have children.

If you’re trying with a partner, talk about sperm health from the start. The NHS says a GP can arrange checks for both partners. You can ask to be checked without deciding who might be having problems.

Talk to your prescriber about testosterone

Testosterone treatment can lower sperm production. Sometimes no sperm at all are found in semen. The American Society for Reproductive Medicine (ASRM) warns about this in its patient information. If you take testosterone and want to have a baby using your sperm, talk to the clinician who prescribes it.

Don’t stop a prescribed medicine without talking to your doctor. Bring a list of your prescribed treatments and anything you buy without a prescription, including supplements or herbal products. Say what you take and what you hope to do. Ask how your treatment and your fertility plans can fit together.

Anabolic steroids belong in that talk too. The CDC lists them among things that may lower sperm production, along with smoking and heavy drinking. You can ask for help without making every change on your own first.

Smoking, alcohol and weight

For people with a low sperm count who are trying for a baby, the NHS suggests stopping smoking and cutting down on alcohol. Heavy drinking can affect sperm production. But drinking less doesn’t guarantee a fertility problem will go away.

NICHD reports a link between obesity and lower sperm count and quality. The NHS suggests support with weight for people who are overweight. Ask what suits your health. Don’t treat reaching a target weight as proof that your fertility has improved.

At an appointment, pick the worry you most want help with. For example: “I smoke and want support to stop,” or “I’m worried about how alcohol fits into this.” Ask what help is available and agree a next step.

Heat advice has limits

The CDC lists frequent high heat on the testicles as a risk factor for male infertility. If you’re often exposed to heat at work or in daily life, tell your clinician.

Advice about underwear is less clear. The NHS suggests loose underwear, because tight underwear can make the testicles warmer and may affect sperm quality. NICHD says the type of underwear you wear isn’t linked to infertility. Because the experts disagree, no one can promise that changing your underwear will raise the chance of pregnancy.

What happens after the sample

A semen test is part of a check that can also include questions about your medical history and an examination. If the first semen analysis suggests a possible problem, the NHS says another one is usually done around 3 months later. More tests may follow, depending on the results.

Ask the clinic how to collect the sample and how you’ll get the results. Ask who will explain them, whether you’ll need to give another sample and what you’ll talk about at the next appointment.

When to arrange an assessment

Book a GP appointment in the UK, or see your doctor in the US or elsewhere, if getting pregnant is taking longer than expected. Get advice sooner if you’ve had a testicle injury or fertility problems, or if you’re planning a pregnancy while taking testosterone.

The NHS low-sperm-count page uses over 1 year of trying, or 6 months if the partner trying to get pregnant is 36 or over. US CDC advice uses 6 months when the woman is 35 years or older. These are the usual points to get checked. If you already have concerns, ask sooner.