Male Fertility 101: What You Didn’t Learn in Sex-Ed

Two men looking over fertility test results

Infertility is often considered a “women’s issue.” But when it comes to having a baby, sperm is 50% of the equation — and people who produce sperm are just as likely to experience fertility challenges as people who produce eggs.

Let’s break down the need-to-know about male fertility, how male-factor infertility is diagnosed, and what men and people with sperm can do to improve their chances of creating a healthy pregnancy.

“Male factor” contributes to approximately one third of all infertility cases

Approximately one in eight heterosexual couples face infertility, which is defined as the inability to conceive a healthy pregnancy within six to twelve months while having unprotected sex. About one third of these cases are due to the male partner’s inability to create and ejaculate healthy sperm, also known as “male factor infertility.”

Fertility experts estimate one third of cases are due to female factor infertility, such as polycystic ovary syndrome, endometriosis, or diminished ovarian reserve. One third of cases are a result of male factor infertility, such as low sperm count, and the final third are due to a combination of subfertility factors from both partners, or are unexplained.

Male-factor infertility can be due to:

  • Low sperm count: too few sperm in the semen
  • Low sperm motility: too few moving, “swimming” sperm
  • Poor sperm morphology: too many abnormally shaped sperm
  • High sperm DNA fragmentation: too many sperm that carry damaged DNA
  • A combination of the above abnormal semen parameters, which often occur together

The underlying cause(s) of these issues may be linked to hormonal imbalances, genetic factors, advanced age (especially after 40), lifestyle factors such as smoking or poor diet, or exposure to chemicals that damage fertility, such as pesticides or chemotherapy.

Male fertility may be getting worse

Several recent studies have indicated that average sperm count and quality has declined significantly — up to 50% — in the Western world. A research review published in 2017, titled “Temporal trends in sperm count: a systematic review and meta-regression analysis,” looked at the results of over 42,000 semen analyses performed between 1973 and 2011. They found that sperm count had declined, on average, 1.4% per year, with a total decline of 52.4% in just 38 years. Additional studies of sperm count, motility, and fertility outcomes support the idea that something is affecting male fertility on a population level.

The possible culprits:

  • Exposure to endocrine-disrupting chemicals (EDCs), chemicals that interfere with the endocrine, or hormone, system: EDCs are commonly found in plastics, like the plastic in water bottles and food packaging, as well as pesticides and chemicals used in manufacturing. People may be exposed to EDCs because of their jobs, or through eating food or drinking from plastic containers.
  • Lifestyle: In most of the Western world, people are more sedentary than ever. Physical activity is associated with improved hormone levels and sperm quality. It’s feasible that more sitting — along with other common habits today, such as not getting enough sleep or eating a diet high in sugar and saturated fat — is contributing to decreased male fertility.

Sperm quality may be affected by day-to-day habits

The testes constantly make sperm— about 1,500 sperm per heartbeat — in a process that takes about 72 days. Everything that affects a person’s overall body function will also affect their sperm. Sperm quality is reflective of the past two to three months of someone’s health and habits.

Therefore, building a habit as simple as walking or jogging regularly may dramatically improve sperm health. “The effects of three different exercise modalities on markers of male reproduction in healthy subjects: a randomized controlled trial,” a study published in Reproduction, found an improvement was seen after just twelve weeks of moderate-intensity cardiovascular exercise, three to four times per week.

Smoking cigarettes has a detrimental impact on sperm. The American Society for Reproductive Medicine (ASRM) estimates that infertility rates are about twice as high in smokers, male or female, compared to non-smokers. Smoking is associated with decreased sperm count, motility, morphology, and genetic health. Physicians and researchers are also examining the impact of cannabis on male infertility, and suggest staying away from it while trying to conceive. 

On the nutrition front, studies such as “Dietary patterns, foods and nutrients in male fertility parameters and fecundability: a systematic review of observational studies”illustratethat a diet rich in vitamins, minerals, and antioxidants — especially those found in fruits and vegetables, nuts, seeds, whole grains, fish and lean meats — has been associated with better male fertility. Conversely, eating saturated and trans-fat, processed meats, and added sugars has been associated with lower numbers of moving sperm.

Finally, sleep may affect male fertility. Men who sleep less than seven hours per night on average, or those who have interrupted or low-quality sleep, are at a higher risk of sperm health issues.

Male infertility may not have any other symptoms

For people with ovaries, a regular menstrual cycle is a good indicator of a functioning reproductive system.

People with testes don’t necessarily get that same feedback from their bodies. Most men who experience infertility don’t have a problem having sex or ejaculating. Apart from a few specific situations — outlined below — the sole “symptom” of male infertility is typically the inability to get your partner pregnant.

Symptoms that may indicate male-factor infertility include:

  • Erectile dysfunction (ED): Most infertile people don’t have any problems with sexual function, and most people with ED are fertile. However, erectile dysfunction is more common in men with infertility. This may be due to an underlying hormone imbalance, such as low testosterone levels.
  • Low testosterone levels: Also known as hypogonadism, low T can manifest in weight gain, difficulty getting or maintaining an erection, and tiredness. The process of making sperm doesn’t require high testosterone levels, so many people with low T are still fertile. However, low testosterone may be a result of an overall hormonal imbalance that also affects fertility.
  • Dry orgasm or low semen volume: If someone isn’t producing much semen — or any semen at all — when they orgasm, that could indicate a blockage or issue with ejaculation.

Sperm testing is a simple way to get a deeper understanding of male fertility

The good news is that semen analysis can provide a decent snapshot of sperm health. During this test, a scientist will examine a semen sample with a microscope to determine the number of sperm, how they’re swimming (motility), and whether they’re the right shape and size (morphology).

A semen analysis won’t come back stamped “fertile” or “infertile,” because fertility is diagnosed based on a couple’s inability to get pregnant. Plenty of couples can conceive a child naturally, even with sperm that has one or more poor semen parameters. However, this analysis can alert a person to issues with their sperm production that may affect their ability to conceive, such as low sperm count.

There are different ways for someone to test their sperm. You can go to a fertility clinic, urologist or cryobank, or use a mail-in sperm testing kit, like those offered by Legacy. All provide invaluable information about fertility, but the options offer flexibility for varying comfort levels.

Regardless of how you would like to move forward, Progyny members have access to Legacy semen analysis and sperm freezing through their employers at no extra cost. Please contact your Patient Care Advocate (PCA) for more details.

Male fertility declines with age — and sperm freezing can be just as important as egg freezing

There are famous cases of advanced-age fatherhood, like Mick Jagger having kids into his 70s, that may make men and people with sperm believe they’re fertile forever.

But sperm quality actually declines measurably with age. Research summarized in a Reviews in Urology review from 2011 demonstrates that sperm motility at 55 is less half what it was at 30. This can impact a couple’s chances of conceiving. In fact, heterosexual couples in which the male partner is over 35 are 52% less likely to get pregnant, compared to couples with younger male partners.

The genetic health of sperm declines with age, too. One study, “Sperm DNA damage: correlation to severity of semen abnormalitiesfound that the proportion of sperm containing damaged (fragmented) DNA was 33% higher in men over 50, compared to men under 30. The prevalence of DNA fragmentation increased about 5% for every 10 years of a man’s life.

DNA fragmentation can contribute to infertility, miscarriage, and adverse health outcomes for the child. Poor sperm genetic health may help explain why older fathers are, for example, more likely to have a child with cancer (Clinical Epidemiology and Global Health) or autism (Archives of General Psychiatry).

Bottom line: Fertility decreases over time, impacting a couple’s chances of having a healthy baby.

Sperm freezing is an option for men and sperm-producing individuals who want to have kids someday, but not yet. Sperm freezing preserves the quality of sperm for use later — and protects the option to have a genetic family regardless of age or medical history.

Fertility treatments offer new options for people with male-factor infertility

In addition to sperm freezing, there are several fertility technologies that can help people and couples diagnosed with male-factor infertility. Using donor sperm is not the only option.

  • Intrauterine insemination (IUI): In this process, the semen is washed to isolate the sperm, then inserted directly into the uterus to give it a “kickstart.” IUI is done on the day the female patient is ovulating, to maximize chances of fertilization. IUI can help people with moderately low sperm count or motility and requires 10 million motile sperm.
  • In vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI): IVF is a process in which eggs are removed from the ovaries and fertilized with sperm in a lab. ICSI is an IVF technique in which a single sperm is injected directly into an egg, improving chances of fertilization even in cases of severe male-factor infertility or very low count.
  • Testicular sperm extraction: Some patients produce sperm, but the sperm can’t get to the ejaculate — whether because the sperm count is too low, or because there’s a problem with the vas deferens, the duct that transports sperm out of the testes. A testicular sperm extraction or aspiration is a procedure in which sperm are retrieved directly from the testicular tissue; these sperm can be used in IVF with ICSI.

Male factor fertility is a huge piece of the conception puzzle, and the more sperm-producing people know about their bodies, the better equipped they are on a fertility journey. Legacy and Progyny make it easier and more affordable to take control of your reproductive health, so reach out to your Progyny PCA to get more information. 

Legacy is a digital fertility clinic that allows you to test, freeze, and improve your sperm from home. A proud member of the Progyny network, Legacy offers mail-in sperm analysis and freezing, male fertility supplements, and clinical support.