This is Infertility is a bi-weekly podcast where we fuse narrative storytelling with experience and science to give you a new perspective on what it’s really like to go through a family building journey. Each episode dives into the emotional, physical, and financial burdens carried by those who experience infertility on their path to parenthood. Be it IVF, IUI, egg freezing, surrogacy, adoption, etc., the path is never the same and it can be long, painful, and lonely. It’s our mission to give those struggling a platform to be heard, a community connection, and an opportunity to raise awareness of the 1 in 6 who, for many reasons, struggle with infertility.
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This is Infertility

Episode 135: Fertility 101: The 4Ts of Male Fertility

The Fertility 101 Series, because there’s no shortage of daunting terms to keep your mind running, is a quick and dirty breakdown on a specific topic with insights from a fertility expert. 

Dr. Lowell Ku from Dallas IVF will help break down what can lower sperm quality, thus impacting overall male fertility. Each of these causes starts with the letter T and can serve as a good reminder to practice healthy habits.  

To reference the episode around male infertility, check out Episode 108: Fertility 101: Male Factor Infertility 

Guests: Dr. Lowell Ku, Dallas IVF 

Host: Dan Bulger 

For more information, visit Progyny’s Podcast page and Progyny’s Education page for more resources. Be sure to follow us on Instagram, @ThisisInfertilityPodcast and use the #ThisisInfertility. Have a question, comment, or want to share your story? Email us at

Here are some highlights from this episode:

The Big Three Categories for Male Factor Infertility

02:45 – 4:17

The big categories for male factor are what we call pre-testicular, the next is testicular, and the third one and final one is post-testicular. So, pre-testicular is anything that is in the body or in the environment that is affecting the testicles, and causing it not to work, whether it be a hormone production issue, and not telling the testicles to produce sperm, or it maybe taking the testosterone hormone, and that can shut down the testicles. Testicular reasons can be literally exactly just like a problem with the testicles, like maybe one’s missing, or both are missing, or both are nonfunctioning, like they have failed, like there’s testicular failure. Post-testicular is anything after the testicles in other words, for example, the passageway from the testes to the outside world where the sperm exit, basically, if there’s a blockage in that tract, like the vas deferens or the epididymis, that can lead to a blockage and lead to blocking the sperm from coming out. So, it’s either the inability to make sperm, the inability of making something because of hormones or because of testicular problem itself. Or the testicles work fine, and they’re trying to send the sperm out, but something’s blocking it from coming out. So those are the three main big sort of like categories as to what male factor infertility diagnosis. 

The Four Ts of Male Infertility

06:48 – 10:49

The four things that all begin with the letter T that have the ability to lower the sperm quality and lower thus the male fertility. Number one, first T is tobacco usage. So we always say no smoking, and that also includes no tobacco usage, like no dipping, and no tobacco or nicotine like patches, because it’s the nicotine in the smoking that really affects the sperm quality, and the sperm count and the motility. So, smoking really has a big impact.

The second T is THC or marijuana. So, marijuana, interestingly enough, has components, chemicals in it, that can lower sperm production. In fact, these types of chemicals act like estrogen, it can lower the testicles’ ability to make a good amount of sperm. So, sometimes when we see a semen analysis that shows us a, like a moderately low sperm count. Here’s the easy fix, all you got to do is stop the marijuana and the sperm production will return after about three months.

The third T is testosterone. Testosterone is that one hormone that we see that guys take, and it makes sense, because you know, as the guy gets older, the ability to produce enough endogenous or natural testosterone is lowered. And so, a guy will have lower testosterone he’s going to start to feel more fatigued, is not going to feel as mentally focused. It’s going to be really sort of grumpy. And, and so one of the most important things about testosterone is that there are some sperm friendly options that include testosterone, too, help sperm production, occur still, and yet still allow the husband or the partner to feel still himself with some testosterone hormone insights.

Fourth T is tubs so in other words, hot tubs, bathtubs, saunas, anything that a guy does where he literally soaks, and boils his testicles. So, let’s talk about that. The heat exposure to the testicles will cause the testicles to malfunction slightly, thus causing the testicles to really have an inability to package and produce sperm in the proper shapes. So, what we see is that heat exposure really changes the shapes of the sperm. And what I mean by the shape is like, well, it might package the sperm with two tails, or two heads, or a small head, or no head, or pin size head. All these things are abnormal shapes, and really hampered the sperm from really fertilizing and delivering the DNA to the egg.

Dan Bulger


Dan Bulger
Producer at Progyny

Dan has been in the healthcare industry for the last six years as a multimedia content producer. Better known as ‘Video Dan’ he as interviewed numerous doctors, patients and other experts in the world of fertility. He’s also the producer for this podcast, This is Infertility. On a personal note Dan’s parents started fostering kids when he was four years old, and he considers himself a proud older brother to over 100 foster children.

Dr. Lowell Ku


Dr. Lowell Ku
Reproductive Endocrinologist

Lowell T. Ku, M.D. is an award winning and leading provider of infertility treatments in the Southwest United States. Board certified in both Obstetrics and Gynecology as well as Reproductive Endocrinology and Infertility, Dr. Ku has been awarded numerous recognitions including Texas Monthly Super Doctor® and as a D Magazine Best Doctors in Collin County and Dallas.  However, the best award is being nicknamed Dr. KnockedUp by his patients.  As one of Dallas’ highly respected infertility experts, Dr. Ku is regularly seen on television programs sharing his medical expertise on the topics of infertility and reproductive health.  Having personally struggled with and overcome infertility, Dr. Ku has a never-ending determination to help his patients overcome seemingly impossible odds to achieve their dreams of parenthood.

Music From This Episode:

Artist: Jahzarr  
Track: Family Tree