With all the focus on female fertility, we seem to forget that half the time — yes, 50 percent — it's the sperm that's to blame. But good news: There's a lot you can do to keep your swimmers strong and healthy. Here's where to start.
1. She has a gynecologist. Why don't you have a urologist?
"Most women have had a relationship with their gynecologist since they started menstruation — men don’t have such a relationship with their urologist," says Marc Goldstein, M.D., Professor and Surgeon-in-Chief of Male Reproductive Medicine and Urology at Weill Cornell Medical College of Cornell University. The irony is that it’s much easier to diagnose an issue in men due to simple logistics: "Everything I need to know about male anatomy is accessible, hanging right out there in the breeze," Goldstein says. In some cases, a doctor can determine an issue just by reviewing the patient’s history, especially if he has a history of testicle or hernia repair surgery, sexually transmitted diseases, chemotherapy, or radiation treatment.
2. Take a look in your medicine cabinet.
A December 2013 study found that taking finasteride, an ingredient commonly found in alopecia medication, has a negative effect on sperm count. (Topical treatments like Rogaine have no such negative effect.) Additionally, many selective serotonin reuptake inhibitors (SSRIs), found in anxiety and depression medications like Prozac, have been shown to negatively affect sperm motility, or how fast your sperm is swimming. Talk to your psychiatrist about getting off SSRIs and transitioning to another antidepressant prior to trying to conceive.
3. The trouble with hormone therapy.
If you're hitting a wall at the gym, or just have low energy in general, it might be tempting to start popping testosterone supplements. But talk to your urologist before heading to the pharmacy, because taking testosterone can have seriously negative effects on baby-making. "Practically speaking, [testosterone] is a contraceptive," says Joseph Alukal, M.D., Director of Male Reproductive Health and Associate Professor of Urology and OBGYN at NYU Langone Medical Center. "Some patients do need to be on testosterone, but we need to make that diagnosis correctly."
4. There's no better excuse to lose weight.
In case you needed one more reason to get to a healthy weight, the World Health Organization conducted large studies to establish what constitutes normal sperm count for semen analysis, and the results indicate that men who are overweight (or have a BMI over 30) typically show lower sperm counts and higher DNA fragmentation (AKA, nicks in the sperm DNA) than those who are at a healthy weight. A higher fat percentage can also create a hormonal dysfunction that affects sperm motility, meaning your sperm can’t swim as well.
5. Don’t overdo it in the gym.
There isn’t an exact threshold of how much exercise is beneficial before it negatively affects sperm production, but too much can lower your chances of getting someone pregnant. "If [a man] is 50 pounds overweight and wants to do an Ironman in six months, it’s a noble goal, but it’s more likely to put the body in a physical state of stress, negatively impacting sperm count," Alukal says. Your doctor can help you determine the right amount of exercise for you.
6. No, you don't have forever.
"There’s a lot known about how a woman’s fertility is affected by age. For men, there’s no clear andropause (or male menopause) — it’s a very slow, gradual drop," Goldstein says. But studies now show that paternal age is actually important too: Men over 45, even with an under-30 partner, have twice the risk of having a baby with Down syndrome, three times the risk of having a baby with schizophrenia, five times the risk of autism, and the risk of major birth defects is twice as high.
7. Take it easy on the intoxicants.
"Testicles are the canary of the human body," Goldstein says. "Semen quality and fertility are the first things affected when you’re exposed to toxic chemicals." Marijuana binds to estrogen receptors in the testicle — and stays there for up to three weeks. Even one joint a month causes a concentration in the testicles, called a gonadal toxin, and can result in an abnormal semen shape that can affect conception. Alcohol should be limited to six drinks per week, preferably not all at once.
8. Get tested already.
There are several home sperm-count tests on the market that can help identify an immediate issue in sperm count (SpermCheck makes a popular one). But both Goldstein and Alukal advise a follow-up laboratory analysis because home tests can still miss problems in sperm vitality, shape, and DNA. Laboratory tests, including relatively new tests called TUNEL (terminal deoxynucleotidyl transferase dUTP nick end labeling) and SCSA (sperm chromatin structure assay), can also determine the number of fragmentations in the sperm DNA. A basic blood test will diagnose any hormonal issues that are affecting fertility.
Right now, apps and wearable technology for women still dominate the fertility-tech space. But Alukal is encouraged by the fact that more researchers are taking time to analyze male fertility for the first time, including working on a hormonal male contraceptive. “I don’t think those drugs are quite ready, but it means researchers are paying attention and putting in additional effort to understand how hormones work in a guy,” Alukal says. “This is half the world’s population, and we need to understand better.”