There is no denying that male fertility is in decline but it has only started to gain mainstream attention more recently with articles appearing in the Guardian 'There's a crisis in male fertility but you wouldn't know it from the way men behave' and a documentary on Channel 4 called 'Celebrity save our sperm'. Acupuncturists see many women or couples who have been told sperm test results are 'normal' or even 'good' when they actually fall below the normal threshold and could explain why they have been struggling to conceive. There are a number of reasons why this happens, the main one being that since sperm health has been in fast decline, poor results are now relatively normal. There is no ‘medicine’ to fix poor quality sperm and one of the best ways to improve it is through diet and lifestyle which isn’t usually a focus in conventional medicine training. Fertility clinics rarely/never advise 3 months of prep to maximise sperm and egg quality before starting IVF but this would improve chances of success (and probably mean less people need IVF at all which might have something to do with why it isn’t part of the standard process). If you’re struggling to conceive and not working on sperm quality, there is a MASSIVE potential to improve your chances. Men are producing new sperm all the time and the quality of it can be changed quite quickly, at minimal cost.
Sperm test results, what is normal?
First of all it’s important to say that sperm isn’t static, test results vary and depend on a number of factors. Even with the same individual results could be different on one day to the next and are likely to be different if the sample is taken at home in comparison with a fertility centre. However they do provide a useful indication of fertility. Sperm tests check a variety of parameters and the most important ones to look at are:
Volume: The physical amount of semen in the sample
Concentration: The number of sperm per ml of semen
Motility: The % of the sperm that are mobile
Progressive motility: The % of sperm that is moving forwards (as opposed to round in circles etc)
Morphology: The % of the sperm that are a ‘normal’ shape
The World Health Authority (WHO) publish a guide for clinicians to refer to called the ‘laboratory manual for the examination and processing of human semen’ and the latest one is the 6th edition which was published in 2021. Here are the reference ranges for normal, borderline, and pathological sperm. In simple terms we’re looking for at least 2ml in volume containing at least 20 million sperm/ml, progressive motility of at least 50% and morphology of at least 14%.
The sad reality is that 14% morphology is rarely seen especially in couples who are having issues conceiving or have been diagnosed with ‘unexplained’ infertility.
What is sperm morphology?
The new guide also includes a pictoral representation of abnormal forms, which include head defects, defects to the middle section or tail. So if you have eg 3% morphology on a sperm test result, it means 97% of your sperm has some sort of defect like in the image below.
It isn’t a massive leap to see why abnormal forms are going to have an impact on chances of conception and the likelihood of a healthy pregnancy.
Morphology as low as 4% was considered normal in the previous edition released in 2010 but is now considered borderline, however many clinics still refer to anything above 4% as normal or even ‘good’.
While the normal reference ranges for motility have fluctuated up and down over time, normal morphology has fallen off a cliff over the last 40 years, in 1980 sperm morphology needed to be above 80.5% to be considered normal. The update to the ranges in the 6th edition will impact many men who fell into the ‘normal’ range previously but are now considered either ‘borderline’ or ‘pathological’.
DNA fragmentation
DNA fragmentation is common in infertile men and male partners of couples undergoing IVF/ART. Not only does DNA fragmentation make it harder to conceive, it can also have an impact on recurrent early miscarriage. DNA abnormalities impact on many fertility factors including:
- Embryo development
- IVF fertilization rates
- Implantation rates in ICSI
- Increased miscarriage rate
- Childhood health
Due to cost issues a sperm DNA fragmentation test is rarely carried out, however the 6th edition of the WHO manual recommends it as an additional test in certain situations:
- Men with a varicocele
- Men with ‘unexplained’ infertility
- Men with repeated IUI failures
- Recurrent pregnancy loss
- IVF and/or ICSI failures
- Borderline abnormal or normal semen parameters with risk factors
If you fall into any of these categories it could be a good idea to get a test done and see what the DNA status is as it can be improved much like many of the other parameters.
Why is sperm quality declining?
No one knows exactly why sperm quality has decreased so rapidly in the last 40 years but it is likely to be a combination of different factors including:
- Exposure to plastics like BPA, microwaves and microwave meals in plastic containers
- Toxins in cleaning products
- Toxins in beauty products
- Increase in paternal age
- Worldwide obesity pandemic
- Smoking
- Alcohol
If you’ve had abnormal test results the good news is there is a lot you can do, the first port of call is to go back to your GP and ask to be referred to an andrologist for further investigations. There are various reasons for a sub optimal result including:
- Varicocele (enlarged veins in the scrotum)
- Low testosterone/ hormonal imbalance
- Sperm antibodies
- Blockages in the ducts
- Bacterial infection
- Medications
The other piece of good news is that men create new sperm all the time and there are many ways to improve it through diet and lifestyle. If you haven’t seen the documentary Celebrity save our sperm it is a worthwhile watch as it illustrates just how much you can change sperm parameters in a short time. Here are some key tips to improve sperm health:
Heat
Heat has an impact on sperm development and quality. The scrotum is outside the body for a reason and optimal scrotal temperature for spermatogenesis (sperm production) is 34℃. Infections and varicoceles can increase temperature and impact on sperm quality so it is important to rule these out. It is also a good idea to avoid tight hot clothing, hot tubs, saunas and hot baths for a few months before trying to conceive. Don’t keep your mobile phone in your front pocket and don’t have your laptop on your knee when you’re working.
Alcohol
The research is clear, alcohol has a detrimental impact on sperm quality. Studies show that higher doses are the most harmful, and while some people advise cutting it out entirely I would restrict to 1-2 drinks per week if they help you to relax and/or socialise as this could have a positive benefit on your wellbeing.
Medications
Many medications impact on sperm health so it is worthwhile reviewing any meds you are taking to see if they have an impact and if so, whether they can be stopped or reduced. Medications that can have an impact include antibiotics, anti-inflammatories, immunosuppressants, diuretics, opioids, antidepressants and steroids.
Diet
Keep it simple and focus on a diet high in real foods and low in processed products and ingredients you don’t recognise. Cook food at home as much as you can so you know what’s in it. Eat a wide range of fresh vegetables and fruit in all colours of the rainbow, buy organic where you can afford it, high quality meat and fish, nuts and seeds, eggs and legumes. Reduce sugar, packet items and trans fats. Increase protein, healthy fats and nutrient dense foods. For a more detailed look at nutritional advice, this is a great podcast featuring a fertility nutritionist.
Hydration
Simple but important, hydration is needed and often forgotten. Try to drink 2 litres a day. I sometimes find that my clients don’t feel like drinking water in the colder months and it could be because we tend to drink cold water. Hot water is also hydrating and can be a lot nicer to drink in the winter, give it a try.
Exercise
The studies show that exercise has a positive impact on sperm heath but don’t go mad, too much causes stress in the body. Training for a marathon or going on 50 mile bike rides will probably have a negative impact. Regular 30min – 1 hour sessions of weight training, yoga, cardio or running will probably be beneficial.
Smoking
Smoking not only impairs your chances of conception, it has an impact on the health of the child if you do conceive so it definitely needs to stop.
Sleep
Sleep problems are connected to reduced fertility. Make sure adequate sleep is a priority, ensure enough time in bed, avoid screens before bedtime, and work on stress levels. See more tips to improve your sleep in this post.
Stress
Stress has an impact on hormones and therefore fertility, find ways to reduce it through breathwork/meditation, exercise, alternative therapies, yoga, reducing screen time, and making time for self-care.
Supplements
Vitamin deficiencies or sub-optimal levels of certain nutrients can impact sperm quality, so it can be worth considering supplementation. Choose high quality supplements (don’t just buy them from high street stores as these are often difficult to absorb and a waste of money). The supplement buying guide from Rebecca Fett is a great place to start.
Medicinal mushrooms
Studies have shown that medicinal mushrooms can have a positive impact on fertility and could be worth talking to your healthcare professional about. For example reishi and cordyceps have been used traditionally for many years in Asia and are gaining popularity in Western culture. Nutritional brands like Wild Nutrition now incorporate functional mushrooms into many of their formulas. There was an interesting podcast on Zoe recently if you would like to learn more about their use for widespread health benefits.
Acupuncture
There is now plenty of research into acupuncture and fertility, and it can help both male and female partners. As we have seen above sperm quality is a reflection of the individuals health from a holistic perspective, with many different factors having an impact Acupuncture has been shown to improve stress levels and sleep, can help energy and improve the mind body connection. Listen to this podcast snippet (6 mins) about acupuncture and fertility with Neuroscientist Dr Andrew Huberman to hear more about the research:
Tam Handley offers acupuncture for male fertility in Brighton & Hove and acupuncture for male fertility in London. Read more about acupuncture for fertility here.
Book an appointment online, or get in touch to have a chat.
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