Functional Fertility: Male Factor

This post is the second in a series about functional fertility. Start with Functional Fertility Basics. You may also want to read the related post Prepare for Fertility and Conception with Functional Medicine.

Let’s talk about the guys!

50% (that’s right, half) of known infertility is due to “male factor” causes. This comes as a surprise to most women and men.

We tend to think that infertility is a woman’s problem. In fact, a recent study showed that only 41% of OB/GYN physicians even considered an evaluation of the male partner.

Perhaps this is why women are typically the ones who seek help before men. Also, women tend to be more willing to get a thorough exam, which can involve invasive procedures like a blood draw, pelvic exam, laparoscopy, and a fallopian tube plumbing check (a hysterosalpingogram, or HSG).

A man starts with a simple physical exam, a blood draw, and a semen sample – less invasive than what women go through. Sometimes it’s only a semen sample.

Men don’t want to find out there’s a problem with their sperm or semen, to the same degree that we women don’t want to hear our fertility is comprised! Silly or not, we often tie this into our self-esteem as a man or a woman.

Male factor infertility

Male factor infertility is usually due to sperm production issues. These include abnormal morphology (shape), low count, and poor motility. These alterations from the norm must be in one of two samples, collected one and four weeks apart. Be warned, some doctors will only test count, or count and motility, and leave out morphology. Ask for two tests, with all three parameters! While you’re at it, ask for anti-sperm antibodies and liquefaction status (more on these below).

The World Health Organization (WHO) criteria for functional sperm is based on:

Sperm count

Infertile sperm count is fewer than 15 million sperm in 1.5 mL of semen. The average is 60 – 80, and optimal is above 80.

Sperm motility

Sperm can move forward slowly or quickly. Sometimes we call slow sperm “sleepy.” To be effective, we want sperm to move through cervical fluid at a velocity of 25 micrometers per second. We also want more than 40% of the swimmers to make it past the cervix into the uterus.

Sperm morphology (shape of head and tail)

Normal spermatozoa have oval heads with long, straight tails. Abnormal sperm shape can mean the head is doubled, crooked, or oversized, or the tail is crooked.

Guys, at least 4% of your sperm must be normal to be fertile. The average is 15%. This means that on average, 85% of sperm are abnormally shaped!

Other male factors

Other, less common male factors include:

  • Structural abnormalities that men can be born with or that can result from surgery or infection.
  • Sperm production problems from prior vasectomies or varicoceles (scrotal varicose veins).
  • Ejaculation disorders such as retrograde ejaculation or erectile dysfunction.
  • Immune problems such as anti-sperm antibodies.
  • Endocrine (hormone) disorders that affect sperm production.
  • Thick, viscous sperm that does not liquify within 20 minutes.

Where to start?

First and foremost, men, get a physical exam that includes a prescription for a blood draw and a semen analysis. See a reproductive specialist. This can be a urologist or a reproductive endocrinologist. This should identify if you have a known male factor.

Male infertility can be a sign of a deeper and serious problem, so it is important to get checked by an expert!

Sorry, guys: no alcohol, weed, or cigarettes

This reveiw of studies concludes that alcohol definitely decreases sperm count, motility, and percent of normal shaped sperm.

Marijuana can increase ejaculation problems, erectile dysfunction, and impotence, as well as reduce sperm count and motility.

There is no doubt that smoking significantly reduces sperm count and motility, and lowers semen volume, as shown in this review of studies.

Exercise like Goldilocks

Studies show that moderate exercise, specifically one hour of exercise three times weekly, improves sperm count, motility and shape.

However, more frequent and vigorous exercise can have a negative effect!

The best approach, as with many things in life, is moderate exercise. This review of studies goes in-depth into the effects of different types of exercise on sperm.

Protect your junk

Sperm exposed to radiation from cell phones may have a lower count, motility, and damaged DNA! Don’t keep your cell phone in the pocket of your pants. Use a wired headset and keep your phone off your body. Unfortunately, radiation increases in small contained spaces like CARS!

Tight clothing and hot tubs may impair sperm production, because of higher scrotal temperature.


In the next post we delve deeper into things you men can do to optimize sperm with natural approaches.

I welcome your comments and questions below,

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