Men considering their fertility might also be wondering where to begin. More than 40% of the problems that cause infertility are related to male factors. Around 1 in 20 men will struggle to conceive yet public awareness of this is not high.
The first place to start is self-examination, which is an important part of understanding your own fertility. All men should be aware of their bodies and be able to identify problems early. Each testicle should be examined separately rolling it gently between the thumb and forefinger. The surface to the testicle will feel smooth and should not have any lumps or bumps or tenderness. Familiarise yourself with your own anatomy and the structures of the epididymis and the spermatic cord. Always ask a specialist if you are uncertain or if you notice any unusual lumps or bumps.
Testicular size is an important marker of normal function. However, most men will not have anything to compare their testicular size to. At puberty the testicle is around 8mls volume. A study in the British Medical Journal in 2001 observed that an alternative way to assess testicular volume was to compare testicular size to a ‘Celebrations’ Malteser chocolate sweet, which happens to be 8mls in volume.
Adults are expected to have testicles around 20mls in volume and this has been associated in the literature with normal function and normal semen parameters. As testicular volume decreases this has been linked linearly to worsening sperm parameters. So if you are wondering if your testicles are a normal size buy a box of celebrations chocolates and if your testicle volume is about the size of two Malteser sweets then you are probably doing ok.
Most men will know if they can maintain an erection and successfully ejaculate. However, this tells us nothing about the content of the ejaculate. A man’s ejaculate is composed of two main components. The first is seminal fluid (semen) and the second is sperm cells (sperm). If you ejaculate it is possible that there are no sperm in the ejaculate. This is an unusual finding but the only way to check if a man is producing sperm is through successful natural conception or a laboratory semen analysis test is performed.
If you have been struggling to conceive for a year with a partner then your GP should arrange for a semen analysis test through the NHS. The easiest way to check whether your sperm count is normal is to find a fertility clinic and book in for a semen analysis test.
A sperm analysis test involves first abstaining from sexual intercourse or masturbation for 2-3 days before the test. You will need to masturbate to produce a fresh ejaculate sample into a small pot. This can be done at home or in many cases will be done at the fertility clinic itself in a private room. The sample will be analysed and the sperm parameters checked.
The four parameters of interest are:
1) Sperm volume ( >1.5mls)
2) Sperm concentration ( >15 million/ml)
3) Sperm motility ( >32 % progressive)
4) Sperm morphology ( >4%)
Home sperm testing kits have become increasingly popular recently due to the ability to take the test and obtain the results from the comfort of your own home.
Exseed Health are the most prominent home sperm testing company on the market in the UK. Receive 15% off any online purchases by using the discount code TOTALFERTILITY15 at checkout.
Lifestyle, Diet & Nutrition
Tobacco smoking is considered as one of the major factors leading to male infertility. It is clear from studies that smoking has a detrimental impact on both the quantity and quality of sperm. It is thought that the toxins contained in cigarettes might be harmful to male germ cells and their development. Smoking does not seem to affect male hormones so the mechanism of injury to sperm is damage due to nicotine and the toxins in tobacco. Several studies have shown that tobacco smoking is associated with a reduced sperm count and a higher number of abnormal sperm in the ejaculate. If you are wanting to quit smoking and looking for support you can become Smoke Free.
Alcohol consumption has been shown in several studies to have a detrimental impact on the male reproductive system. Alcohol seems to alter semen parameters and affect the testes. In most cases low levels of alcohol probably have minimal impact. However, some individuals may be more susceptible to sperm damage than others. Alcohol consumed in high quantities can cause testicular and liver damage and in some cases lead to impotence and more severe problems. The vast majority of people who consume low levels of alcohol will not see an impact. Though if you are noted to have poor quality sperm it may be an important factor to consider.
Underwear choice really can impact on the quality of men’s sperm. A study from Harvard looked at men’s choice of underwear and found that men that wore boxers more frequently had 25% higher sperm concentrations than men who wore other types of underwear. Men who wore boxers were also found to have around 33% higher numbers of actively swimming sperm. It was noted in this study that men who wore tighter underwear were still found to have sperm counts in the normal range. Therefore the take home message here is that men that are struggling to conceive naturally may want to look closely at their choices of underwear.
Sex frequency was studied by a Chinese research group in 2018, which looked at the impact of short periods of abstinence on the quality of sperm. It studied the frequency of sexual intercourse and found that it appears to be beneficial to have regular intercourse as this can improve sperm parameters. After many years of research it is felt that having more frequent sex produces sperm of better quality, increasing the likelihood of a successful pregnancy.
There are many dietary, nutritional and lifestyle changes that you may want to consider to give your sperm the best chance. Read our article on optimising sperm to understand more about how to approach this.