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Male fertility
Beyond the sperm count: understanding the many causes of male fertility challenges
Male factors are thought to contribute to around half of infertility cases, yet male fertility often receives far less attention than female fertility, even though both partners contribute to the fertility picture.
A semen analysis is an important starting point, but the headline numbers don't always tell us everything. I look at the actual results alongside your health and reproductive history, lifestyle, relevant medical factors and what has happened so far when trying to conceive or during fertility treatment.
Depending on the individual picture, there may also be reasons to consider whether further male fertility investigation would be useful.
The aim is to understand the male side of the fertility picture properly, rather than simply whether a semen analysis has been described as “normal”.
Factors that may be relevant
Physical
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Varicocele
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Previous testicular injury or trauma
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Previous surgery or other relevant medical history
Infection & inflammation
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STDs
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Genitourinary infection
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Semen culture findings
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Signs of inflammation
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Relevant microbiome findings
Sperm & semen parameters
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Morphology
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Concentration and total count
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Motility
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DNA fragmentation
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Oxidative stress
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Antisperm antibodies where relevant
Medical & hormonal
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Certain medicines and drugs affect sperm quality
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Testosterone and reproductive hormones
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Thyroid health
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Other relevant medical conditions
Lifestyle & environment
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Diet
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Smoking
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Alcohol
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Weight & metabolic health
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Heat exposure
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Occupational or enviroinmental exposures
Looking beyond a standard semen analysis
A semen analysis can give us useful information about sperm concentration, motility and morphology, but in some situations there may be a reason to look further.
I review the results you already have alongside your history before considering whether any additional investigation may be worth discussing with an appropriate specialist.
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Diagnostic semen analysis: count, motility, morphology, MAR testing, white blood cells, pH
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DNA fragmentation: to assess the quality of the DNA, which is essential for conception and a healthy baby. Fragmented DNA is associated with IVF failure, poor blastocyst development, implantation failure, early miscarriage, and infertility.
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Semen microbiome
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Physical examination and testicular ultrasound with a urologist
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Blood tests: LH, FSH, prolactin, testosterone, thyroid hormones
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Genetic testing in certain cases – Y chromosome microdeletions or karyotyping
I consider the biomedical findings alongside my assessment from a Chinese medicine perspective, and acupuncture treatment is tailored to the individual rather than to a semen analysis result alone.
Where something requires investigation or treatment outside my scope, I refer or recommend that you discuss it with an appropriately qualified medical or fertility specialist.