What is “sperm quality” and why does it matter?
If you thought all sperm were created equal, you are wrong! Sperm health has a much greater impact on fertility than most people realize. This article will educate you about sperm and empower you with strategies to improve sperm quality.
“Sperm quality” in a fertility context refers to the health of sperm, particularly their chromosomal normality. Chromosomes carry genetic material which is the blueprint for building an organism. Humans have 23 pairs of chromosomes (46 total), with half of each pair contributed by the egg and half by the sperm.
Discussions and examinations around fertility often focus disproportionately on the egg-contributing partner. But it is crucial to recognize that BOTH egg and sperm quality are vital as each provide 50% of the chromosomal material for an embryo. Male factors are estimated to be the sole cause of infertility in about 20% of cases and to at least contribute in up to 50% of cases. Fertility treatment is simply incomplete without good assessment and support for sperm health!
Sperm quality influences the ability of sperm to successfully fertilize an egg that can then develop into an embryo that results in a viable pregnancy. Improving sperm quality can improve chances of fertilization and subsequent successful pregnancy and birth whether naturally or through assisted reproduction techniques such as intrauterine insemination (IUI) or in-vitro fertilization (IVF). For IVF as an example, healthier sperm can also yield more healthy embryos, and potentially fewer cycles, saving precious time, energy, and money.
My experience with sperm quality
If you are wondering about your sperm health, you are not alone! In my article Got Eggs? How to support egg quality I shared how and why I became interested in egg and sperm quality after experiencing a challenges trying to conceive my second child.
In addition to working on my own egg quality, I realized my husband’s sperm quality could also use some support so I made changes to our diet, lifestyle, and home environment. I also added supplements to improve his sperm development (in addition to supporting my egg quality). And after a couple more chemical pregnancies in the next four months we conceived my son in January 2020!
Click the links to learn more about me and how I work with patients to enhance fertility.
Small but mighty swimmers
Did you know that testes in a fetus are formed by the late first/early second trimester? Descending of the testicles into the scrotum happens in the third trimester and is complete only a few weeks before the due date.
That means that male reproductive health via the testes (which will later produce sperm) is influenced by maternal health during pregnancy and offers another reminder how inter-generational health matters.
Can sperm quality be measured?
Unlike egg quality, sperm quality can be more directly measured!
A conventional semen analysis measures the quantity, motility, and shape (or morphology) of sperm which can provide insight into any issues of sperm health.
An additional test called sperm DNA fragmentation assesses DNA damage in sperm and therefore provides a more direct and useful measure of sperm quality. It is great to have lots of sperm that can move normally, but if a high percentage of them have damaged DNA that can result in fertility challenges.
Can sperm quality be improved?
A common misconception about sperm is that they remain pretty much the same over the lifespan, BUT just like eggs, sperm quality also declines with age. And just like eggs, supporting the health of the place sperm develop (the testes) can reduce the effects of aging and improve sperm quality.
Unlike eggs, which are present in the ovaries as undeveloped follicles from birth, sperm cells are continuously produced by the testes starting at puberty. The entire process, from an immature germ cell to a fully mature sperm capable of fertilization, takes approximately 74 days, or about two and a half to three months. During these important few months there is a huge opportunity to positively affect the health of the developing sperm that may become a baby.
How long does it take to improve sperm quality?
While any improvements to overall health and the testicular environment where sperm are produced can have immediate impact, it is ideal to allow at least three months to see the full effect of any treatment. And beyond three months you can continue to benefit from supporting sperm quality.
What to AVOID to improve sperm quality
What should you NOT do? Many exogenous toxins (harmful substances from outside our bodies) negatively impact fertility by causing chromosomal damage and disrupting hormones. Reducing exposure can have a significant beneficial effect on sperm quality.
Smoking or vaping:
Nicotine is toxic to sperm and smoking is associated with lower sperm count and motility and greater DNA damage. Male smoking seems to have a greater negatiave effect when combined with maternal age greater than 35. We are still learning about health impacts of vaping, but it doesn’t look good, so rather than wait, I recommend patients stop vaping too.
Cannabis (and other recreational drugs):
Cannabis has a clear negative impact on sperm quality, even when used only once per week. Smoking marijuana more than once per week was associated with 28% lower sperm concentration and 29% lower sperm count than male subjects who never smoked marijuana. Most studies are on smoking; edibles and oils have less data so far but there is information on how cannabis constituents affect sperm health that suggests these forms are also harmful. When cannabis is combined with alcohol and/or cigarettes there is even further increased risk. Many other recreational drugs also have negative effects so I recommend avoiding altogether for optimal fertility.
Alcohol:
Daily alcohol intake versus occasional intake negatively affects sperm, especially volume and morphology. Male alcohol consumption is associated with less success in IUI/IVF. Even small amounts can be detrimental, and both partners should consider abstaining for at least 12 weeks before attempting conception.
Medications:
Some medications have known fertility effects. Testosterone supplementation reduces sperm production. Opiates can disrupt testosterone and decrease the quantity and/or quality of sperm with long-term use. Any concerns about current medications should be discussed with your healthcare professional to assess what is safe for you.
Caffeine:
Research on caffeine intake and sperm health has yielded mixed results. Some studies show no relationship between caffeine intake and sperm quality or live birth rates. But other studies have found that over 400mg caffeine per day (about two large cups of coffee) reduces male fertility and four to seven caffeinated drinks per day for the sperm contributing partner delays time to planned pregnancy compared to lower caffeine intake of less than three caffeinated drinks per day. I recommend that patients trying to conceive aim to bring their caffeine consumption to at most three cups of coffee daily before pregnancy is achieved.
Devices:
If you’re attached to your phone, this one is for you! Devices such as cell phones and laptops carried or used closer to the scrotum seem to affect sperm parameters. Avoid carrying your cell phone in your pocket or using your laptop directly in your lap whenever possible. Adding a physical barrier (like a case) and increasing physical distance (at least six inches) seemed to reduce the negative effects.
Environmental toxins:
This is a big topic with data continuing to grow, but it is clear that environmental toxins have a negative effect on both egg and sperm quality. There are simple steps you can take to reduce your exposure to the most harmful toxins immediately.
Bisphenol A (BPA)
BPA is an endocrine disruptor with wide-ranging effects, even from very small amounts. It has been associated with chromosomal abnormalities and increased risk of miscarriage, among many other health risks such as diabetes, heart disease, liver toxicity, thyroid disorders, and other hormonal imbalances. Avoid BPA whenever possible, including:
- Packaging containing BPA: Cans are usually lined with BPA and BPA substitutes can also be problematic so choose packaging other than cans, especially canned tomatoes (worst due to acidity)
- Products coated with BPA, such as most receipts
- Plastics made with BPA: usually number 7 recycling code and avoid hard/clear plastics
Phthalates
Phthalates are widely used in food processing, plastics, vinyl, cleaning/personal care products, nail polish, and fragrances. They are known estrogen and testosterone disruptors, impair egg development and embryo survival, reduce sperm quality, and they may increase likelihood of miscarriage. Reduce your exposure to phthalates by:
- Cook at home more often, using whole/less-processed foods
- Avoid products that list “fragrance” or “perfume” as an ingredient as these often contain phthalates (choose fragrance-free products instead)
- Avoid nail polish (contains high levels of phthalates), fabric softener (choose dryer balls instead), and products made with PVC, such as shower curtains or yoga mats
Plastics
Many plastics (probably all plastics to some extent) also act as endocrine disruptors, including those labelled BPA-free. Reduce your plastic exposure by:
- Never use plastic for reheating, cooking, and food storage (choose glass, stainless steel, or ceramic for food storage, bowls, cups, kettles, colanders, and other kitchenware)
- Hand wash plastics to avoid high heat from dishwasher
- Avoid highly processed foods which are more exposed to plastics via processing and packaging (choose whole/less-processed foods instead)
- Avoid buying/using plastic water bottles, straws, disposable drink cups/lids, plastic bags, and plastic toys (choose glass or stainless steel for drinking, use cloth bags and washable produce bags)
How to improve sperm quality
Now that you know key things to avoid that negatively impact sperm quality, there are several key steps you can take to proactively improve sperm quality starting NOW.
Thorough health evaluation:
Good health = good reproductive health. For any patient working on fertility, the most important starting point is to review what has been assessed and diagnosed (or ruled out) so far. In nearly every case, and especially if patients are embarking on fertility procedures like IUI and IVF, I recommend additional assessment to rule out often overlooked conditions.
Sperm DNA fragmentation
If you remember only one thing from this article it should be this: Sperm DNA quality matters more than conventional semen parameters. The sperm DNA fragmentation test assesses chromosomal damage in sperm which influences both ability to conceive and chance of miscarriage. It is a specialty test that is run by fertility clinics and for which you must pay out of pocket (although in some cases it may be covered by insurance benefits). Often you have to specifically ask for it, but for patients investing thousands of dollars into fertility treatments, spending a few hundred dollars on this test first (and taking steps to improve sperm quality if needed) is well worth it.
Additional testing
Each of these conditions in the sperm contributing partner has a strong link to infertility and miscarriage and are often NOT tested automatically by fertility clinics:
- Insulin resistance
- Vitamin D deficiency
- Low sex hormone binding globulin
- Low (or high) total and free testosterone
Testing can be done in by a medical doctor or can be fairly affordable if ordered by a naturopathic doctor (paid out-of-pocket), especially if you have health benefits that cover naturopathic testing.
Good sleep:
Sleep is vitally important for health, including reproductive health. Poor sleep can wreak havoc with the body’s hormonal balance which of course affects sperm quality. Testosterone is a nocturnal hormone, meaning it is produced at night. Short sleep and later bedtime are associated with lower sperm count, motility, and decreased sperm survival.
The National Sleep Foundation recommends seven to nine hours of sleep per night for adults 26-64 years old. This need seems hard-wired for humans, which means that while we can survive on less sleep, for optimal health and performance this amount is pretty non-negotiable. Getting less than seven hours of sleep per night is consistently associated with many negative health outcomes, and less than five hours of sleep per night carries even more significant health risks.
Key recommendations for better sleep:
- Get into bed at least 8 hours before you need to wake the following day
- At least 1 hour before bed avoid stimulating/stressful activities and dim household lights and screens
- Keep your bedroom cool (18-20 degrees Celsius is recommended) and dark (if you open your eyes in the night, you shouldn’t be able to see anything)
If you still have trouble falling or staying asleep, seek appropriate treatment from a naturopathic doctor. There is so much we can do to improve sleep, you don’t have to struggle!
Nutrition:
Nutrition also has a dramatic impact on health. Most patients tell me they want to eat better and in my experience nutritional advice should be individualized depending on the patient and their needs. Changes are most sustainable when implemented gradually and with accountability and support from a healthcare practitioner educated in nutrition, such as a naturopathic doctor.
When focusing on fertility, there are some basic recommendations that are shown to improve reproductive health:
Carbohydrates and fibre
Diets high in refined carbohydrates are associated with higher rates of infertility in both partners. I recommend:
- Prioritize beans/legumes, nuts, seeds, whole fruit, and especially vegetables: aim for at least 1-2 servings of vegetables at every meal
- Choose whole grains: Whole rolled/steel cut oats, brown rice, wild rice, quinoa, buckwheat, and other whole grains
- Limit simple carbohydrates like white rice, potatoes, corn
- Avoid processed grains like pasta, breads, cereals, quick/instant oats
- Avoid baked goods, candy, dried fruit, and fruit juice
- Avoid white/brown sugar, corn syrup, rice syrup, agave, and artificial sweeteners, choosing minimal amounts of more natural, less processed sweeteners like maple syrup, honey, molasses
Fats
Higher intake of saturated fats is associated with worst fertility outcomes, while higher intake of healthy fats are associated with better fertility and lower miscarriage rates. I recommend:
- Limit saturated fats found in red meat, butter, and coconut oil
- Increased healthy fats found in olive oil, nuts, seeds, plant-based oils, and fish
Protein
Finally, many adults do not eat sufficient protein. Proteins provide essential amino acids necessary for health, including hormonal health and reproduction. Aim for at least 0.5-1 gram of protein per pound (1-2 grams per kilogram) of target body weight daily. Here are some examples of protein content for various foods:
- Chicken or turkey breast OR extra-lean ground beef (3 ounces): 25-26g
- Halibut OR salmon (3 ounces): 18-21g
- Pea or whey protein powder (1 scoop): 20-24g
- Greek yogurt (half cup plain, whole) OR mozzarella cheese (1.5 ounces): 11-13g
- Lentils (half cup cooked) OR Pumpkin seeds (1 ounce) OR Tofu (firm, half cup): 9g
- Soybeans OR black beans OR pinto beans (half cup, cooked): 8g
- Chicken egg (1 large) OR Almonds (1 ounce) OR Nutritional yeast (2 Tablespoons): 6g
- Chia seeds OR hemp hearts (1 Tablespoon): 3g
Exercise:
Did you know that sperm concentrations are significantly higher in men who exercise and strength train at least two hours per week. Even moderate exercise is associated with better fertility. But beware that excessive exercise can negative impact fertility IF caloric and macronutrient intake do not match energy demands.
However, cycling, especially intense cycling, may worsen semen parameters, possibly due to increased temperature in the scrotum. If cycling is your exercise of choice, take a break to cool down every 30 minutes or less.
Supplements:
There are so many supplements marketed for sperm health, but it is best to work with a naturopathic doctor to tailor a plan to your needs and ensure safety and efficacy. A few commonly used supplements to support sperm quality:
- Omega-3 Fatty Acids can improve functionality of sperm and are associated with higher normal morphology and less DNA damage
- Coenzyme Q10 (CoQ10) enhances energy production in developing sperm cells, improving sperm concentration, motility, morphology, and DNA integrity. There are variations in dosing and form depending on your needs, so best to seek professional advice.
- N-acetyl-cysteine (NAC) can improve total motility and morphology while reducing DNA fragmentation. It is not right for everyone and can cause minor side effects, so speak to a professional if you think this may be right for you.
Beyond these basics, there are many other supplements than may be indicated to support fertility, so work with a naturopathic doctor to find out what is right for you.
Ready to work together?
Book a free 15 minute Meet and Greet consultation to learn more about me, Naturopathic Medicine, and find out if this is a good fit for you or click the links to learn more about me and how I work with patients to enhance fertility.
