Male fertility

The primary test is a semen analysis, which evaluates sperm count (concentration), motility (how well sperm swim), and morphology (shape). Depending on results we may recommend hormone testing (testosterone, FSH, LH), genetic testing, or referral to a reproductive urologist for further evaluation.

WHO 6th edition (2021) reference values consider normal to be a concentration above 16 million sperm per millilitre, total motility above 42%, progressive motility above 30%, and morphology (strict Kruger criteria) above 4% normal forms. These are statistical lower reference limits drawn from fertile men, not a pass/fail line — a single result below one of them is not a diagnosis of infertility.

Yes. Sperm regenerates roughly every 72 days, so changes to diet, weight, alcohol use, tobacco, marijuana, sleep, and heat exposure (hot tubs, laptops on laps) can measurably improve parameters within three months. Our Tips for Men resource covers this in detail.

ICSI is used for significant male-factor infertility, prior fertilization failure, and when using surgically retrieved sperm. In our practice we may also recommend it without a male-factor indication, because it ensures the sperm penetrates the egg and prevents polyspermy, which reduces the chance of an abnormal chromosome count.

Azoospermia means no sperm are found in the ejaculate. It's classified as obstructive (sperm are being produced but blocked) or non-obstructive (sperm production is impaired). In many cases sperm can be surgically retrieved from the testicle and used with IVF/ICSI, so azoospermia is not the end of the road.

For meaningfully abnormal semen analysis results, azoospermia, a varicocele, prior groin surgery, or hormone abnormalities, referral to a reproductive urologist is often valuable — they may identify a correctable cause. For mild abnormalities, IUI or IVF often addresses the fertility issue directly without requiring urology intervention.

Sperm quality declines gradually with age. Older paternal age is associated with modest increases in miscarriage risk, in certain rare single-gene conditions, and in some neurodevelopmental conditions including autism. The absolute increases are small.

A two-to-five day abstinence window is the historical convention, but longer intervals tend to produce a poorer sample. Current evidence does not support prolonged abstinence, and frequent ejaculation has been shown to support motility while maintaining count. Follow whatever instruction your physician gives you for your own analysis. We can provide a home collection kit — the sample needs to reach the clinic within one hour and be kept at body temperature in transit.

Yes — sperm can be frozen before chemotherapy, radiation, or gender-affirming procedures that would affect fertility. The process is straightforward, can typically be scheduled within days, and frozen sperm remains viable indefinitely. If you're facing a fertility-affecting treatment, do not wait to ask.

On a strict reading of the evidence, antioxidant supplements have not been shown to benefit men with abnormal semen parameters, including those with elevated sperm DNA fragmentation.