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It takes two . . .

In my experience, long term infertility is usually a two person problem with issues on both sides. If the eggs are amazing, the sperm can be so-so and the magic should still happen. If the sperm is amazing and the eggs are so-so, the magic should still happen. In the majority of cases that we see, there are issues on both sides. On one side the issues may be more significant, but rarely do we find that the issues are all one sided.


So - if you are starting to contemplate complicated female fertility testing, get a semen analysis done. Ideally more than once.

Sperm parameters change like the wind - sleep, stress, food intake, how long since he last ejaculated, whether he had a sniffle last week, how long since he last had a hot bath - all these things and more can influence a semen analysis. The same man could find his results vary week to week so if an issue comes up, test again a couple of months later as sometimes the issues are transient.


If possible, pay for a private test at a clinic that specialises in male fertility, the quality control is higher than the standard NHS test and the results provide more detail than the standard NHS test. In the past year I have had multiple clients be given terrifying semen analysis results through their GP, but yet when examined at a quality controlled non-NHS lab the results were much less scary (there's an NHS lab near me that seems to hand out 0% morphology or 0% motile sperm reports like smarties).


There are many things to pay attention to in a semen analysis:


These things all have a relationship to one another - Concentration and Volume are used to compute Count.

The absence of sperm in a semen analysis is an issue for around 10% of men struggling with infertility. This is known as 'Azoospermia'. If he has a semen analysis that shows azoospermia, the first thing is to retest - ideally a month later. There are some transient reasons for azoospermia (passing illness or infection, toxic exposure etc).

If the situation persists, he needs to see a urologist to determine whether obstructive or non obstructive.

  • Obstructive azoospermia is due to something blocking the pipes - sometimes that can be cleared, or surgical sperm retrieval may be an option.

  • Non obstructive is either an issue with sperm production, or an issue with hypothalamus/pituitary/testes hormone feedback loops. It is important to see a urologist to work out what is causing the azoospermia, rather than rush straight into IVF as it can often be resolved.

If there are issues with count, then the next step would be to check some of the basic male hormones - FSH, LH, Testosterone, Oestrogen and the thyroid hormones. Again, this is rarely done.


This is an indicator of how fast the sperm are swimming. In a good comprehensive test, motility will be broken down into four categories:

  • A: rapid progression

  • B: slow progression - swimming in a circular/spiral pattern

  • C: twitching, but not swimming forward

  • D: not moving (possibly asleep, possibly dead or dying)

Motility is given as a percentage of the total amount of sperm - so to make sense of this you need to look at the number of sperm and work out the total number of progressively motile sperm which is known as the Total Motile Sperm Count (TMSC).

In my experience, low motility is often associated with infection or with inflammation. It is worth putting the time into investigating this because the cause of poor motility is likely to have a negative impact on the quality of the sperm DNA.

A high percentage of immotile is a concern, unless the abstinence window was too long. Sperm pile into the 'departure lounge' where they can survive for a certain period of time before perishing. If it has been over 5 days since the previous ejaculation, you are likely to see a high percentage of immotile sperm and increased amounts of debris. If that is the case, a retest is advised with an abstinence window of 2-3 days.


One thing to pay attention to in a semen analysis is the sperm morphology. Low sperm morphology is often an indicator of sperm DNA fragmenation issues so if this shows up, take it as a hint to dig more deeply into male fertility (more on sperm DNA fragmentation later in the series!).

Other aspects of a semen analysis

 pH is a good one to pay attention to - in my experience a pH of over 8 is often linked to infection, and pH under 7.2 suggests a blockage in the seminal vesicles.

Is there a lot of debris (indicated by ++ or +++) and if so, what is the cause of that? Infection, toxic exposure, inflammation?

Is there a comment about the colour, the viscosity, round cells - there are so many aspects of a semen analysis that can help us to work out what to look at next.

It is frightening how often I find women being pointed towards IVF when the sperm health is poor when an appointment with a urologist or andrologist would be a more logical option. If you are going into IVF with poor sperm health, it will be even more difficult to land on the right side of the success statistics (not impossible, but definitely more difficult).


When it comes to improving sperm health, diet, lifestyle, stress and sleep can all make a huge difference. Yes, sometimes there are infections, varicocele, hormone regulation issues, problems with the plumbing, but often we find sperm health is sub optimal simply due to diet and lifestyle habits. The most sensible thing to do when faced with a poor semen analysis result would be to invest in a good male fertility supplement such as Naitre or Nua Fertility for Men and commit to cleaning up your diet and lifestyle for a few months. In many cases that is enough to make a significant improvement to a semen analysis.


I'm a Fertility Support Trained Acupuncturist. Yes, we do the acupuncture magic stuff - but we also know a lot about the science of fertility and how to investigate it properly.


Stay tuned for the rest of my 12 Days, 12 Posts - and if you think someone needs to be following this series, please share.

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