The Importance of Fertility Testing For Men

For a couple that's ready to start a family, fertility evaluation should involve both partners. Often, it's assumed that, because only people who ovulate become pregnant, infertility is a "women's issue". This is simply not the case.

People assigned male at birth are equally as affected by infertility as people assigned female at birth. Evaluating male fertility health can be the first step toward a successful and healthy pregnancy.

The Myth of Male Fertility

Because the discussion around fertility has historically focused on women, men are often either left out of the conversation or feel that infertility does not apply to them.

"Male factor infertility is actually quite common, and certainly a lot more common than people realize," says fertility specialist Sanaz Ghazal, MD, co-founder of RISE Fertility.

Ramy Abou Ghayda, MD, chief medical officer of at-home fertility solution Legacy and assistant professor of urology at University Hospitals in Ashland, Ohio, notes that 30-50% of infertility cases involve the male partner.

"There is a big cultural and social pressure," says Dr. Ghazal. "Male fertility has been for the longest time considered a stigma and taboo subject. Toxic masculinity and classic gender expectations and prejudice have dictated the narrative around this topic. Sperm is half of the future baby, and its health is just as important as egg health."

Because of this stigma, there can be a certain sensitivity around discussions of infertility in people assigned male at birth.

"They can feel like it’s questioning their manhood or their masculinity," says Dr. Ghazal. "It's important for men to understand the factors as well as their options and to realize that most of the time male infertility is not their fault. It’s nothing that they did wrong or shouldn’t have done. It’s just their biology."

The conversation around infertility is changing in ways that are beneficial to both men and women. By opening up the conversation to both partners, there is a better chance of finding the right treatment and seeing its success.

What Affects Male Fertility?

Dr. Abou Ghayda points out that for men, fertility is assessed by looking at certain parameters like sperm count, sperm shape and structure, and how they move. Of these parameters, research shows as high as 90% of fertility issues are linked to sperm count.

"Male fertility is an impressive, complex process," says Dr. Abou Ghayda. "Semen parameters are de-facto the best predictor of male fertility. Even though we have established many elements that are correlated with semen parameters, the scientific research is still in its infancy, and often the level of evidence supporting these associations is weak."

These parameters can be affected by a number of internal and external factors, such as age, stress, chronic diseases, infections, and medications, as well as exposure to heat or radiation and lifestyle choices like smoking, excessive alcohol use, physical inactivity, or eating a diet heavy in processed foods and red meat.

From the ages of 30 to 40, men will typically see a 52% decrease in their fertility rate. And men aged 45 years or older are nearly 13 times more likely to take more than two years to conceive when compared to men aged 25 or younger.

Conditions such as diabetes, celiac disease, hypertension, cystic fibrosis, varicocele, spinal muscular atrophy, sickle cell disease, as well as urinary tract infections and certain sexually transmitted infections (STIs) can negatively affect fertility. Medications can have an impact, as well. Consult with your doctor and a fertility expert if you take immunosuppressants, antidepressants, anticonvulsants, antihypertensive agents, or anti-rejection drugs.

Who Should Get Tested?

Signs of potential infertility can be less visible in men than women, suggests Zaher Merhi, MD, FACOG, HCLD, a reproductive endocrinologist in New York City.

"For example, when a woman starts to have irregular periods, it is obvious that she might have ovulation issues," Dr. Merhi says. "Additionally, there is a misconception among men that if they ejaculate, they are fine, which is not true."

For this reason, it's important that men who are trying to conceive or are thinking of starting a family undergo fertility testing. Dr. Abou Ghayda recommends proactively testing sperm health, as opposed to waiting until after the traditionally advised 6 to 12 months of trying to conceive.

Alternatively, some individuals aren't ready for a family just yet but are planning for the future. Sperm can be frozen for any number of reasons. It's common for transgender folks, military personnel, and people that are about to undergo cancer treatment to freeze their sperm in hopes of preserving it at its youngest, healthiest state. Fertility testing before this process is important to ensure healthy, fertile sperm.

For individuals that have gotten a vasectomy or vasectomy reversal, Dr. Abou Ghayda recommends testing 12 weeks after the procedure to determine whether it was successful. Similarly, after a vasectomy reversal, the doctor suggests sperm testing every month for a year to ensure there's been a full recovery.

Same-sex couples, men on testosterone or hormone replacement therapy, and individuals that are simply seeking more data on their health should also undergo testing.

"There are strong associations between male infertility and obesity, metabolic syndrome, elevated blood pressure, testicular cancer, lymphoma, and even mortality," says Dr. Abou Ghayda. "Sperm health may be a biomarker for overall health."

The fertility test itself is a simple process. In consulting with a fertility specialist or your sexual health doctor, patients are often given the option to either collect a sample in the doctor's office or at home and bring the sample to the appointment. Alternatively, more contemporary options exist for at-home, mail-in testing.

Improving Fertility

Many adverse influences on male fertility are receptive to changes in lifestyle and health habits. And there are plenty of steps to take for increasing male fertility.

But some methods can be misleading. Dr. Ghazal recommends practicing caution in taking supplements or over-the-counter treatments that claim to promote fertility. In some cases, such as with testosterone or steroids, these options can even have the opposite effect and be harmful.

Instead, Dr. Ghazal recommends prioritizing a healthy lifestyle by introducing vitamins, a balanced diet, and regular exercise into your life.

"And don't be afraid to talk to a fertility specialist," says Dr. Ghazal. "We can help you understand your risk factors and look at your lifestyle and medical history to see if there could be anything contributing."