In our previous article, The Worried Man’s Guide to Getting a Semen Analysis, we explained what happens when a man is told he needs to get a semen analysis done. For some men, the semen analysis results will come back normal and there is nothing further to do. Just keep trying!
However, some men find out their semen analysis results were abnormal – meaning there is something wrong with sperm count, motility (the ability of the sperm to swim), or morphology (the sperm’s shape).
So, what happens now that you know your semen analysis results are not normal?
Time to see the urologist.
Most likely, you’ll be encouraged to make an appointment for an evaluation by a urologist who specializes in male fertility. The purpose of the evaluation is first to see if a clear cause for the abnormal semen analysis results can be identified and possibly corrected. And second, even if no clear cause can be identified, there may still be treatment that can improve things.
During your first visit, the urologist will take a thorough health history and do a basic physical exam. Once you complete these first steps you may need to complete some additional diagnostic testing.
Why is my history important?
What questions does the ‘history’ try to answer? There are several factors in your history that may be impacting your sperm health. Some of these are lifestyle factors (smoking, drinking alcohol, etc.) while some are medical (health problems, past surgeries, etc.).
Some doctors will ask you to fill out a ‘fertility questionnaire’ exploring those issues. You can expect to answer questions like these:
- Have you ever fathered a pregnancy before? If so –how, when, and with whom?
- Are you currently dealing with any health problems?
- Do you take any prescription medications?
- What over the counter products do you take regularly?
- Have you ever been in the hospital?
- Have you ever had any surgery?
- Are there any issues with your sexual function?
- Do you smoke? If so, how much?
- How much alcohol do you drink?
- Do you use any other drugs, such as marijuana?
- Do you ever use a hot tub?
What happens during the physical exam?
Next, the doctor will do a brief physical exam which, understandably, will focus on the scrotal area. The exam will typically check things like the size and consistency of the testicles, and whether a varicocele is present. Approximately 15% of all adult men have a varicocele. A varicocele is a painless condition in which the veins around the testicles are dilated. A varicocele is a very common cause of an abnormal semen analysis.
Do I need to do any more diagnostic tests?
Once your history and physical exam have been completed, the doctor might suggest some additional diagnostic tests such as blood tests or ultrasounds.
The blood work usually includes tests to check the levels of important reproductive hormones, including testosterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH). In certain cases, particularly if the sperm count was extremely low, you may have to undergo blood tests that check for genetic abnormalities.
Ultrasound tests use sound waves to make images of the body. The doctor may suggest that you get an ultrasound scan to look more closely at your scrotal contents or prostate gland.
How can I improve my semen analysis results?
Once the evaluation is complete, the doctor may suggest possible treatments. If a varicocele is the problem, it can be repaired surgically. If further diagnostics show that hormone levels are too low, medication may be able to improve them.
If sperm motility (ability for the sperm to swim) and morphology (sperm shape) issues are present, certain lifestyle changes may be helpful.
Several studies have linked cigarette smoking to lower sperm count, motility, and morphology. Other research has shown that smoking also increases levels of oxidative stress in the semen and can lead to sperm DNA damage and genetically abnormal sperm.
Excessive alcohol consumption has been shown to impair normal sperm. The evidence regarding moderate alcohol intake is less clear. However, most experts agree it’s best to avoid more than one drink per day.
The likelihood of a woman becoming pregnant is much higher when you have intercourse in her “fertile window.” This window begins three days immediately leading up to and including ovulation. You can determine when the woman ovulates either by using basal temperature charts or with an over-the-counter ovulation predictor kit.
The frequency of intercourse during the fertile window generally doesn’t matter. Although earlier studies seemed to show that several days of abstinence might increase sperm counts, more recent findings indicate that more frequent intercourse may, in fact, be better.
Avoid the use of any artificial lubricants such as K-Y Jelly® or Replens® which can be toxic to sperm.
The testicles should be cooler than the rest of the body for optimal sperm production. The harmful effect of a varicocele on sperm production may result from the extra warming of the area due to dilated veins.
While there is no scientific evidence to support the claim that boxer style shorts are better than jockey type, it is important to avoid other sources of heat exposure to the testicles such as hot tubs, laptop computers, high-temperature work areas, or prolonged baths.
Eating a healthful diet rich in fruits, vegetables, and whole grains can be beneficial for sperm function and male fertility. Drinking enough water to stay well hydrated is also important.
Moderate exercise may be beneficial. Aim for at least 30 minutes of moderate physical activity (walking, running, cycling, swimming, etc.) every day.
If your work or hobby brings you into contact with environmental dangers you may be unknowingly impairing sperm production. Some environmental dangers include pesticides, solvents, organic fumes, or radiation exposure.
Harmful Nutritional Supplements
Nutritional supplements that provide hormone-like substances such as DHEA or “andro” can actually impair fertility by stopping sperm production. If you are taking any of these types of supplements, or other products intended to build muscle mass, it’s best to stop.
Medications That Impair Fertility
Certain medications or medical treatments can interfere with sperm production. Radiation treatment for cancer can impair testicular function. Many chemotherapy drugs will have a permanent effect on production. Some drugs, such as testosterone replacement therapy, can stop sperm production. This is a temporary effect that should reverse within a few months of stopping the testosterone. Your urologist or fertility specialist should be able to guide you regarding your medication use while you are trying to conceive.
Vitamins C and E
Vitamins C and E are essential antioxidants that protect the body’s cells from damage from oxidative stress and free radicals. Vitamin C is the most abundant antioxidant in the semen of fertile men. It contributes to the maintenance of healthy sperm by protecting the sperm’s DNA from free radical damage.
Vitamin E is a fat-soluble vitamin that helps protect the sperm’s cell membrane from damage. Vitamin C functions to regenerate vitamin E, thus these vitamins may work together to improve sperm function. Selenium is a trace mineral that also functions as an antioxidant and it is thought that is work with vitamin E to support healthy sperm motility.
L-carnitine is an amino acid derivative. Your body produces it naturally and you can get it from some foods. L-carnitine transports fat so that your body can use it for energy. Most importantly, L-carnitine has antioxidant properties. L-carnitine provides energy for the sperm and supports healthy sperm movement. Rich food sources of carnitine are meat, fish, poultry, and milk.
Zinc and Folate
Zinc is an essential trace mineral that is important for healthy sperm. Folate is a B-vitamin that is necessary for DNA synthesis. Together these nutrients have been shown to support healthy sperm function. Folate rich foods are spinach, liver, asparagus, and brussels sprouts, but it is also present in many other foods, such as dark green leafy vegetables, nuts, beans, peas, seafood, and dairy products. Oysters contain more zinc per serving than any other food, but other good food sources include beans, nuts, crab and lobster, whole grains, fortified breakfast cereals, and dairy products.
If your semen analysis results are less than normal, do not lose hope! After a thorough evaluation, you may be able to improve your semen parameters, depending on the findings. It may take two or three visits, but hopefully, your semen analysis results will improve after appropriate treatment and lifestyle changes.
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