One of the first questions I ask my (mostly female) patients who come to see me for acupuncture to support fertility is: has your partner done a semen analysis? What is the health of their sperm?
Low sperm count and concentration and poorly formed sperm can reduce the likelihood of achieving natural conception and if conception does take place, embryo development can be impaired. Sperm health can impact miscarriage risk and some studies suggest up to 50% of recurrent miscarriages may have a paternal genetic component.
Quality of sperm is declining over time
The sperm health factor is increasingly an issue in fertility because sperm parameters have been declining over recent decades, particularly in Western countries. It’s not a pretty picture. Here’s an overview of the key findings:
- Studies have shown roughly a 50-60% decline in sperm counts between 1973 and 2011 in men from North America, Europe, Australia and New Zealand
- This decline appears to be accelerating, with a particularly steep drop noted since the year 2000
- Research indicates declines in both sperm concentration (number of sperm per millilitre) and total sperm count.
- A 2022 meta-analysis found a significant decline in motility (sperm movement) of about 14% over the past decade.
- The ability of sperm to maintain motion over time (vitality) has also shown declining trends
- Studies have shown a decrease in the percentage of normally-formed sperm (morphology). This is reflected in the dramatic change in WHO guidelines – from considering 50% normal morphology as the threshold in the 1980s to just 4% in 2010.
The WHO has updated its reference values for semen parameters (what is considered normal) several times to reflect these changes. The reference values are declining.
1980s guidelines:
- Sperm concentration: ≥20 million/ml considered normal
- Total motility: ≥60%
- Normal morphology: ≥50%
2010 guidelines showed significant lowering:
- Sperm concentration: ≥15 million/ml
- Total motility: ≥40%
- Normal morphology: ≥4%
Due to the significant decline in sperm parameters the recent WHO guidelines can be considered as baseline thresholds, rather than optimal values. The quality of semen has declined so significantly over time that we just don’t commonly see the former levels anymore. And for fertility, the recent guidelines are not an accurate indication of the sperm health required to support natural conception. In my clinic, I am looking for much higher parameters to consider that natural conception is a possibility.
Understanding how the sperm parameters impact fertility
Here’s how each sperm parameter affects fertility:
Concentration & Count:
- Lower numbers reduce the chances of a sperm reaching the egg
- Even if other parameters are good, too few sperm makes natural conception difficult
- Total count matters because volume helps sperm survive the acidic vaginal environment
Motility:
- Crucial for traveling through the female reproductive tract
- Sperm must swim ~15-18cm to reach the egg
- Need to maintain movement for 48-72 hours to allow time for egg fertilization
- Progressive motility (straight-line swimming) is especially important (we don’t want sperm swimming in circles!)
- Poor motility often means sperm exhaust themselves before reaching the egg
Morphology (sperm shape/structure):
- Affects ability to penetrate the egg
- Normal head shape needed to attach to egg surface
- Proper tail structure required for efficient swimming
- Midpiece contains mitochondria for energy – defects here affect stamina
- Abnormal morphology often indicates genetic issues that could affect embryo development
The combination matters too:
- Problems in multiple parameters compound each other
- For example, low count plus poor motility dramatically reduces chances
- Some issues can be overcome with assisted reproduction (IUI, IVF, ICSI)
- However, severe morphology problems may require careful sperm selection even with IVF
What is causing the decline in sperm health?
The causes of this decline are likely multifactorial, with researchers pointing to:
- Environmental toxins and endocrine disruptors
- Changes in lifestyle factors (diet, exercise, smoking)
- Increased exposure to plastics and chemicals
- Higher rates of obesity
- Delayed parenthood
What can you do?
Get your sperm tested early! See this accompanying blog post to understand why this is particularly important.
There is a range of diet and lifestyle modifications to support sperm health. Your practitioner can advise you on these and it typically includes drinking enough water, cutting the alcohol, avoiding drugs, eating real food, avoiding the laptop on your lap and mobile phone in your pocket, and avoiding overheating activities such as saunas. Nutritional supplements such as zinc and anti-oxidants, among others, have been shown to improve sperm health.
Depending on the outcome of the semen analysis you may be recommended to have a physical examination and treat any underlying conditions (varicocele, infections) that may be impacting the sperm.
Acupuncture and Chinese herbal medicine can also help in specific situations and you should discuss this directly with your local practitioner to understand what might be possible.
Medication interventions such as Intrauterine Insemination (IUI), In Vitro Fertilization (IVF) and ICSI (Intracytoplasmic Sperm Injection) may be considered when sperm parameters are very low and where other supports are not effective.
If you’d like to discuss your specific situation, please reach out or make a booking directly via the link above.
Photo by Jose Garcia on Unsplash
