Reduced motility, morphology, or overall concentration

It’s surprising, but a vagina isn’t the friendliest place for sperm. In fact, 99% of sperm will die there within 20 minutes. So it helps when there’s a high concentration (number of sperm), high motility (swimming skills) and good morphology (shape of sperm). If any of these three factors are low, it makes it harder for the sperm to successfully fertilize the egg.

How it’s tested

A battery of tests can help determine if sperm motility, morphology or concentration are the issue:

Standard semen analysis:

  1. Volume
  2. Count (concentration)
  3. Motility
  4. Morphology

Newer sperm tests currently available:

  1. DNA fragmentation (how well your sperm is “packed together” genetically)
  2. Sperm penetration/binding assays (your sperm’s sticking-and-burrowing-into-an-egg skills)
  3. Direct DNA (FISH) analysis (the DNA integrity of individual sperm)
  4. Autoantibodies to sperm

Frequently ordered mens’ tests:

  1. Hormonal screen
  2. Autoimmune screen
  3. Karyotype and Y microdeletion (a genetic test)
  4. Physical exam/scrotal and transrectal ultrasound to look for varicocele and other testicular issues

How it’s treated

To increase your sperm concentration, some sources recommend a few days of abstinence. However, there’s a lot of conflicting information out there about the ideal amount of time to abstain—and we can never predict ovulation perfectly, anyway. Abstaining for two to four days is a pretty safe bet.

It’s also good to avoid lubricants, which can impede the progress of sperm towards the egg. If you need extra lubrication, Pre-Seed or regular saliva are less harmful.

Increasing your quality of sperm, however, is a little trickier. It’ll take as long as 3 months to improve sperm quality. That’s because it takes about 72 days for sperm to mature from stem cells to fully-functioning sperm. Any intervention or new healthy habit you try (minimize excessive heat around your groin, limit alcohol and caffeine, quit smoking, maintain a healthy BMI, eat red meat) will need to be present from start to finish.


Several studies indicate the real value of antioxidant vitamins. In particular, vitamin therapy should improve the epigenetic profile of sperm. A diet rich with fresh fruit and vegetables is a good place to start, we also suggest the following:

  • Vitamin E up to 400IU/d
  • Zinc up to 70mg/d
  • Selenium up to 250mcg/d

Other suggestions include Folate (1-5mg/d), Vitamin C (500-1000mg/d), and Co-enzyme Q10 (200mg/d). L’carnitine supplements may help men who choose not to eat red meat.

There are several pre-packaged supplements that take these suggestions into account.


Medications such as Sudafed, HCG, clomiphene, letrozole, and rFSH preparations have a role in treating male factor subfertility, but in most circumstances they’re of limited value at best.

It can be frustrating for men that there aren’t more medications, more things to take, than there are. However, the majority of cases really will respond best to lifestyle changes and vitamins alone. Often, further interventions won’t truly help.


A urologist who subspecializes in subfertility can assist when the problem is more surgical in nature, like a repair of a varicocele.

If treatment is unsuccessful, you can increase your pregnancy rates signficantly through intrauterine inseminations (IUI) or in vitro fertilization with intracytoplasmic sperm injection (IVF/ICSI).


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