Healthy Men: Fertility is not just a women's issue

Dear Healthy Men: My wife and I have been trying for seven months to have a child but haven't had any luck. We've got an appointment scheduled with my wife's OB, but I've been reading about how sperm counts around the world are down and I'm wondering whether our trouble conceiving could be on my end. Is that possible?

A: It's definitely possible. But before we get into that, let's talk about the other issue you raised: declining sperm counts. While the roughly 50% decline in sperm counts over the past 50 years or so makes for alarming headlines, experts disagree on whether more sperm necessarily means greater fertility.

A "normal" sperm count means between 15 million and 250 million sperm per milliliter of semen. Anything less than 10-15 million is considered "low." At least as important as the count is the morphology (the shape and size of sperm) and the motility (the ability of the sperm to swim in the right direction). There's no question that a zero sperm count would make it nearly impossible for a man to father a child. It's also a pretty safe bet that, assuming morphology and motility are the same, a man with a 40 million sperm count would theoretically be more likely to get his partner pregnant than one with a 10 million count. However, it's far from clear whether going from 40 million to 80 million or from 80 million to 200 million would make any difference at all. After all, all it takes is for one of those little swimmers to reach the egg.

OK, let's get back to whether the trouble you and your partner are having getting pregnant could be on your end. Again, it's a definite possibility. Overall, about a quarter of couples conceive within a month or two, half are expecting withing six months, and about 85% are pregnant within a year. Put a little differently, one in seven couples is infertile, meaning that they haven't conceived after 12 months of unprotected sex.

Although the "blame" for infertility has historically fallen on women, experts I've spoken with say that about 40% of fertility issues are caused by the woman, 40% by the man, and 20% are unexplained.

And while low sperm counts often contribute to male-side infertility, other factors include your age (the older you are, the harder it will be to conceive); your underwear (sperm need to be a few degrees cooler than your body temperature to thrive, but briefs hold the testicles closer to the body, where the temperature is warmer); your weight (being overweight or obese increases infertility risk by affecting sperm production as well as your libido); how much you drink (alcohol can decrease testosterone levels, which can lead to erectile problems, and can also lower sperm quality); and whether you smoke (recent studies by the World Health Organization and the CDC have found that toxins from tobacco smoking may negatively affect sperm production, quality, and motility).

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