Infertility Appointment Questions

Q: Should I wear briefs or boxers to improve my sperm count?

Answer: This question is a very common question without a strong affirmative answer. Heat does reduce sperm production. Some people's sperm production is more susceptible to heat than others. In general, the increase heat associated with tight underwear is less than the heat seen with varicoceles, hot baths, febrile episodes, or high scrotal testes. I recommend boxers because every little bit helps but I do not expect great improvement in sperm count based on underwear type alone.

Q: How long should I abstain from sex before I give a semen analysis?

Answer: The quality of the semen analysis is highly dependant on the method of collection. The ideal number of days to wait after sex to give a semen analysis is three to five days. Giving a semen analysis in less than three days after an ejaculation produce a small volume low count semen sample. Giving a semen sample after greater than five days from ejaculation can cause the sperm to have decrease motility.

Q: Are there any diet changes I can do to improve my semen quality?

Answer: My recommendations are based on well designed studies. Vitamins C, E, Zinc, and Selenium improve the quality of the seminal fluid which bathes the sperm. Drinks or activities to be avoided include excessive alcohol intake, large amounts of coffee or any recreational drugs. DHEA pills and anabolic powder supplements can also decrease sperm quality.

Q: How long does it take for my sperm count to improve after treatment?

Answer: Sperm require around three months to fully mature. Once you remove the offending condition then three months are needed for a new cycle of sperm to be released. Some men see improvements in their semen analysis sooner if the offending condition is minor. Some men take longer to improve if the size and firmness of their testicles are poor.

Q: How come the quality of my semen analysis is so different between laboratories?

Answer: The quality of a semen analysis is very highly dependent on the processing technique. Method of collection, time of specimen drop off, temperature of the specimen in the laboratory, pippeting technique, and counting system all can introduce error into the results. Daily controls by the lab is very important to standardize the process of semen analysis. It is hard to compare semen analysis between two laboratories unless both labs follow the recommended processing technique.

Q: Does exercise affect sperm quality?

Answer: Moderate exercise is good and is helpful to reduce stress. Endurance training or high intensity exercise may decrease the quality of the semen analysis. A semen analysis prior to changing your exercise routine can be helpful to answer this question.

Q: When is the best time to have sex when we know the ovulation date?

Answer: The best time to have sex is on the day of ovulation and 24 hours afterwards. Healthy sperm can survive around 48 hours in the female reproductive tract. By having sexual intercourse back to back you increase your chances of having higher sperm counts at the fertilization site.

Q: If my sperm count is normal then does that mean I am okay?

Answer: A normal semen analysis is a pretty good indication of normal male fertility. The one aspect of semen quality which is poorly measured on semen analysis is sperm function. The morphology of the sperm approximately measures the quality of the sperm function. The morphology evaluation is the hardest test to perform correctly in the semen analysis. A normal count, motility and morphology is a good indication of normal male fertility.

Q: At what sperm count am I no longer able to father a child?

Answer: The lower limit of normal sperm count is 20 million sperm per milliliter of semen. Many men with lower sperm counts have initiated pregnancies. The standard for low sperm count was derived from looking at the fertility history of thousands of men and whether they initiated a pregnancy. There was a modest break in fertility potential when the sperm count decreased below 20 million sperm per milliliter. Your semen quality has to be high enough to overcome whatever deficiencies in fertility your wife may have. Fertility potential is judged based on the deficiencies that exist within the couple.