Why Male Fertility Shouldn't Be Ignored

When a couple is having difficulty getting pregnant, the conversation often centers around the woman: her hormones, her cycle, her ovarian reserve, her age, her nutrition.

But fertility involves two people.

Male factors contribute to infertility far more often than many couples realize. Current fertility guidelines recommend evaluating both partners at the same time rather than completing an extensive female fertility workup before considering the male partner.

That matters because sperm health can be influenced by hormones, lifestyle, nutrition, environmental exposures and certain underlying medical conditions. Looking at male fertility early can give couples a much more complete picture of what may be affecting their ability to conceive.

Male Fertility Is Half of the Conversation

According to the American Urological Association and American Society for Reproductive Medicine, difficulty conceiving is related in whole or in part to male factors in approximately half of infertile couples.

Yet I still see fertility treated as primarily a women's health concern.

A couple may spend months tracking ovulation, testing female hormones, changing the woman's diet and focusing on egg quality while relatively little attention is given to sperm.

Ideally, we should be looking at both sides of the fertility equation from the beginning.

What Does a Semen Analysis Tell Us?

A semen analysis is an important part of the initial male fertility evaluation. It typically looks at several characteristics of the semen and sperm, including sperm concentration, movement and morphology.

One important point is that a single number doesn't tell the whole story. Semen parameters naturally fluctuate, and individual parameters by themselves do not always predict whether a man is fertile or infertile. AUA/ASRM guidance notes that semen measurements can vary substantially between samples and that repeat testing can be important when the first analysis is abnormal.

When abnormalities are found, a male reproductive specialist can determine whether additional evaluation is appropriate.

What Can Affect Sperm Health?

Sperm production is influenced by overall health, which is why I like to look beyond the semen analysis itself.

Depending on the individual, factors worth considering may include nutrition, body composition, sleep, stress, alcohol, smoking, certain medications, environmental exposures and underlying hormonal or medical issues. Research into many lifestyle and environmental factors is still evolving, so these shouldn't automatically be assumed to be the cause of an abnormal semen analysis.

From a functional medicine perspective, this is where I may also look more closely at nutritional status, metabolic health, inflammation and other aspects of the patient's overall health when clinically appropriate.

The goal isn't to chase every possible "root cause." It's to identify the factors that are actually relevant to the individual.

Sperm Health Takes Time

One reason I encourage couples to think about male fertility sooner rather than later is that changes in sperm health aren't necessarily immediate.

Supporting fertility is generally not something you start two weeks before trying to conceive and expect to completely change overnight. Nutrition, lifestyle and appropriate medical care are better approached as part of a longer-term preconception plan.

This is especially important when a couple already knows there are concerns with sperm concentration, motility or morphology.

Acupuncture and Male Fertility

Acupuncture may be a valuable addition to a comprehensive male fertility plan, particularly when the goal is to support healthy sperm parameters.

Research has found encouraging results. A systematic review and meta-analysis found improvements in sperm concentration and progressive sperm motility among men receiving acupuncture, although the researchers noted that larger, higher-quality studies are still needed.

More recent research has also been promising. A network meta-analysis of randomized clinical trials found that acupuncture was associated with improvements in sperm concentration, total motility and forward motility. In that analysis, acupuncture showed a significant advantage over placebo for total sperm motility.

This is important because sperm count and motility are two of the parameters routinely evaluated when looking at male reproductive health.

In my practice, I like to incorporate acupuncture into a broader fertility plan rather than looking at sperm health in isolation. Depending on the patient, we may also address nutrition, stress, sleep, lifestyle, metabolic health and other factors that could be influencing reproductive health.

For couples preparing for pregnancy, I believe the male partner deserves just as much attention as the female partner. Supporting sperm health before conception can be an important part of creating a more complete fertility plan.

Chinese Medicine Looks at the Individual

Chinese medicine approaches fertility a little differently because treatment is based on the individual's overall pattern rather than simply the diagnosis of "male infertility."

Two men can have similar semen analysis results and still present very differently from a Chinese medicine perspective.

I may consider factors such as energy, sleep, digestion, temperature, stress, libido and other signs and symptoms when determining a Chinese medicine pattern and treatment strategy.

Acupuncture points and Chinese herbal formulas can then be individualized rather than giving every fertility patient exactly the same treatment.

Don't Forget the Medical Evaluation

Natural and integrative approaches shouldn't replace an appropriate fertility evaluation.

A reproductive history and semen analysis are recommended components of the initial male fertility evaluation, and men with abnormal semen parameters or suspected male infertility should be evaluated by a male reproductive specialist.

This is important not only for fertility. Male infertility can sometimes be associated with other medical conditions that deserve attention.

Finding those issues early gives couples more information and helps determine the most appropriate next steps.

Dr. Stephanie’s Tip: If you've been trying to conceive and nearly all of the testing, supplements and lifestyle changes have focused on the female partner, it may be time to widen the conversation.

I prefer to look at fertility as a couple's health issue rather than a woman's health issue.

That doesn't mean assuming something is wrong with either partner. It means gathering enough information about both people to make a more informed plan.

A Whole-Couple Approach to Fertility

Supporting fertility isn't about placing blame on one partner.

It's about understanding all of the factors that may be influencing conception and addressing the ones we can.

For men, that may mean starting with a semen analysis and appropriate medical evaluation, then looking at nutrition, lifestyle and overall health. Acupuncture and Chinese medicine may also be incorporated as complementary parts of an individualized fertility plan.

Frequently Asked Questions About Male Fertility

How do you know if male fertility may be a factor?

A semen analysis is usually one of the first steps in evaluating male fertility. It provides information about sperm concentration, motility and morphology. If results are outside the expected range, additional testing may be recommended to better understand what could be affecting sperm health.

What can affect sperm quality?

Sperm health can be influenced by many factors, including overall health, nutrition, smoking, alcohol, certain medications, environmental exposures, heat exposure and underlying hormonal or medical conditions. Because every patient is different, I prefer to look at the whole picture rather than focusing on a single factor.

Can acupuncture help improve sperm health?

Research on acupuncture and male fertility is encouraging. Studies have reported improvements in important sperm parameters, particularly sperm concentration and motility. Acupuncture can be incorporated into a comprehensive fertility plan alongside appropriate medical evaluation, nutrition and lifestyle support.

How long does it take to improve sperm health?

Changes in sperm health take time because sperm develop over a period of several weeks. For this reason, I generally think of male fertility support as a preconception process rather than something to begin immediately before trying to conceive. Starting earlier also gives us more time to address nutrition, lifestyle and other potentially modifiable factors.

Should the male partner be evaluated even if the woman already has a fertility diagnosis?

Yes. One partner having an identified fertility issue doesn't rule out contributing factors in the other partner. Current fertility guidelines recommend evaluating both partners concurrently, which can provide a much more complete picture and help couples make informed decisions about their next steps.

At New Direction Natural Medicine in Altamonte Springs, I work with fertility patients using acupuncture, Chinese medicine, nutrition and functional medicine to create a more comprehensive approach to preconception health.

When you're trying to build a family, both partners deserve to be part of the conversation.