Whether you’re looking to start a family next month or next year, you’ve likely put some thought into how you can promote healthy sperm development. Dr. Levens discusses male fertility and what a semen analysis can tell you.


By Dr. Eric Levens

Being proactive about your reproductive health is a solid first step toward preparing for that family you’re looking forward to having one day. After all, 40 to 50 percent of infertility cases are attributed to male fertility issues.

Primary causes of male infertility

While there are many different causes of male infertility, each falls into one of three categories.

  1. Sperm production disorders. Your brain sends signals to your testicles, telling them to produce sperm. These signals are sent through hormones—primarily follicle-stimulating hormone (FSH) and luteinizing hormone (LH). In some cases, however, your testicles are unable to produce sperm, even though they’re receiving the signals from your brain. In other cases, the signal isn’t strong enough. Though your testicles can produce the sperm, you may lack sufficient FSH or LH hormones to kick them into sperm production mode. As specialists, the way we handle a sperm production disorder depends on what exactly the problem is. In some cases, we can use medicine to create the ideal hormonal balance. In others, we retrieve sperm from the testicle.

  1. Obstructive issues. Obstructive issues, which result in reduced sperm count and often lower seminal volume, occur when sperm is prevented from being ejaculated. While there can be many causes, obstructive issues are often congenital (present at birth), such as the congenital absence of the vas deferens. Problems of this nature can also result from a failed vasectomy reversal. Some men, particularly those with diabetes, experience outflow obstruction—also known as retrograde ejaculation. When men have this issue, their semen will flow into the bladder instead of out the urethra during ejaculation. When a man has an obstruction issue, fertility specialists are commonly able to extract sperm cells from the epididymis. In the case of retrograde ejaculation, we can usually reduce urine acidity using medication, then extract sperm from the urine.

  1. Immune system dysfunction. In some cases, your immune system may be fighting against your fertility. Because sperm is naturally antigenic, your body can form antibodies against them. In some cases, a man’s body forms antibodies that attach to sperm, making it more difficult for sperm to move. When a problem pertaining to your immune system is hindering conception, we are often able to “wash” the sperm, remove the antibodies, and proceed with more advanced reproductive care—like an IVF cycle.

What’s a semen analysis, and when should I have one?

A semen analysis is a non-invasive, low-cost test in which we assess your sperm. In a semen analysis, we examine three main things:

    • Count – How many sperm you have
    • Motility – How well your sperm move
    • Morphology – How your sperm are shaped

    Because a semen analysis is such a simple test that yields a substantial amount of information, we suggest that couples have this test as part of their primary fertility work-up. In many cases, where patients initiated low-tech treatment such as timed intercourse with Clomid under the care of their OB/GYN or primary care physician—only to have an unsuccessful result—the answer was only revealed after a simple semen analysis. Had that couple started with an early semen analysis they could have saved precious time with other treatment strategies.

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    The bottom line, if you’ve been having unprotected sex for one year with a female partner under 35 or six months with a female partner over 35 and she hasn’t yet conceived, it is time to see a fertility specialist for testing of both the male and female.

    If you have reason to suspect you may have an issue with your sperm—like if you’ve ever had testicular trauma, erectile dysfunction, or problems ejaculating—consider skipping the wait, regardless of your partner’s age or how long you’ve been trying, and get tested immediately.

    When it comes to conception, knowledge is power. And a semen analysis can offer a quick, easy snapshot of your sperm health, providing knowledge that can be crucial to your starting a family. We recommend supplementing with a prenatal for men to ensure healthy and fertile sperm when trying to conceive.


    This piece was contributed by doctors from Shady Grove Fertility, a leading fertility and IVF center of excellence. SGF offers patients individualized care, innovative financial options, over 30 accepted insurance plans, and pregnancy rates among the highest of all national centers. SGV has 19 full-service and 6 satellite locations across Maryland, Pennsylvania, Virginia, and Washington, D.C.