IT TAKES TWO TO TANGO: SPERM HEALTH FOR OPTIMAL FERTILITY
Herein female relates to female-assigned-at-birth and male relates to male-assigned-at-birth.
Males are oftentimes overlooked in the fertility world, whilst so much attention is placed on the female. However, up to 20% of infertility in couples will be primarily from male factors, and up to 40% of infertility will be from a combination of both male and female factors. So it pays to consider sperm health in preconception and especially if there are assumed fertility issues.
Mature sperm are created in the testes via a process called spermatogenesis. This process is largely regulated by testosterone production, which is governed by negative feedback mechanisms in the brain. It takes approximately 70 days for sperm to mature from a spermatocyte (baby sperm) in the testis. It then takes another 12-21 days to transport the sperm via the epididymis to the ejaculatory duct.
A sperm consists of a tail that helps propel it forward to swim toward the egg and burrow into the egg’s coat, and a head that contains genetic material. Ejaculate contains both sperm and semen, which is the fluid (lipids, sugars, and proteins) that helps sustain sperm on their journey toward the egg. And, we could see up to to 200 million sperm per millilitre of semen!
Sperm are incredible. They hold half of a baby’s genetic material and they are designed to swim a marathon! Establishing their quality helps to ensure that not only does the sperm make it to the egg (hooray!), but that its genetic material is intact and the morphology of the sperm is normal, allowing it to penetrate the egg (abnormal sperm can have two tails, inhibiting them from swimming, or two heads, inhibiting them from penetrating the egg). In the neck of the sperm (or ‘midpiece’) are mitochondria. This section provides energy for the sperm to power forward on their swim.
For optimal fertility, we would want to see a great sperm count and adequate seminal ejaculate, with sperm that are normal (one head, one tail), with intact DNA, containing adequate powerhouse mitochondria that are working efficiently to provide good motility (the ability to swim efficiently in a forwards progression toward the egg).
To summarise so far:
Low sperm count means less sperm embarking on the swim, which means less chances of one arriving;
If there are morphology issues the sperm either won’t swim to the egg (two tails), or once they arrive they won’t be able to penetrate the egg (two heads);
High levels of DNA fragmentation—or, rather, damage of the genetic material in the head of the sperm—can result in implantation failure, or miscarriage;
Poor motility where either the sperm isn’t moving fast enough, or isn’t moving in a forwards progression, means the sperm may never even arrive at the egg.
Factors that can affect these parameters include alcohol and other drug intake, diet/nutrient status, environmental toxins, age, obesity, infections, gut microbiome and sleep. Ideally, our main priorities for sperm health are optimising nutrient status and reducing oxidative stress in the body. This could be by encouraging a healthy weight, omitting alcohol and other drugs, healing the gut, improving sleep hygiene, and/or becoming aware of environmental toxins that impact male fertility and reducing them.
A semen analysis (including DNA fragmentation) is a great way to see what you’re working with, and where additional herbal or nutritional supplementation could be really beneficial. If you have the semen cultured as well, then we can understand if there are any infections that could be impacting fertility. Considering it takes ~91 days from sperm creation to ejaculation, what’s been happening over the past 3 months has influenced the development and maturation of today’s live sperm! Therefore, it can take anywhere from 3-6 months to turn sperm around, so it’s great to start preparations and investigations at the same time as your female partner.
It can be worthwhile finding a supplement regime personalised to you, supporting either gaps in diet or helping to override some of the other factors (like age, which is out of our control). Unfortunately, we live in an environment where it is difficult to escape environmental toxin exposure, and general stressors in life can have their own oxidative effects too. We just do our best!
General Sperm Health Practices
Essentially, the nutrients required for sperm health are antioxidants (selenium, CoQ10, vitamins A, C, and E, zinc and alpha lipoic acid), B vitamins, essential fatty acids, amino acids (protein!), vitamin D and calcium. They all have specific roles in either sperm development, mitochondrial function, or DNA integrity. Given this, a lovely Mediterranean diet with lots of protein-rich foods, antioxidant-filled fruits and veggies, essential fatty acids and quality carbohydrates is a great place to start.
Minimising alcohol (or eliminating altogether) for up to three months before starting to try and conceive and especially whilst trying to conceive is excellent practice. Alcohol not only impacts testosterone levels and sperm count, morphology and motility, heavy drinking can also increase DNA fragmentation (research here if you’re interested). Similarly this can be seen in other drugs such as tobacco (including vaping!), marijuana, opioids and anabolic steroids.
It’s also great to become aware of environmental toxins like endocrine disrupting chemicals and limiting exposure where possible. Dr Shanna Swan speaks to this beautifully, and it might be something you are interested in learning more about. You can do so here.
Other areas to be aware of are the level of heat exposure to the testis (saunas, spas etc), mobile phone use, as well as direct exposure (phone living in your pocket) and individual factors that might need to be addressed (like sleep hygiene, gut health, weight loss etc).
So, in essence, though often overlooked, optimising sperm health is a surefire way to improve fertility outcomes. I implore you (hi, guys) to take your sperm health seriously, especially in light of trying to conceive and in a situation where there could be some fertility issues.
