My answer to this question is not a medically supported one; it is drawn from inference and many, many sperm analysis tests conducted across multiple IUIs and IVFs. But the answer, for me, is overwhelmingly yes. I've listed my observations here, in hope that it may bring others some good luck and better health.
Sperm is actually produced and replenished on a very short cycle, so it is worth the little bit of work that goes into improving the overall statistics. A man is constantly producing new sperm, although sperm itself has a 3-month production cycle. A healthy man is able to replenish his full supply of sperm within 24 hours. Getting slight improvements can work in your favour, even in IVF, where the sperm is selected.
My husband is quite fit, but is not inherently Month 27-31: Can you improve your husband's sperm count? the most healthy person. He is bulky and generates a lot of heat; he sweats constantly in Singapore's tropical climate. I have noticed that a lot of men with mild sperm issues have these characteristics and I wonder if there is anything to the rationale that they are perhaps musty, hot and suffocating in their nether regions.
He also has high cholesterol, he does not control his diet, he doesn't always work out and he doesn't have the best sleep patterns, being somewhat insomniac. Years of competitive swimming while growing up made him generally complacent about food and rest. His sperm analysis is viscous and acidic, the counts are high, between 95-109mn, but his motility is 51-69%, with a low 4%-10% rapid and his morphology is a consistently low 2%. Or put a different way, 98% of everything produced is abnormally shaped.
A semen analysis is the first step in determining whether there are any male factor infertility issues. In case you think it is not necessary or embarrassing, it affects more than 1/3rd of the couples who are unable to have children. Men are just like women, their sperm analysis will show different patterns at different times, react to different stimuli and have totally individual characteristics.
The factors are the following:
Volume. This is a measure of how much semen is present in one ejaculation. Volume between 1.0 ml and 6.5 ml is considered normal.
Liquefaction time. Semen is a thick gel at the time of ejaculation and normally becomes liquid within 20 minutes after ejaculation. Liquefaction time is a measure of the time it takes for the semen to liquefy.
Sperm count. This is a count of the number of sperm present per millilitre of semen in one ejaculation.
Sperm morphology. This is a measure of the percentage of sperm that have a normal shape.
Sperm motility. This is a measure of the percentage of sperm that can move forward normally. The number of sperm that show normal forward movement in a certain amount of time can also be measured (motile density).
pH. This is a measure of the acidity (low pH) or alkalinity (high pH) of the semen. A pH value of 7.2-7.8 is considered normal, too acidic and there may be vesicle problems, too base and he may be fighting an infection.
White blood cell count. White blood cells are not normally present in semen.
Fructose level. This is a measure of the amount of a sugar called fructose in the semen. The fructose provides energy for the sperm.
Sperm DNA fragmentation. A more advanced test will show whether there is DNA fragmentation in the sperm head, which may cause higher rates of fragmentation in embryos and affect embryo quality.
The World Health Organization standards for what constitutes normal sperm have been dropping over time, which suggests that as a population, we are all becoming less and less fertile.
A normal sperm count is over 15 million sperm per millilitre, according to the WHO in 2010, while older definitions state 20 million per millilitre. The average sperm count today is between 20 and 40 million per millilitre in the Western world, having decreased by 1-2% per year from a substantially higher number decades ago.
The sperm count or concentration is one of the most important characteristics, because motility and morphology are all expressed as a percentage of count. Therefore, say for dear husband, a 2% morphology on a 109 mn sperm count is, in absolute numbers, far more usable sperm (2.18mn) compared with 2% on a 15 mn sperm count (0.3mn).
[Embedded graph image]
As shown by the above graph, for normal conception, pregnancy rates start to plateau out after 20mn, which is why it is deemed as sufficient.
But when we researched IVF programs or egg banks which gave guarantees based on sperm quality, almost all were willing to overlook the lower morphology percentage, because the higher sperm count still gave them more sperm to work with, so it does help if you can get the absolute count up.
A normal sperm motility is over 50% and must be measured within 60 minutes of collection, according to the WHO. They also have a parameter vitality, with a lower figure of 60% live sperm. A man can have really high total numbers of sperm, but still have bad quality because too few of them are alive, or forward moving.
However, with a high sperm count, then a lower motility may still not matter, because the total alive and progressive sperm of a 14.34% motility of a 109 million count is the same as a 50% motility of 15 million count, i.e. 7.6mn in absolute.
There are several different grades of motility:
Grade a: Progressive sperm. These are the strongest and swim fast in a straight line. Sometimes it is also denoted motility IV. This is also called Rapid sperm. In the case of my hubby, the rapid sperm count was very low but also very variable, between 4-10%.
Many people believe that if a man has extremely high rates of rapid sperm, he is very likely to only father boys, as the fastest sperm tend to be the male XY sperm, whereas the XX female sperm swim slower but live longer.
Grade b: (non-linear motility): These also move forward but tend to travel in a curved or crooked motion. Sometimes also denoted motility III. This is known as the Sluggish sperm and it turns out dear hubby has sluggish swimmers, between 45-53% of the motile sperm were sluggish.
My husband is a competitive swimmer and a swimming champion growing up and for months, his chief gripe and anguish was that his swimmers are slow! I swear this was his chief disbelief in the whole process. I am still curious to find out if this means he is pre-disposed to father girls.
Grade c: These have non-progressive motility because they do not move forward despite the fact that they move their tails. Sometimes also denoted motility II.
Grade d: Immotile. Basically, this is sperm that is not moving and dead on arrival.
Isn't it lovely to think of all the sperm dying inside you, after sex? Oh the joys of being a woman.
A normal sperm morphology is 4% as defined by WHO. However, before 2010, the normal sperm morphology was defined as 15%. The reason they moved it down so much was that so many men were failing this 15% standard, that the resultant graph was no longer a bell curve. Isn't that scary?
Of course, a good sperm morphology is over 15% and an excellent sperm morphology is over 50%. You know those friends of yours who seem to get pregnant every time their husband drops his pants? You know, the one who conceived every single time on their first month of 'trying'? Guess what her husband's sperm looks like?
If your husband has 50% normal-shaped viable sperm, you have a chance of getting pregnant from every other sperm that goes in. Every alternate sperm from even an average 20 million count. Basically, as long as you have an egg, or even a half-decent egg, you will probably get a bun in the oven on any given month. That boggles the infertile mind, doesn't it?
[Embedded sperm-morphology diagram image — Normal, Condensed Acrosome, Small Head, Large Head, Doubled Headed, Double-Tailed, Abnormal Middle-Piece]
Normal shaped sperm have to have a full and proper head, which contains all the genetic information to form a child, a midpiece, which contains the mitochondria for energy to live and swim and a tail section, to propel it forward. Abnormal sperm are ones with two heads, missing or damaged mitochondria or two tails.
The other reason you should care about morphology is that it is the key predictor of success in fertilizing oocytes during IVF. Low morphology has a great deal to do with overall sperm quality and chromosomal abnormalities caused by the sperm. Some people have told me that unless you have >5% morphology, your chances on IUI are actually very slim and it is better not to repeat it too many times.
During an IVF cycle, the semen sample is spun, analysed and then carefully selected. The sperm tube is inverted, and all the strongest swimmers start swimming upward, leaving all the immotile sperm dead or struggling at the bottom.
The tube is then inverted again, and all the strongest sperm have to reverse direction and again start swimming toward the top, where they are skimmed off. They are then inspected under a microscope for the correct shape and picked out.
When the eggs are fertilized in an IVF cycle, many sperm are introduced to the eggs, or one may be selected for ICSI — a process by which a single sperm is injected into the egg. If the fertilized embryo has 2 pro-nuclei (one from each DNA contributor) on Day 1, it is good to go.
However, if the sperm is abnormal, the egg will fertilize abnormally, it may have 1 pro-nuclei, meaning that there was one set of egg gametes but the sperm set had chromosomal abnormalities. An egg with no pro-nuclei (0PN) or one pro-nuclei (1PN) will not develop into a viable, normal embryo.
In the three viable IVF rounds that we undertook, we got 80% fertilization of all the eggs on the first round, but then improved to 100% fertilization of all the eggs on the subsequent two rounds. We got one 1PN embryo on two of the rounds, with one round yielding all normal 2PN embryos. It is important to do your best to get over the abnormal fertilization hurdle, so that you don't waste those precious eggs.
What can you do to improve sperm quality?
Unlike eggs, which are a finite resource, sperm is actually constantly produced. Having been on this TTC and IVF journey for so long, I am not a fan that there is a magic silver bullet for infertility or for improving egg quality.
Over the last three years, I have tried acupuncture. There have also been times that I've not done acupuncture. I've been on and off traditional Chinese medicine. I've been on supplements, I've taken enough folic acid to grow a third folic acid arm.
Over the course of that time, I've been stressed, I've been happy, I've been relaxed, I've taken holiday after holiday. I have both obsessed about it and tried to let things go. I've slept with socks on and socks off. You get the idea.
I honestly think it is simplistic to chalk up improvements in egg characteristics or IVF performance to single factors. Similarly, with sperm, large changes in sperm quality and characteristics are unrealistic without surgery or invasive medical intervention, but because it is replenished and reproduced so often it is possible to improve on what can anyway be fairly volatile ranges of quality and efficacy.
(1) Remember to relieve sperm 3-5 days prior to giving a sperm sample. This is by far the most important factor — ejaculation should be done between 3-5 days before the sample is given. There was one instance, where the hubby was made to give an impromptu sperm sample and the resultant sperm had not been cleared for a week.
The result? The progressive sperm motility plummeted to 27% (from his average 57%), meaning that 73% of the sperm was dead upon production. We were immediately disqualified from the guarantee by this sample and had to negotiate with the clinic for a follow-up test. At the follow-up test, where he had 'cleared' everything within 5 days of giving the sample, the motility was back up to 63%.
Even when you are trying naturally, contrary to the idea that you should store up sperm, old sperm is bad sperm. Or even dead sperm. The funny corollary is that this means men should naturally and consistently be ejaculating, to keep it fresh and alive. Maybe it is what God intended, after all!
(2) Get a full night's sleep. This is the second most important criterion. Guess when that disastrous sample was taken? Right after the World Cup. And to top it off, he had spent a few hours in the sauna, napping. When you don't rest, sperm, like the rest of your bodily parts and fluid, doesn't have the time to recharge and replenish either.
(3) Take zinc and multi vits. My husband felt that the zinc pills prescribed by the doctor, along with Tribestan and Proseed, made him dizzy, particularly when taken without food. So he stopped taking them altogether for most of the last two years. However, in the months leading up to his best sperm samples, he started taking Multi-Mega Minerals from GNC, which has 400iu Vitamin D, 22.5mg Zinc and 95mg Potassium.
What we both found very helpful is to gift your husband a shopping spree at GNC — somehow men love shopping there, it's equivalent to luxury brand shopping for women and if he buys them, he is more likely to take them. Another tip is to keep the vitamins in the office, so that he has more time during the day to remember to take them.
(4) Take magnesium. Magnesium is the nutrient and mineral that is most often deficient in humans, because it occurs only in small concentrations within dark leafy vegetables and nuts. Taking a magnesium supplement helps to bolster the sperm quality but more importantly, it is a de-activator of adrenalin, thus improving the regulation of heart rate, blood flow, blood pressure and deeper sleep.
(5) Drink more water. The issue of pH and viscosity went away when he started to consciously drink more water. We noticed that this usually had the effect of bumping up his count and rapid motility from 4% to 10%. We started to keep a slim 1 litre glass bottle in the car and another in the office, which we aimed to finish and refill every day.
(6) Cut back on meat and eat more vegetables. Although he will probably always struggle with weight gain, there was a period of time, back when I first knew him, when the hubby was actually fully vegetarian. It didn't last. For the last months however, he has consciously been more vegetarian, although he does eat meat and has stopped consuming milk. He noticed that this had a drastic effect on his girth and his skin cleared up.
(7) Exercise regularly and avoid the hot tub or sauna for the days leading up to the sperm sample. Other than the obvious benefits, moving to a regular 4-5 times a week exercise schedule improves blood circulation and his testosterone levels, which were shown to be unusually low in his hormone profile.
I believe this helped his overall count, which climbed all through the time he exercised regularly. How significant was the improvement? At its lowest, his sperm count was 84mn and at its highest, it was 116mn, which is a 28.6% variance. Considering that this determines the absolute number of motile and normal morph sperm, it's pretty significant.
Leading up to the sperm samples, he would get into a holding pattern of easing off that week and avoiding the sauna. I cannot vouch for pure efficacy of avoiding hot tubs or saunas, as this seemed common sense enough that it wasn't a regular occurence anyway. But I can't see that it wouldn't help to avoid sweltering hot rooms and tubs.
(8) Freeze a back-up sample of sperm. For an IVF cycle, your husband is asked to produce a fresh sperm sample on the day of egg retrieval. But have you ever wondered, what would happen if this sample was somehow contaminated or if he couldn't produce it? Eggs don't live that long and are fragile until fertilized.
When I switched from a public to private hospital, we were asked to give a back-up sample for sperm, produced between 5 days and a week previous to the actual egg retrieval, which would be frozen as a back-up to the fresh sample. When I thought about it, I realized this was a very clever idea and when I asked my doctor, he grimaced and said, we always take this precaution, some of our patients have had issues before.
Imagine this scenario — you won't know a thing because you will be under GA, getting your eggs removed, and when you wake up, the nurse says to you, he tripped and the whole sample was spilled or he couldn't produce it. I'm sorry, but we can't continue. If only for your own peace of mind, and an IVF cycle that you, the wife, have worked so hard for, please freeze a back-up sample.
If you think this is an unlikely scenario, don't. In his first sample, my husband entirely missed the cup. Not knowing what to do, and not wanting to cause problems or anger, he scooped up whatever was available and probably speckled with carpet linolium and sent in a contaminated and entirely inaccurate sample for analysis. (Of course, it was awful).
