Once your sperm tests have been done, you might need to increase sperm quantity and/or quality. In this post I will explain how to do just that.
Quantity of sperm (and volume of ejaculate)
Sperm quantity will be measured, by our laboratories, as the number of sperm in the ejaculate. A few days of abstinence is the best way to achieve optimal numbers. There is a lot of conflicting information on the internet, and in books and research papers, about the ideal amount of time to abstain. Some people worry that if the man waits too long, the sperm that will arrive will be post-mature, and somehow less functional. But one good study asked men to wait a full two weeks, and the results were exactly the same as when they waited just a few days. It is fortunate, of course, that there is no exactly perfect number of days, for we can never predict ovulation perfectly. In our practice, we recommend that men abstain for two to four days to assure themselves and us that sperm quantity will be maximized.
When a couple are having intercourse, they should avoid most lubricants, for they act to effectively reduce the quantity of able to reach the cervix. The one lubricant on the market that we believe to be fine is Pre-Seed. Saliva is also fine.
When men are providing samples, they are acutely aware of the volume of ejaculate they are providing. Most men would like to provide as much as possible, though as long as the volume is >1.5cc, the final amount probably doesn’t matter. Nonetheless, if you wish to try to maximize volumes, some have suggested that bringing oneself close to, but not actually at, orgasm several times in the days leading up to a sperm sample will maximize volumes. However, there is no scientific evidence for this approach.
If volumes are consistently too low, you may suffer from retrograde ejaculation. First line treatment for this condition is Sudafed, but I won’t go into further detail here, for if this is an issue for you, it is really something that you should be discussing with your doctor.
Quality of sperm
It will take as long as 3 month to improve sperm quality. This is because it takes about 72 days for sperm to mature from stem cells to fully-functioning sperm. Your “new” intervention may need to be present from start to finish.
· Minimize excessive heat
· Limit alcohol & caffeine
· Quit smoking
· Consider stress-reduction techniques including exercise and time with friends
· Maintain a healthy BMI through exercise
· Eat well, including red meat in your diet
Subfertility can place strain on relationships, and lifestyle changes in particular can be a source of friction and pressure, because the definitions are so soft.
Take the admonition to “reduce heat exposure” for example. What, after all, is too much heat exposure? Is it a laptop on your lap? Tight undergarments? The occasional bike ride? Five hours a day on a bike? The details are limitless, interpretations can differ, and perfect answers elusive. Common sense must be your guide. But if you really are not sure about a particular activity, ask your doctor.
Several studies, including our own, point to the real value of antioxidant vitamins. In particular, vitamin therapy should improve the epigenetic profile of sperm. A diet rich with fresh fruit and vegetables is a good place to start, we also suggest the following:
· Vitamin E up to 400IU/d
· Zinc up to 70mg/d
· Selenium up to 250mcg/d
Other suggestions include Folate (1-5mg/d), Vitamin C (500-1000mg/d), and Co-enzyme Q10 (200mg/d). L’carnitine supplements may help men who choose not to eat red meat.
There are several pre-packaged supplements that take these suggestions into account. We usually suggest Coast Reproductive’s Male Fertility Supplement. The formulation is not exactly the same as the list above, but it is appropriate for most men.
Whenever male factor is suspected, surgical procedures may make all the difference. We work with Urologists who subspecialize in subfertility when considering, for example, repair of a varicocele.
It is critical to see a Urologist who you can trust implicitly. I work with the extraordinary team at the Murray Koffler Urologic Wellness Centre, in Toronto.
Medications such as Sudafed, HCG, clomiphene, letrozole, and rFSH preparations have a role in treating male factor subfertility, though in most circumstances they are of limited value at best.
Indeed, it can be frustrating for men who suffer from low sperm quality that there are not more medications, more things to take, than there are. It is simply the nature of the diagnosis, however, that the majority of cases will respond best to lifestyle changes and vitamins alone. Often, further intervention will not provide further benefit.
It is important to maximize sperm quantity and quality, but once all has been done, some male factor subfertility may still remain. Perhaps pregnancy will be possible through intercourse alone, but we should also be able to increase pregnancy rates substantially through intrauterine inseminations (IUI) or in vitro fertilization with intracytoplasmic sperm injection (IVF/ICSI). Which may be right for you, IUI or IVF/ICSI? It is a question that I will explore in a future post.