Infertility treatments: What is healthy sperm?

How is sperm quality determined?

There isn’t any single test that can predict healthy sperm, says Ari Baratz, a fertility specialist at the Create Fertility Centre in Toronto. The good news, though, is that you can have your sperm analyzed fairly quickly and easily.

The clinic will ask for a sperm sample from the male partner and analyze the quality of the sperm for four general characteristics: sperm concentration, motility (which refers to how rapidly the sperm is moving in the sample—specialists like to see 40 percent of the sperm moving forward), normal morphology (which refers to what percentage of the sperm are normal in shape—Baratz likes to see four percent of the sperm having normal oval heads and single tails) and ejaculate volume.

Typically, the sample is produced in a dedicated room in the clinic. The testing takes about two hours, and the results usually come in within a week.

What matters more: count or motility? “Motility and morphology are probably the most important factors,” says Robert Casper, a fertility specialist at Trio Fertility in Toronto. “The concentration or count isn’t as important as long as it’s above a certain minimum level.” While there is no absolute minimum, fertility specialists generally like to see a concentration greater than 15 million per millilitre. It’s important to remember that an individual can have a low sperm count but still have very mobile sperm. The quantity of the sperm cells in a sample only increases the chances of conception without any reproductive help, but what ultimately ensures conception is their motility and morphology.

If sperm quality is low, what are the next steps? There are a number of options. Couples could consider trying a procedure called intrauterine insemination (IUI), where a sperm sample is placed in the female reproductive tract via catheter in the clinic. In cases of very low sperm count (for example, samples with less than five million motile sperm), in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) is likely the most effective option, says Baratz. He also suggests consulting with a urologist to look for any reversible or genetic causes that could warrant further patient counselling. There is also the option of using donor sperm.

Is there a way to improve sperm quality? Casper points to recent research that shows that coenzyme Q10, which increases energy production by mitochondria, could increase sperm motility and morphology. “Vitamins C and E have also been suggested to help improve the quality of sperm,” he says. These vitamins are antioxidants and may prevent reactive oxygen damage to healthy sperm.

There are certain things that you can do to avoid a decrease in sperm quality. “We believe that extreme heat exposure isn’t good for sperm production, so males should avoid going in hot tubs or steam baths frequently or wearing tight clothing,” says Baratz. “Sperm production really depends on the appropriate temperature for the testicles, so allowing the testicles to avoid being exposed to excessive heat is important. Certainly any type of exposure to toxins like cigarettes, drugs and chemotherapy can affect sperm quality and quantity.”

If the male partner has been diagnosed with cancer, he should consult with his medical oncologist and a fertility specialist who deals with oncofertility. Baratz recommends freezing his sperm, even if he isn’t sure if he wants to have kids. “He can consider it biological insurance if the sperm don’t recover after chemotherapy or radiation therapy,” he says.

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