139. What Nobody Told You About Your Semen Analysis

If you have been focused entirely on your own cycles, hormones, and fertility markers — and your partner has not yet had a full semen analysis — you may be missing half the picture. Male factor contributes to fertility challenges in up to 40-50% of couples, and yet it is often the last thing evaluated, or evaluated incompletely.

In this episode of Cycle Wisdom, Dr. Monica Minjeur breaks down exactly what a semen analysis measures, which numbers matter most for conception, and what a complete male factor evaluation actually looks like. Through the story of Zoe and Charles — a couple who had been trying to conceive for nearly a year — you will see how a home test that came back normal was only part of the story, and how targeted changes turned things around within three months.

You will learn:

• What each metric on a semen analysis means and which ones actually predict conception
• The overlooked factors — heat, alcohol, infection, and medication — that quietly damage sperm quality
• How sperm can meaningfully improve within 8 to 12 weeks with the right targeted approach

If you and your partner have been trying to conceive without evaluating male factor, this episode is for you. Learn more or schedule a free discovery call at radiantclinic.com.

Transcript

Speaker 0:00

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Speaker 3 0:34

What if the fastest way to move your fertility forward is to look at the half of conception that most couples overlook male factor. Today we're going to decode semen analysis what the numbers actually mean, which metrics matter most for getting pregnant, and the simple evidence-based steps that can improve semen results in the next eight to 12 weeks. I'm Dr. Monica Minjeur, the host of Cycle Wisdom, where we empower women and couples to restore natural cycles to improve health and promote fertility. So let's dive a bit deeper into male factor fertility and how to make sure you are not missing out on the proper evaluation. So as always, we'll get started with a patient story. So today's story is about a couple that we'll call Zoe and Charles now, they had been trying to conceive for the past 11 months, but were feeling stuck. Zoe had tracked her cycles meticulously for the past year. She saw normal ovulation and her OB had told her that her labs looked mostly fine. However, she was exhausted by the flood of information. She continued to get on social media. Wondering what she might need to do next and how she needed to make a change. They had done a home semen analysis early for Charles, and this was normal, but this test only checks for count and movement of the sperm. Charles quietly was worrying that he might be the problem, but he avoided the topic because he didn't want to go through any additional evaluation, and after all, the home test was normal. Right. Just after they reached the one year mark of trying to conceive, Zoe booked an appointment with our office and while we started the evaluation looking for more answers with Zoe's in-depth hormone panel. We also discussed the importance of a complete semen analysis for Charles. Although his home semen analysis showed normal count and movement, there is also many other factors that we wanted to look at. So his initial semen analysis did confirm there was normal count and movement. However, there was decreased morphology, which is how the sperm looked, and also increased agglutination or clumping of the cells along with white blood cells that are present, which normally shouldn't be there. Her, we did take a look at all of Zoe's factors, and she had a clear ovulation day. She timed her hormone levels appropriately and honestly, most of her hormones were looking pretty good. We did work together to optimize some thyroid function as well as deal with some other stressors in her lifestyle, but we wanted to instead focus on Charles's profile. Okay. After doing some additional evaluation on his history, we found that he oftentimes stayed up very late at night. He did a lot of computer work, but he did get regular exercise on a regular basis. He was going for long bike rides or daily hot yoga. He also spent a lot of time with his friends on the weekend, and oftentimes would have four or more alcoholic beverages on a weekend night. Typically, he did not drink any alcohol during the week, and he did not have any other significant negative exposures like any tobacco or marijuana usage. After we found all of these pieces from Charles' history and in looking at his semen analysis, we checked some additional blood work to discern the underlying cause of why his morphology or how the sperm looked was decreased. And we also analyzed the seminal fluid checking for infection with a microbiome test. Finally, we ordered an ultrasound to screen for a varicose seal, which is a varicose vein of the scrotum, which can sometimes cause alterations in sperm quantity as well as quality. Once we had all of these pieces back, we determined the appropriate treatment strategy for Charles. And in his case we talked about cutting out excess heat. So in his case we said, no more hot yoga. You can still do the yoga, but just not with the heat cutting back on the amount of bike riding that he was doing, limiting alcohol to no more than two drinks in a day. And we also did find a mild bacterial overgrowth in the seminal fluid that we treated. We repeated his seminal fluid analysis test three months later, which has showed significant improvement in the overall morphology, how the cells look, and complete resolution of the agglutination and white blood cells showing that there was no longer an infection or inflammation present. So let's break it down a little bit, because oftentimes people think that all that we're looking for on a semen analysis is just the numbers. How many swimmers do I have? What does that number mean? And so we're gonna talk on each of the factors that are in most common semen analyses and also discuss what are the important factors we wanna be looking at. So one of the first things that's typically reported is the volume. So the volume means the total amount of fluid that was actually submitted. Now, there are multiple variables that can play a role with this, and so I don't put a whole lot of effort into worrying about if this is too low or too high. Now we do wanna pay attention that if the volume is always chronically low, might there be an issue with the ducks or the prostate, or maybe even dehydration that could be decreasing the volume. But volume alone is not a factor when it comes to looking at pregnancy rates. The next thing that we look at is the concentration and the total count. So typically this is going to be reported in number of millions. So concentration generally report how many million sperm are present in one milliliter of the fluid. The total count says how many million sperm are present in the entire sample. So either of these numbers can be reported. Sometimes both are there. Sometimes it's just one or the other. But we're really looking to see how many sperm are present with each time that we have a sample collected. Motility or progressive motility is another factor that we look at. So motility means how many percentage of those sperm are moving and progressive motility means are they moving forward? Are they moving in the right direction? And this becomes really important because if you have a great number of sperm, but not many of them are moving, or if they're not moving well, this can dramatically decrease your chances of pregnancy. So in our practice, we will always take and multiply the total number of sperm times the total motility in order to get what we call a total modal count. And what that tells us is how many sperm are A present, and B, moving in the right direction because this is really the count that matters. Morphology is another factor that is included in a typical seminal fluid analysis, and this looks for the percentage of sperm that look to be normal. Now, I will say this criteria has changed dramatically over the past couple of decades, and it is incredibly difficult to have a. Perfect looking sperm. So most labs will report anything normal is 4% or greater. And yes, this means that only 4% of the sperm look to be normal based on these very strict criteria. Now, when they made the criteria much more strict, what we found is that some men have as low of counts as 0% morphology, meaning none of them look to be normal. But we do still see pregnancies with these. So if this is your only factor that is abnormal. I generally don't get too worked up about it, but if there are other factors that are present in the setting of ongoing fertility concerns, definitely worth the evaluation to see might there be something else going on causing problems with that morphology. The next category is sometimes lumped together, and sometimes we see different pieces of it reported or sometimes not at all. So this is going to be things looking for liquifaction, which is basically the viscosity of it, or how sticky the actual Seminole fluid is. The pH, so how acidic or basic it is and any white blood cells that are present, and as I mentioned, was with a case with Charles, we should not see any white blood cells present. So if we have a pH that is out of range or if we have high agglutination or not enough viscosity or white blood cells present, these are all flags or markers that we want to be looking for. Some source of infection or inflammation. Now in men, they may not have a ton of symptoms that would indicate that there is a prostatitis or a low grade chronic infection present, but these can all be markers that show up in the semen. And so this is really one of the crucial areas that we wanna make sure we look at. When we get that complete semen analysis. And then the last piece that I do wanna mention is something called sperm, DNA fragmentation. Now this is not routinely checked with a semen analysis, and it's generally a separate lab, as most hospitals do not do this testing. But I do want to briefly mention it here because DNA fragmentation. Looks for the actual integrity of the genetic material of the DNA chains itself. This is key for fertilization and early embryo development, and so in cases where there may have been a miscarriage or early implantation failure, this can be something that we look for. So you can have completely normal looking sperm. You can have completely normal counts and motility and no problems with infection or inflammation, but if the quality of the sperm itself is not in great shape. You can still have fertilization occur or sometimes not, and also have problems with early embryo development. So as that embryo starts to divide and increase in the number of cells, the complexity of the DNA starts to break down more and can cause an early miscarriage. So I do want to just mention that, like I said, it's not a part of a regular semen analysis, but it is something that people are talking a lot more about recently. So as you can see, there's a lot that goes into looking at a semen analysis, and one number rarely tells the whole story. So sperm production can take about two and a half to three months for most men and patterns and trends over time matter if you were exposed to excessive amount of stress. Or heat or an illness or had a high fever, or maybe you went on a binge drinking buzz or had certain medications that could have impacted sperm count. It can take a full two to three months before those new sperm are generated and able to improve the quality and the quantity. So what does evaluation look like when it comes to a restorative reproductive medicine lens? So first of all, we always start with looking at both partners, making sure that we're evaluating female factor, which I know we talk a lot about on this podcast, but also ordering a full semen analysis for men, especially if it has not been updated recently. In our world, we typically are going to want to have it repeated if it has not been done within the past year because again, sperm completely changes over every two to three months, and so we want to make sure that we are assessing what is going on in real time with overall male health. Now as far as collecting the semen analysis, typically it's best to abstain from any intercourse or ejaculation for two to five days prior to the sample. This ensures that we have the highest quality and the highest quantity and amount present. It is okay to collect during a natural active intercourse. We typically just say, you must use a non lubricated condom so that it does not interact negatively with the processing. And you generally need to dump the contents of that condom into a container, get it to the lab within 30 to 60 minutes of collection time at body temperature. So usually we say just stick it under your armpit or put it between your thighs as you're driving to the lab. If we make any changes from a lifestyle standpoint or after you're done with an illness or maybe from a medication or supplement standpoint, we would repeat that semen analysis no sooner than 10 to 12 weeks before we make all of those changes. So, as we mentioned was in the case with Charles, there's a lot of factors that can contribute to this. So we'll go through some of these and some of'em are things that Charles had and some of them are things that you may not think of. So we always are going to look at a complete history, especially if we see anything abnormal in the semen analysis. So things like a fever or illness in the past three months. Again, higher temperature is not good for sperm. That's part of the reason why the scrotum is outside of the body. It's a little bit cooler. But if the body is under higher temperatures, so whether that's a sauna, a hot tub, a laptop that sits on your lap, anything that would cause increased heat can significantly impair sperm quantity and quality. For guys, other things to think about. Bicycling. We do know that guys that cycle a lot can have more problems with this. We think it's because of the microtrauma that can be provided to the scrotal area, just with your seat and long riding. Um, sometimes it can also be related though to your clothing that you wear when you're biking. Many guys will wear bike shorts or tight underwear, and this is not always the best case scenario for the scrotum itself because again, we're increasing the heat to that area. Certain medications can cause problems, so any type of anabolic steroids, so things used for bodybuilding or weightlifting, any testosterone prescription, these can significantly block and actually take your sperm counts down to completely zero. Over time, it can be more challenging to get that to come back. So I generally recommend anybody who's wanting to conceive in the future, not beyond testosterone supplementation because it can absolutely trash your sperm counts. Other medications that are common to see with guys causing sperm issues. Finasteride. Now, Finasteride is used most of the times in men in order to help with either prostate issues or in some cases to help with hair loss, but it can also block the conversion of testosterone. And so one of the things we wanna watch for is making sure that it's not negatively impacting sperm counts if you're trying to conceive. Okay. Some antidepressant medications can also cause problems, as can vaping, smoking marijuana usage, heavy alcohol usage, history of sexually transmitted infections, especially if they've not been treated. And we always will also ask about any urinary symptoms because this can play a role. So it's not just about do I have sperm or not? It's all of these other factors that go into it when we do this evaluation. Now as was the case with Charles, if we find anything abnormal on the semen analysis, next steps typically include evaluation to see if you qualify for any testing of infection. We also oftentimes will check an ultrasound to rule out any osee or hernia or look at the actual size of the testes to make sure there's not anything problematic. And then always looking at selective hormonal labs. Again, looking for any underlying cause that may be leading to decreased counts or morphology or quality of the sperm itself. Now, if we find that you have incredibly low counts or movement, or perhaps you have no sperm whatsoever, we absolutely refer and work with our urology colleagues. With that being said, I have personally helped couples to conceive when their counts are as low as 150,000. Now, for reference, normal we say is 15 million or above, so it doesn't require that we have to have perfect counts in order to improve your chances of pregnancy, but even having an improved number of counts as well as improving quality, making sure there's no infection present. All of those things will help to improve your chances of conception. So things that you can actually do today. Get rid of any excess heat. Looser underwear. No hot tubs, no saunas. Keeping your laptops off of your lap, eliminating any other toxins that are in your world. Tobacco vaping, marijuana. Excess alcohol, solvents, or chemicals at work, wherever we can make the changes to avoid those things that can negatively impact sperm count, start that now. Lifestyle changes also make a big difference for guys, making sure that we also are getting sleep seven to eight hours a night. Again, as I've discussed in the past on episode number 98, sleep is so important, not just for female hormone health, but also for production of sperm. We also say, yes, exercise is good. Avoid anything that is extreme over training. Avoid anything that is applying increased pressure or micro damage to the testicles. And then again, focusing on what is the underlying cause and fixing that cause. So if we identify that there are issues with insulin resistance or thyroid dysfunction, or a varicose seal, so that, again, that varicose vein, getting that repaired, if we identify infection or inflammation. Treating those things appropriately. And then finally, make sure to review your medications with your doctor if you have not already done so. Certain medications can impact your quality of sperm as well as the counts. So definitely testosterone or any anabolic steroids can suppress sperm, so you must stop them. Recovery from this can take months to years in some guys. So if it is anywhere on your radar, please stop them now. If you are on medications like Finasteride or certain antidepressants, these can also impair your quality of ejaculation, which can decrease your overall sperm counts and motility. So just make sure to review that with your doctor if you are on one of these medication. So let's wrap up with a couple of frequently asked questions we get when it comes to semen analysis. So my morphology is 2%. Is that game over if only 2% of the sperm look normal. And again, as I mentioned, not necessarily morphology is now such strict criteria that we see. Even guys with 0% morphology able to conceive as long as all of the other factors are high quality. How about DNA fragmentation testing? Should everybody do that? And we typically say, not always. Now, most of the time we reserve this testing. If you have had recurrent pregnancy loss, if there's older paternal age, or if we're concerned that there might be something else going on with the quality of the semen itself. Now, most of the time we're able to pick this up on lab testing first. So in our practice, we generally are going to do blood work analysis. First, because that way if we find something going on from a metabolic or hormonal status, we're going to correct that first before we go through the more expensive, more detailed DNA fragmentation testing. What about how quickly can my numbers improve? As I mentioned, sperm mature over the course of about three months, but you can see a meaningful change even within eight to 12 weeks if you are strongly adhering to the lifestyle changes and the recommendations given to you based on your appropriate treatment. And finally, we were referred to IVF because the seminal fluid analysis was borderline. Is this necessary? My short answer here is no. Most male factor issues respond to targeted lifestyle care and to focusing on treating the underlying cause of the low counts or motility in the first place. Most importantly, these changes can turn around within a couple of months, so we escalate care thoughtfully and in an appropriate sequence that makes sense in order to treat your underlying cause of male factor fertility. Imagine if improving sperm quality could feel practical and doable because you focused on the metrics that matter. Removed the hidden unknown factors, and worked together with a doctor who understood what to do in order to target appropriate treatment. Over the course of a few months, sperm numbers could trend upwards. Timing can feel less pressured, and your chances to conceive can increase from evaluating all the components that matter all to improve health and promote fertility.

Speaker 2 21:01

If you're ready to work with our elite team of healthcare professionals, go to our website, radiant clinic.com to schedule a free discovery call and learn more about our package based pricing for comprehensive care. We are currently able to see people for in-person appointments in our Cedar Rapids, Iowa Clinic, or can arrange for a telehealth visit if you live in many different states across the us. Check out our website for current states that we can serve medical clients and let us know if your state is not listed to see if we can still cover you there as we are constantly expanding our reach. Please note that our fertility educators are able to take care of clients no matter where they live. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom.