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Home : Contents : Current Management of Infertility : Before Seeing an Infertility Specialist — Men

Male Infertility Information

Getting pregnant always involves both male and female issues. Some of the techniques we use are quite powerful and can overcome most sperm problems. However, technology is expensive and time-consuming and we would like the sperm to be as good as they are able to be naturally. What follows is a brief discussion of some of the issues related to the male contribution to fertility.


Functional sperm are produced over a period of two to three months. Thus events that occurred in the last few months affect the current sperm count now. This is one of the reasons that sperm counts taken at different times may vary. Most sperm that men produce are not capable of fertilizing an egg. Only a small proportion of sperm naturally have this ability. Assessing the proportion of competent sperm usually can only be done in a subspecialty sperm lab. Most sperm are also prevented from getting to an egg by a woman's cervix. The right sperm can get to the egg at the right time more frequently when many good sperm are present. However, even when there are only a few good sperm, one can be lucky enough to get to the egg at the right time.


Anything in excess is probably not a good idea, but normal caffeine has not been shown to be detrimental to achieving pregnancy. It makes sperm swim faster which may be beneficial close to ovulation and detrimental more distant from ovulation.


Smoking is associated with an average 20% decline in sperm production and a much greater negative impact on sperm function. We strongly recommend that smokers take vitamin C (1000 mg) to compensate for missing anti-oxidants in the semen. More significantly, smoking is also associated with DNA damage that is transferred to the baby and increases the chances (related to amount smoked) of giving birth to a baby who develops childhood cancer. The risk of childhood cancer is still very low, but it is estimated that 15% of all childhood cancers are due to male smoking. These negative effects of smoking should be gone three months after stopping smoking.


Most data on alcohol use is also associated with smoking. Alcohol is distributed through all tissues of the body. Drinking more than two drinks a day is probably not optimal.

Nutritional Supplements/Vitamins

We recommend vitamin C (500 to 1000 mg) for its anti-oxidant effect, which can protect sperm membranes from damage and also 400 to 800 mg of folate (folic acid). One study suggests that taking vitamin E together with vitamin C makes vitamin C act as an oxidant.

Many male fertility supplements contain zinc. We strongly recommend that you avoid any vitamins or supplements containing zinc. Although zinc is a structural component enabling sperm to attain motility, sophisticated data suggests that the more zinc that a semen specimen contains, the worse the sperm specimen is. Our experience with men taking zinc supplementation suggests a negative impact. Many male fertility supplements are marketed to men and women. We have had patients who have taken some of these and are not aware of any supplement that is of benefit. Because of the multi-factorial and probabilistic nature of male infertility, good research is hard to do. A single paper demonstrating an improvement in a sperm parameter may be enough to launch the marketing of a product, but is not enough to be convincing scientifically. Based our knowledge of sperm production and function, it is unlikely that there will ever be a "magic bullet" for male fertility.

Temperature issues

Anything that elevates a man's scrotal temperature decreases sperm production. By design, the testicles are three degrees cooler than the rest of the body. Ten minutes in the sauna for ten days has been shown to decrease sperm production by 50% ten weeks later. Prolonged truck driving (without air conditioning), working with a laptop computer on one's lap, sleeping on a heated waterbed, wearing bike pants, intense exercising, and varicoceles have been shown to increase a man's scrotal temperature. Men with some occupations have seasonal variations in sperm counts (e.g., roofers) due to temperature variations. A varicocele may be a correctable cause of elevated scrotal temperature.


Most attempts to look at the impact of stress on sperm production have found no effect. An interesting exception to this is a study that compared semen analyses before and after the 1995 Kobe earthquake in Japan. Large differences before and after the quake were observed in men who were either close to the epicenter of the quake or lost family members from the quake.

Medications and chronic illnesses

The most common problems we encounter involve hypertension and diabetes. One class of drugs used for hypertension is the calcium channel blockers. These drugs interrupt a mechanism in sperm that enable sperm to bind to eggs. They have potential utility to be developed as a male contraceptive in the future. Some men with diabetes have had damage to a nerve that causes some of the semen to be lost in the bladder.