When it comes to male fertility, there are four basic parameters: semen, sperm, testosterone, and erections. Fortunately, getting a fix on where a man stands—his sexual biological age as opposed to his chronological age—is relatively easy.
Testosterone levels are checked by drawing a blood sample, usually from the arm. Blood samples should be taken in the morning, since that’s when levels are highest. If the levels are below or near 300 ng/dl, another one or two samples may be taken on other days to confirm the first result, since testosterone levels fluctuate daily and seasonally.
Whether or not a man has erectile dysfunction is something he and his partner judge for themselves based on their personal experience. All men occasionally can’t get it up, the question is how often that happens and to what degree the man and his partner are bothered by it. These days a man complaining of erectile dysfunction is usually given a trial prescription for an erection-enhancing pill.
Only if he can’t take the pill because of other risk factors such as being on a nitrate-containing medication, or if the pill fails to work are more elaborate tests done to try and pinpoint the problem. Such tests can include injection of erection-producing drugs to check the health of the man’s penile arteries and veins, and the use of devices that detect the presence and quality of night-time erections.
The quality of a man’s semen and sperm are assessed on a sample of ejaculate produced by masturbating into a small, sterile plastic container. For some men, this isn’t a big deal. They just go to a bathroom in a clinic or doctor’s office, do their job, and…presto!…a nice, fresh sample which is immediately analyzed. (Some facilities have private rooms for semen collection that often include erotic magazines or videos to help overcome the unnaturalness of the process.) Other men prefer to masturbate at home and bring their sample to the lab. And some men, for religious reasons, need to collect their semen by having intercourse using a special sterile condom (not standard latex or lambskin condoms).
Regardless of how semen is obtained, the sooner it is analyzed, the better. Sperm swim less and less vigorously as the minutes pass after ejaculation. To gauge the vigor of a man’s sperm, his semen should not be more than an hour old. In addition, the sample must not be contaminated by other substances or bacteria, which means men should not have unprotected intercourse to bring themselves to the point of orgasm, and they should not use artificial lubricants during masturbation.
It’s good to plan a semen collection in advance since timing is everything. A man should not “store up” his semen for a long time because sperm in the vas deferens slowly die. If a man doesn’t ejaculate for 4-5 days, his semen will contain more dead sperm than normal. On the other hand if he has ejaculated one or more times in the past two days, his semen volume will be lower than normal. It’s a good idea, therefore, for a man to make sure his last ejaculation was two or three days before the day he collects his semen. (Note: if a man has had a recent high fever or a serious illness or injury, he should talk to his doctor about delaying a semen analysis for about three months to allow his sperm production to recover.)
Sperm counts are given as the number of sperm in each milliliter of semen. Healthy men have between 40 million and 300 million sperm per milliliter, and average sperm count is between 60-80 million. Counts below 20 million per milliliter are considered poor, with counts between 20 million and 40 million considered marginal, though possibly fine if other aspects of the sperm, such as their morphology and motility, are good. Men with counts below 20 million may still be fertile, but it may take longer to initiate a pregnancy and the chances are greater that a pregnancy will not occur. Men with high counts are not guaranteed fertile, particularly if an infection or other abnormalities that affect morphology and motility are present.
Interpreting a sperm count correctly requires knowing the total volume of semen in a sample. For example, if a man has 20 million sperm per milliliter of semen, it might be considered low. But if he ejaculates 5 milliliters of semen, his total number of sperm is 100 million—which would be considered perfectly adequate.
Sperm shape is determined by examining semen under a microscope and counting how many appear normal in the small area in view. Sperm are made in such vast quantities that semen from even the healthiest man contains many dead or misshapen sperm. It’s considered normal to have as high as 70% of the sperm in a sample be abnormal or dead, though obviously the fewer such sperm the better for fertility.
I want to emphasize that a low sperm count is almost always the result of some underlying health problem, which can be serious. In other words a low sperm count is a symptom, or clue, that something is wrong, not a disease state in and of itself. A low sperm count is like high fever—the best approach to a fever is not to just throw aspirin at it but to find the underlying problem that is causing the fever and treat that.
Not all doctors will tell you that. And many won’t pursue the reason for your low sperm count. But you should. Some of the most common underlying problems are hormonal irregularities, use of over-the-counter steroids, distended veins in the testicles, diabetes, pituitary tumors and even testicular cancer.