A man will be diagnosed with a low [sperm](https://nabtahealth.com/glossary/sperm/) count if his semen sample contains fewer than 15 million [sperm](https://nabtahealth.com/glossary/sperm/) per milliliter. The medical term for this condition is oligozoospermia and it is one [reason for male](../causes-of-male-infertility) [infertility](https://nabtahealth.com/glossary/infertility/). Establishing the [prevalence of male](https://nabtahealth.com/articles/why-is-it-so-difficult-to-establish-the-prevalence-of-male-infertility/) [infertility](https://nabtahealth.com/glossary/infertility/) is challenging. However, abnormal [sperm](https://nabtahealth.com/glossary/sperm/) production, including low [sperm](https://nabtahealth.com/glossary/sperm/) counts, is considered to be one of the major contributing factors. Having a low [sperm](https://nabtahealth.com/glossary/sperm/) count does reduce the odds of a couple falling pregnant. However, it can still happen; after all, it only takes a single [sperm](https://nabtahealth.com/glossary/sperm/) to fertilise an egg. A female can only fall pregnant if she ovulates, which is the process by which an egg is released from the ovary. This happens about midway through her menstrual cycle; for a woman with a 28 day cycle, [ovulation](https://nabtahealth.com/glossary/ovulation/) will occur around day 15. This is when she is at her most fertile and conception is most likely to occur. However, [sperm](https://nabtahealth.com/glossary/sperm/) can survive for approximately five days inside the female body. For those who wish to maximise their chances of conceiving, it is worth having intercourse every day. That is, from at least four days prior to the expected date of [ovulation](https://nabtahealth.com/glossary/ovulation/). The released egg is only viable for fertilisation for 12-24 hours after [ovulation](https://nabtahealth.com/glossary/ovulation/). Intercourse after this time will not result in pregnancy. ##### Methods used; There are methods available to assist a female in determining if and when she has ovulated, including commercially available kits and the charting of [basal body temperature](https://nabtahealth.com/charting-your-basal-body-temperature-bbt/) (BBT). BBT will rise 0.5°C after [ovulation](https://nabtahealth.com/glossary/ovulation/). Knowing precisely when [ovulation](https://nabtahealth.com/glossary/ovulation/) is likely and timing intercourse accordingly, will further increase the chances of successful fertilisation. If a female’s cycles are irregular this may be more challenging. Often the cause of low [sperm](https://nabtahealth.com/glossary/sperm/) count in males is unknown, with hormones, medications, genetics and childhood conditions all thought to play a role. To further increase the likelihood of pregnancy without medical intervention, men may be encouraged to make certain [lifestyle changes](../environmental-factors-that-contribute-to-male-infertility). It is important to treat underlying medical conditions. Adopting a [better diet](../do-vitamins-and-other-nutritional-products-improve-sperm-count) and avoiding alcohol and smoking can help. Seeking help for the management of medical issues, such as [](../what-are-varicoceles)[varicoceles](https://nabtahealth.com/glossary/varicoceles/), genital infections and hormonal irregularities. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#463f272a2a270628272432272e23272a322e6825292b) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * “Low [Sperm](https://nabtahealth.com/glossary/sperm/) Count.” _Mayo Clinic_, 18 Sept. 2018, www.[mayoclinic](https://www.mayoclinic.org/).org/diseases-conditions/low-[sperm](https://nabtahealth.com/glossary/sperm/)\-count/diagnosis-treatment/drc-20374591. * Sengupta, P, et al. “The Disappearing Sperms: Analysis of Reports Published Between 1980 and 2015.” _American Journal of Men’s Health_, vol. 11, no. 4, July 2017, pp. 1279–1304., doi:10.1177/1557988316643383.
Diagnosed with Azoospermia will be made if no spermatozoa ([sperm](https://nabtahealth.com/glossary/sperm/) cells) are detected in two semen samples, taken 2-3 months apart. Azoospermia affects approximately 15% of infertile men and, if unexpected, can be quite an upsetting diagnosis to come to terms with. Fortunately, advances in modern medicine mean that a significant number of men who are in this position go on to successfully father children. Before determining which treatment will be most suitable, it is first important to establish whether it is a case of obstructive azoospermia (OA) or non-obstructive azoospermia (NOA). **Obstructive Azoospermia (OA)** -------------------------------- OA, affecting up to 40% of men with azoospermia, occurs when part of the reproductive tract is blocked. The testes are usually normal sized and hormone levels are in the normal range. The blockage can be acquired, for example by previous vasectomy or by surgery or trauma to that area of the body; or it can be congenital. The most well-known example of congenital [infertility](https://nabtahealth.com/glossary/infertility/) is due to [](../causes-of-male-infertility)[Cystic Fibrosis](https://nabtahealth.com/glossary/cystic-fibrosis/). Depending on the part of the reproductive tract affected, reconstructive surgery is an option. Blockages in the [epididymis](https://nabtahealth.com/glossary/epididymis/) or [vas deferens](https://nabtahealth.com/glossary/vas-deferens/) can be treated with vasoepididymostomy or vasovasostomy (also known as a reverse vasectomy). Obstruction of the ejaculatory duct can be treated with transurethral resection of the ducts, whereby a small incision is made in the ejaculatory duct, enabling [sperm](https://nabtahealth.com/glossary/sperm/) to reach the semen. In some cases, even if blockage removal appears to have been successful, additional techniques are implemented to aid fertilisation because the [sperm](https://nabtahealth.com/glossary/sperm/) is prone to poor [](../low-sperm-motility-asthenozoospermia)[motility](https://nabtahealth.com/glossary/motility/). If reconstructive techniques are not suitable or do not work, [sperm](https://nabtahealth.com/glossary/sperm/) retrieval techniques might be attempted. Examples include: – TESE: testicular [sperm](https://nabtahealth.com/glossary/sperm/) extraction – TFNA: testicular fine needle aspiration – PESA: percutaneous epididymal [sperm](https://nabtahealth.com/glossary/sperm/) aspiration – MESA: microsurgical epididymal [sperm](https://nabtahealth.com/glossary/sperm/) aspiration. The choice of technique largely depends on patient preference as well as local expertise. If initial attempts do not yield sufficient [sperm](https://nabtahealth.com/glossary/sperm/), the doctor can try to extract from an alternative location, often at the same time, meaning additional procedures are kept to a minimum. [Sperm](https://nabtahealth.com/glossary/sperm/) retrieval is successful in over 90% of OA cases. Once extracted the [sperm](https://nabtahealth.com/glossary/sperm/) can be used directly for intracytoplasmic [sperm](https://nabtahealth.com/glossary/sperm/) injection (ICSI) or cryopreserved for use at a later date. **Non-obstructive Azoospermia (NOA)** ------------------------------------- NOA usually occurs as a result of a testicular deficiency. The underlying pathologies are varied and include genetic and congenital abnormalities, [](../what-are-varicoceles)[varicoceles](https://nabtahealth.com/glossary/varicoceles/) (enlarged testicular veins), hormonal disorders, medications and toxin exposure. Often men with NOA will have abnormal testes and/or hormone levels. NOA is sometimes associated with specific microdeletions in the Y chromosome (AZFa and AZFb) that have a particularly poor prognosis in terms of [sperm](https://nabtahealth.com/glossary/sperm/) retrieval. Therefore, genetic testing for microdeletions in this region may be offered to these men to determine the likelihood of finding viable [sperm](https://nabtahealth.com/glossary/sperm/) prior to them undergoing any additional procedures. Men with NOA have fewer options available to them. Not all of the [sperm](https://nabtahealth.com/glossary/sperm/) retrieval techniques are suitable, but TESE can be used. If this is unsuccessful, microsurgical testicular [sperm](https://nabtahealth.com/glossary/sperm/) extraction (micro-TESE) can be attempted. This method requires a skilled practitioner and a general anaesthetic, but the advantages are that blood supply is preserved and the surgeon can deliberately identify and select larger [seminiferous tubules](https://nabtahealth.com/glossary/seminiferous-tubules/), i.e. those more likely to contain [sperm](https://nabtahealth.com/glossary/sperm/). [Sperm](https://nabtahealth.com/glossary/sperm/) is found in 40-50% of men with NOA, including men who are azoospermatic as a result of previous [chemotherapy](https://nabtahealth.com/glossary/chemotherapy/). Those men who have been diagnosed with concurrent [varicoceles](https://nabtahealth.com/glossary/varicoceles/) might want to consider undergoing a varicoceletomy, as this has been shown to improve ejaculate [sperm](https://nabtahealth.com/glossary/sperm/) levels in 20-55% of men with NOA. Ideally, [sperm](https://nabtahealth.com/glossary/sperm/) that is extracted from a man with NOA should be used fresh, as freeze-thawing compromises its stability and viability. When compared to OA [sperm](https://nabtahealth.com/glossary/sperm/), NOA [sperm](https://nabtahealth.com/glossary/sperm/) is more susceptible to DNA damage. Men who do have a genetic condition need to consider carefully the chances of passing it on to their offspring if they do undergo additional fertility treatment using their own [sperm](https://nabtahealth.com/glossary/sperm/). **Assisted Reproductive Techniques (ARTs)** ------------------------------------------- Once [sperm](https://nabtahealth.com/glossary/sperm/) is extracted the next step is to attempt to fertilise the female’s egg. The most well-known [ART](https://nabtahealth.com/glossary/art/) is in vitro fertilisation ([IVF](https://nabtahealth.com/glossary/ivf/)). During [IVF](https://nabtahealth.com/glossary/ivf/) the female’s eggs are extracted and mixed with her partner’s [sperm](https://nabtahealth.com/glossary/sperm/) in a petri dish. Once fertilised the eggs are placed back into the female’s [uterus](https://nabtahealth.com/glossary/uterus/). ICSI is a variant of [IVF](https://nabtahealth.com/glossary/ivf/) that involves injecting a single [sperm](https://nabtahealth.com/glossary/sperm/) into an egg. This is ideal in cases where only small quantities of usable [sperm](https://nabtahealth.com/glossary/sperm/) could be harvested using the techniques described above. ICSI fertilisation rates are 45-75% for OA and 20-65% for NOA. Live birth rates following successful ICSI fertilisation are 18-55% for OA and 8-35% for NOA. Whilst these figures may still seem low it is worth considering that advances in reproductive medicine are progressing rapidly and, prior to the development of microsurgical techniques and ICSI, men with NOA would have had no chance of fathering their own children, having to rely instead on donor insemination. Whilst azoospermia can seem like a fairly intimidating diagnosis, it is important to remember that lack of [sperm](https://nabtahealth.com/glossary/sperm/) does not equal complete sterility. Many men still produce [sperm](https://nabtahealth.com/glossary/sperm/) and the techniques for harvesting it are becoming more refined and as a result more effective. Regardless, both OA and NOA may benefit from surgical procedures to correct the problem. If surgery is successful, there is a good chance that fertilisation will be able to occur through normal intercourse, avoiding the need for stressful, costly [ART](https://nabtahealth.com/glossary/art/). It is important to consider that [ART](https://nabtahealth.com/glossary/art/) can be very stressful for the female as she undergoes artificial hormonal induction to retrieve eggs. All options should be discussed with a doctor, prior to making a decision. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#b3cad2dfdfd2f3ddd2d1c7d2dbd6d2dfc7db9dd0dcde) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Esteves, S C, et al. “[Sperm](https://nabtahealth.com/glossary/sperm/) Retrieval Techniques for Assisted Reproduction.” _International Braz J Urol_, vol. 37, no. 5, 2011, pp. 570–583. * Katz, D J, et al. “Male [Infertility](https://nabtahealth.com/glossary/infertility/) – The Other Side of the Equation.” _Australian Family Physician_, vol. 46, no. 9, Sept. 2017, pp. 641–646. * Jungwirth A, et al. _European Association of Urology (EAU)_ guidelines on male [infertility](https://nabtahealth.com/glossary/infertility/). Arnhem, The Netherlands: European Association of Urology, 2015. Available at [https://uroweb.org/wp-content/uploads/17-Male-](https://uroweb.org/wp-content/uploads/17-Male-Infertility_LR1.pdf)[Infertility](https://nabtahealth.com/glossary/infertility/)\_LR1.pdf \[Accessed 31 March 2019\]. * “What Is Male [Infertility](https://nabtahealth.com/glossary/infertility/)?” _Urology Care Foundation_, [www.urologyhealth.org/urologic-conditions/male-](http://www.urologyhealth.org/urologic-conditions/male-infertility)[infertility](https://nabtahealth.com/glossary/infertility/). * Wosnitzer, M, et al. “Review of Azoospermia.” _[Spermatogenesis](https://nabtahealth.com/glossary/spermatogenesis/)_, vol. 4, no. e28218, 31 Mar. 2014, doi:10.4161/spmg.28218.
\***_According to Patient Feedback_** “Who are the best gynaecologists in Dubai? Can anyone recommend an OBGYN?” You asked us and we turned the question back to you. We have compiled the top 10 gynaecologists in Dubai, based only on real patient recommendations, experience and feedback. No healthcare professionals were questioned. Gathered from exemplary recommendations across Dubai social media forums, these top 10 gynaecologists in Dubai not only have a wealth of clinical expertise in their field, they also stand out for the overwhelmingly positive comments from their patients. #### **Dr Salma Ballal, Consultant Obstetrics and Gynaecology, [Genesis Healthcare Center](https://www.genesis-dubai.com/our_doctors/dr-salma-ballal/)** Having delivered well over 1000 babies, Dr Salma Ballal has extensive experience in managing normal and complex pregnancies and deliveries. Dr Salma trained in obstetrics and gynaecology with the UK’s NHS where she developed a strong interest in maternal medicine, high-risk pregnancies, and labour care. She completed advanced maternal medicine and labour ward practice training with the Royal College of Obstetrics and Gynaecology (RCOG) before moving to Dubai in 2014. Dr Salma was most recently at Mediclinic Parkview hospital before joining the Genesis Healthcare Center team. Dr Salma believes in open communication with her patients and that “women should be kept informed through every step of what is the most amazing experience in any woman’s life.” She also offers pre-pregnancy counselling to patients with complicated or traumatic pregnancy history. Patients describe Dr Salma as “refreshingly honest”, and “very safe hands”, saying she “totally respected my wishes”. #### **Dr Esra Majid, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Kings’ College Hospital Dubai**](https://kingscollegehospitaldubai.com/dr/esra-mejid/) Based in Dubai since 2016, Dr Esra has built a reputation for her management of high-risk pregnancies and gynaecological conditions. She worked at Al Zahra Hospital Dubai, where she regularly received excellent feedback from her patients, before moving to King’s College Hospital Dubai. At Kings’ College Hospital Dubai Dr Esra “performs major surgical procedures, follow up of high-risk pregnancies and deliveries, along with natural and water births.” Dr Esra qualified in Baghdad and went on to complete her Board Certificate in Obstetrics and Gynaecology in Sweden. She worked at the teaching hospital Sundsvall County Hospital and as a specialist at Sodra Alv Bord Hospital in Gothenburg before moving to Dubai. Patients have praised Dr Esra for her expertise and skill, describing her as “straight to the point, warm and approachable.” #### **Dr Vibha Sharma, Specialist [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Prime Medical Center**](https://www.primehealth.ae/prime-medical-centers/medical-centers/prime-medical-center-sheikh-zayed-road/dr-vibha-sharma) Working in Dubai since 2004, Dr Vibha is known for her commitment to supporting women with a range of gynaecological and women’s health problems. In the UAE she worked at Ministry of Health and Tertiary Care hospitals prior to joining Prime Medical Center. Dr Vibha specialises in areas of women’s health requiring specialist gynaecological expertise. Qualified in India at Jammu Medical College, Dr Vibha went on to do her post-graduate at King George’s Medical College in Lucknow. She worked at Queen Mary’s Hospital Lucknow and Willingdon and Batra Hospitals and Research Centre in New Delhi before moving to the Middle East. Patients have described Dr Vibha as “consistent”, “approachable”, and “professional”. **Dr Aisha Alzouebi, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Mediclinic Parkview Hospital**](https://www.mediclinic.ae/en/corporate/doctors/1/aisha-alzouebi-dr.html) Dr Aisha Alzouebi has more than 15 years of experience in obstetrics and gynaecology in the UK and the UAE, with specialist expertise in “early pregnancy, management of complications in early pregnancy, family planning and sexual health, [benign](https://nabtahealth.com/glossary/benign/) open and laparoscopic surgery and hysteroscopy.” A member of the UK’s Royal College of Obstetricians and Gynaecologists (RCOG), Dr Aisha attended medical school at Sheffield University and completed her Masters in Surgical Education at Imperial College London. Patient social media feedback on Dr Aisha said, “she was brilliant”, “I would highly recommend her”, “Dr Aisha is great”. #### **Dr Reeja Mary Abraham, Specialist in Obstetrics and Gynaecology,** [**Medcare Women and Children Hospital**](https://www.medcare.ae/en/physician/view/reeja-mary-abraham.html) A specialist in high-risk pregnancies, Dr Reeja takes an “evidence-based” approach to complex and low risk gynaecological issues. Dr Reeja is based at Medcare Women and Children Hospital, where she also “performs and assists in major and minor gynaecological procedures”. A member of the Indian Medical Association (IMA) and the Kerala Federation of Obstetricians and Gynaecologists (KFOG), Dr Reeja began her medical career at Christian Fellowship Hospital in Oddanchatram, Tamil Nadu and worked in hospitals in Kerala and Tamil Nadu before moving to Dubai to work at Medcare Women and Children Hospital. Patients recommending Dr Reeja describe her as “kind and attentive”, “highly professional”, and “detail-oriented”. #### **Dr Nashwa Abulhassan, Head of Obstetrics and Gynaecology, Dr** [**Sulaiman Al Habib Hospital Healthcare City**](https://www.hmguae.com/doctor/dr-nashwa-abul-hassan/) Dr Nashwa is a specialist in normal and complex pregnancies and deliveries, as well as “acute gynaecology and early pregnancy complications management” based at Dr Sulaiman Al Habib Hospital Healthcare City. A member of the Royal College of Obstetricians and Gynaecologists (RCOG) and an accredited member of the British society of colposcopists and cervical pathologists, Dr Nashwa has more than 15 years of experience in the UK and the UAE. Dr Nashwa has been featured in the UAE media discussing pregnancy complications and was most recently in [Gulf News](https://gulfnews.com/uae/health/step-by-step-guide-to-dealing-with-covid-19-during-pregnancy-1.80112211), offering advice for pregnant women who have tested positive for Covid-19. Dr Nashwa’s patients describe her as “kind and caring”. #### **Dr Samina Dornan, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/) and sub specialist in Maternal Fetal Medicine, [Al Zahra Hospital](https://azhd.ae/doctors/dr-samina-dornan/#:~:text=Consultant%20Maternal%20and%20Fetal%20Medicine,London%20to%20come%20to%20Dubai.)** An established international voice on maternal and fetal health issues, Dr Samina Dornan has extensive experience in fetal medicine. At Al Zahra Hospital she works as a consultant [obstetrician](https://nabtahealth.com/glossary/obstetrician/) and gynecologist with a sub-specialty in Maternal Fetal Medicine. Dr Samina qualified at Queen’s University Belfast. She received a fellowship from the Royal College of Obstetricians and Gynaecologists (RCOG) in 2017 and is the “first female Maternal Fetal Medicine sub-specialist \[at RCOG\]” to work with patients in Dubai. Frequently quoted in the media, Dr Samina is “extensively published in complex twin pregnancies”. Patient feedback on Dr Samina is overwhelmingly positive, describing her as “wonderful”, “absolutely fantastic”, “caring” and “amazing”. #### **Dr Sarah Francis, Consultant Obstetrics and Gynaecology,** [**American Hospital Dubai and American Hospital Al Khawaneej Clinic**](https://www.ahdubai.com/doctors-profile/sarah-francis) With clinical expertise in general and [benign](https://nabtahealth.com/glossary/benign/) gynaecology, adolescent gynaecological issues, polycystic ovarian syndrome ([PCOS](https://nabtahealth.com/glossary/pcos/)), and low and high-risk pregnancies, Dr Sarah supports patients at American Hospital Dubai and American Hospital Al Khawaneej Clinic. A member of the Royal College of Obstetricians and Gynaecologists (RCOG), Dr Sarah qualified in Sierra Leone and practised in NHS hospitals and trusts across the UK before moving to the UAE. She worked with patients at Drs Nicholas and Asp clinics before joining the team at American Hospital. Patients say that Dr Sarah is “wonderful” and “exceptionally supportive”. #### **Dr Dragana Pavlovic-Acimovic, Specialist Obstetrics and Gynaecology,** [**Mediclinic Meadows**](https://www.mediclinic.ae/en/corporate/doctors/8/dragana-pavlovic-acimovic.html) Dr Dragana has “a special interest in obstetrics” and consults on “adolescent gynaecology, [menopause](https://nabtahealth.com/glossary/menopause/), family planning” and various gynaecological conditions. Dr Dragana qualified in Serbia and started her career at University Hospital Narodni Front in Belgrade, “the largest specialised obstetrics and gynaecology centre in South-East Europe”. She moved to Dubai in 2015 and worked at Drs Nicholas and Asp before joining Mediclinic. Patients’ experience with Dr Dragana is “great”. #### **Dr Alessandra Pipan, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Mediclinic City Hospital**](https://www.mediclinic.ae/en/corporate/doctors/1/alessandra-pipan.html) With more than 30 years’ experience in gynaecology and obstetrics Dr Alessandra treats a range of gynaecological conditions, is a specialist in [infertility](https://nabtahealth.com/glossary/infertility/) and oncology, and works with high-risk pregnancies at Mediclinic City Hospital. A member of the Royal College of Obstetrics and Gynaecology (RCOG), the European Society of Reproduction and Embryology, and the European Society of Gynaecological Endoscopy, Dr Alessandra qualified at Cattolica University of Rome, Italy and has developed extensive sector experience in positions across the Italian and UAE healthcare institutions. Patients of Dr Alessandra have described her as “great” and “amazing”. \_\_\_ Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [](https://nabtahealth.com/glossary)[menopause](https://nabtahealth.com/glossary/menopause/). You can track your menstrual cycle and get [personalised support by using the Nabta app.](https://nabtahealth.com/our-platform/nabta-app/) Get in [touch](/cdn-cgi/l/email-protection#fc859d90909dbc929d9e889d94999d908894d29f9391) if you have any questions about this article or any aspect of women’s health. We’re here for you.
You’re ready to start a family and you want to know what helps you get pregnant fast. Conceiving can take time, and fertility is different for every woman and couple. If you are trying for a baby, there are natural ways to increase your chances of getting pregnant. #### _Getting your body ready for pregnancy_ You can start by taking some lifestyle steps to prepare your body for conception. Your health before pregnancy can improve your chances of conceiving. And preconception wellbeing contributes to a healthy pregnancy. So, in the 3 to 4 months before trying for a baby: – Take **prenatal vitamins**: Start taking prenatal vitamins with [folic acid](https://nabtahealth.com/product/folic-acid-test/) before and during pregnancy to ensure your body is nutritionally strong, with all the [minerals and vitamins required for healthy fetal developmen](https://nabtahealth.com/articles/4-supplements-to-take-when-trying-to-conceive/)t. – Get a **well-woman health check**: Get a full preconception medical to flag any potential health issues that could affect you getting pregnant naturally or could affect your pregnancy. Use this check-up to make sure your vaccinations are up to date. – **Stop smoking, vaping,** and **drugs**. Limit **alcohol** intake and cut back on **caffeine**. – Eat a [**balanced diet**](https://nabtahealth.com/articles/eating-to-conceive/): Boost your health with a varied diet covering all five food groups. – Keep a **healthy weight**: Being underweight, obese or overweight can affect your fertility. – **Exercise** regularly: Exercise that builds strength, endurance and muscle tone will help your body stay healthy and strong during pregnancy and labour. – Get lots of sleep: Sleep patterns affect hormones. Stick to a regular 7-8 hours sleep routine as you prepare your body to conceive. – **Reduce stress**: High stress levels are linked with difficulties getting pregnant. – **Come off hormonal contraception**: If you’re on hormonal contraception (the pill, [IUD](https://nabtahealth.com/glossary/iud/), patch, ring implant) your body needs time to readjust and for cycles to return to your personal normal. #### _Know your fertile window_ Timing is everything when you want to conceive. You need to time sex with [ovulation](https://nabtahealth.com/glossary/ovulation/). The man’s [sperm](https://nabtahealth.com/glossary/sperm/) must meet and fertilise the woman’s egg at the right time. Knowing your fertile window and timing sexual intercourse with [ovulation](https://nabtahealth.com/glossary/ovulation/) is key to increasing your chances of getting pregnant. Women typically ovulate around 12 to 14 days before their next period. If your periods are regular (the average menstrual cycle is 28 days but it’s normal for women’s cycles to be anywhere from 21 to 40 days) you count back from the first day of when you would expect your next period. #### _Trying to get pregnant_ Have sex at least every 2 to 3 days in the [lead](https://nabtahealth.com/glossary/lead/)\-up to [ovulation](https://nabtahealth.com/glossary/ovulation/). [Sperm](https://nabtahealth.com/glossary/sperm/) can survive for several days in the female reproductive tract and once you’ve ovulated your egg has a 12-to-24-hour window for fertilisation, so for the best chances of conception have regular sex in the [lead](https://nabtahealth.com/glossary/lead/) up to that brief window. #### _What are the signs of [ovulation](https://nabtahealth.com/glossary/ovulation/)?_ Use fertility awareness methods to predict when you are most likely to conceive. If you have irregular cycles, combine these non-invasive physiological cues with tracking your menstrual cycle length to determine when you are most fertile: – Check [**cervical mucous**](https://www.mayoclinic.org/tests-procedures/cervical-mucus-method/about/pac-20393452): As you near [ovulation](https://nabtahealth.com/glossary/ovulation/) you’ll notice your discharge becomes clear, stretchy, and wet, with the consistency of raw egg whites. This means you are at your most fertile. – Chart your [**basal body temperature (BBT)**](https://my.clevelandclinic.org/health/treatments/21065-basal-body-temperature): There’s a small rise in body temperature after [ovulation](https://nabtahealth.com/glossary/ovulation/). Measuring BBT over 3-4 cycles will give a fairly accurate prediction of the exact point of [ovulation](https://nabtahealth.com/glossary/ovulation/). Other methods for tracking [ovulation](https://nabtahealth.com/glossary/ovulation/) include: – **Calendar method**: This works by recording menstrual cycles on a calendar for 6-12 months and calculating fertile periods. It’s most effective as a fertility predictor when combined with cervical mucous and BBT methods. – [](https://nabtahealth.com/articles/how-do-ovulation-predictor-kits-work/)**[Ovulation](https://nabtahealth.com/glossary/ovulation/) predictor kits**: Over the counter [ovulation](https://nabtahealth.com/glossary/ovulation/) kits work in a similar way to at-home pregnancy tests. You pee on a stick measuring luteinizing hormone and a surge in this hormone indicates [ovulation](https://nabtahealth.com/glossary/ovulation/). Unfortunately, this doesn’t prove an egg has been released and a woman can have the hormone surge but fail to ovulate. – **Period tracker apps**: Smartphone [ovulation](https://nabtahealth.com/glossary/ovulation/) tracker apps, like [OvuSense](https://nabtahealth.com/product/fertility-cycle-monitoring-with-ovusense/), monitor menstrual cycles and predict fertility. Fertility awareness, knowing and understanding your body and its menstrual cycles, and lots of patience, helps lots of couples to conceive. But getting pregnant isn’t always as straightforward as knowing your body and having lots of sex. If it’s taking longer than expected to fall pregnant, make an appointment with your healthcare team. If you are under 35 see a doctor after 12 months of trying for a baby. If you are over 35 seek advice after 6 months of trying to get pregnant. [Nabta Health](https://nabtahealth.com/) provides personalised and evidence-based support and resources for women, wherever they are on their fertility journey.
Many factors contribute to male [infertility](https://nabtahealth.com/glossary/infertility/), including genetic defects, [](../what-are-varicoceles)[varicoceles](https://nabtahealth.com/glossary/varicoceles/), abnormal [sperm](https://nabtahealth.com/glossary/sperm/) production, health and fitness and environmental factors. For a detailed review on all these factors and more, click [here](../causes-of-male-infertility). Two conditions that frequently get confused are [azoospermia](../my-husband-has-been-diagnosed-with-azoospermia-what-next) and aspermia. **Azoospermia** will be diagnosed if no [sperm](https://nabtahealth.com/glossary/sperm/) cells are detected in a [sperm](https://nabtahealth.com/glossary/sperm/) sample. It is usually due to a blockage in the male reproductive tract (obstructive azoospermia) or a testicular deficiency (non-obstructive azoospermia). **Aspermia** is more colloquially known as ‘dry ejaculate’ and refers to a complete lack of semen expulsion. It is essentially an ejaculatory disorder and is broadly classified as either anejaculation, where the semen does not pass from the seminal vesicles, prostate and ejaculatory ducts into the urethra; or retrograde ejaculation, where the semen passes backwards into the bladder instead of moving in an antegrade direction. Treatment will depend on which type of aspermia is diagnosed. #### **Anejaculation** Anejaculation, the inability to transport semen, has various aetiologies. These include ejaculatory duct obstruction, pelvic trauma/surgery/radiation, neurological conditions, diabetes and stress. The most common treatment approach for men who have anejaculation with an intact ejaculatory reflex is penile vibratory stimulation, which is successful in restoring antegrade ejaculation in 65-83% of cases. Alternative options are prostatic massage and electroejaculation. These methods are all types of [sperm](https://nabtahealth.com/glossary/sperm/) retrieval and will be used in preparation for Assisted Reproductive Techniques (ARTs). #### **Retrograde Ejaculation** Retrograde ejaculation, an inability to ejaculate in the antegrade direction, will often be diagnosed if [sperm](https://nabtahealth.com/glossary/sperm/) is detected in the urine. Semen enters the bladder, instead of emerging through the penis during orgasm. Retrograde ejaculation is responsible for 0.4-2% of all cases of male [infertility](https://nabtahealth.com/glossary/infertility/) and is most often due to previous medications or surgical procedures that have caused the muscle of the bladder neck to relax. Neurological conditions and diabetes can also affect this area, resulting in retrograde ejaculation. This form of aspermia responds well to drug treatment; specifically, sympathomimetic drugs (stimulate the sympathetic nervous system), which are able to restore ejaculation in 50-100% of cases, with minimal, if any, side effects. #### **The outlook for men with azoospermia and aspermia** The reality is that azoospermia and aspermia both significantly reduce the likelihood of a man fathering a child. Whilst one is classified as a condition of abnormal [sperm](https://nabtahealth.com/glossary/sperm/) production and the other as an ejaculatory disorder, the treatment options for both can be similar. For non-obstructive azoospermia and anejaculation the favoured treatment approach is [sperm](https://nabtahealth.com/glossary/sperm/) retrieval followed by ARTs. Unfortunately ARTs are costly and can be emotionally stressful. They also involve the female partner undergoing artificial hormone stimulation and egg retrieval. Men who have obstructive azoospermia may respond well to surgical blockage removal, avoiding the need to go through [sperm](https://nabtahealth.com/glossary/sperm/) retrieval and [ART](https://nabtahealth.com/glossary/art/); and men who exhibit retrograde ejaculation may respond well to medication. The main thing is to establish exactly what is causing [infertility](https://nabtahealth.com/glossary/infertility/) and devise an appropriate treatment plan accordingly. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#631a020f0f02230d020117020b06020f170b4d000c0e) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Jungwirth A, et al. European Association of Urology (EAU) guidelines on male [infertility](https://nabtahealth.com/glossary/infertility/). Arnhem, The Netherlands: _European Association of Urology_, 2015. Available at [https://uroweb.org/wp-content/uploads/17-Male-](https://uroweb.org/wp-content/uploads/17-Male-Infertility_LR1.pdf)[Infertility](https://nabtahealth.com/glossary/infertility/)\_LR1.pdf \[Accessed 31 March 2019\]. * Mehta, A, and M Sigman. “Management of the Dry Ejaculate: a Systematic Review of Aspermia and Retrograde Ejaculation.” _Fertility and Sterility_, vol. 104, no. 5, Nov. 2015, pp. 1074–1081, doi:10.1016/j.fertnstert.2015.09.024.
 Men have a well-deserved reputation for avoiding the doctor and ignoring unusual symptoms. Sometimes until it’s too late. Unfortunately, it can often take a health scare to get a man in front of a doctor. This is despite men being just as likely to be affected by chronic diseases, cardiovascular disease, type 2 diabetes, cancer, kidney disease, stroke, dementia as women. And there are more unique health conditions such as prostate cancer, erectile dysfunction, and the andropause. #### Habits for a healthy lifestyle Men can protect health, wellbeing, and lifespan by avoiding damaging behaviours and focusing on positive lifestyle actions: * **Exercise** regularly: A combination of cardiovascular exercise and strength training for 30 to 45 minutes at least 3 to 4 times a week. * **Eat well**: Eat a nutritionally balanced diet. Follow a diet low in fat, with a balanced mix of fruit, vegetables, fibre, protein, lean meats and fish, and complex carbohydrates. Limit processed foods and refined sugars. * **Drink water**: Stay hydrated. * **Avoid** excessive **weight gain or loss.** * **Don’t smoke**. **Limit alcohol** intake. **Avoid drugs.** * Reduce stress: Get outside. Change your environment. Take a break. * Get some **sleep**: Aim for a minimum seven hours’ beauty sleep each night. * Go for **routine health checks** and screenings. #### Essential screening tests for men Routine health check-ups and health screening tests (even without pre-existing medical conditions or symptoms) are designed to spot early signs of health problems before they become an issue. Heart disease, stroke, type 2 diabetes, kidney disease and dementia all have early warning markers and can significantly compromise quality of life if not picked up early. Health checks recommended for all adult men include: * Dental: Get your teeth checked yearly at the minimum. * Skin cancer: Check moles and skin lesions every few months. See a doctor every two years for a full body check. * Heart health, blood pressure and [cholesterol](https://nabtahealth.com/glossary/cholesterol/): High [cholesterol](https://nabtahealth.com/glossary/cholesterol/) and elevated blood pressure ([hypertension](https://nabtahealth.com/glossary/hypertension/)) can increase the risk of developing coronary heart disease and type 2 diabetes. * Testicular cancer: Monthly self-examinations are recommended after [puberty](https://nabtahealth.com/glossary/puberty/). See a doctor for a full examination as soon as you notice a lump or any changes. Further screening tests are recommended for men over 50 years: * Prostate cancer: Accounts for high numbers of cancer deaths in older men. Screening includes a PSA (prostate specific antigen) test and DRE (digital rectal examination). * Bowel cancer: Another leading cause of death in older men. Go for a faecal occult blood test every two years. * Hearing and eyesight: Hearing loss and eyesight problems become more common after 50 and can affect quality of life. * Diabetes type 2: Depending on the level of risk a fasting blood sugar test will be recommended every 1 to 3 years. * Dementia: Screening for cognitive impairment is typically included in an annual health check for all adults from 65 years. * Abdominal Aortic Aneurysm (AAA): Affects more men than women. Males over 65 are offered regular screenings. Doctors decide whether to screen earlier based on medical and family history. #### What affects male fertility? Male fertility problems can be caused by low [sperm](https://nabtahealth.com/glossary/sperm/) count, poor quality [sperm](https://nabtahealth.com/glossary/sperm/), or blockages preventing [sperm](https://nabtahealth.com/glossary/sperm/) moving through the reproductive tract. [Sperm](https://nabtahealth.com/glossary/sperm/) can be vulnerable to lifestyle and environmental factors including raised body temperature, weight gain, exposure to toxins, smoking, heavy alcohol intake and drug use. Fertility specialists may recommend blood work to check hormone levels and scan for certain infections or a possible genetic cause for [infertility](https://nabtahealth.com/glossary/infertility/). A doctor may request a [sperm](https://nabtahealth.com/glossary/sperm/) sample to assess [sperm](https://nabtahealth.com/glossary/sperm/) count, shape and movement, and a scrotal ultrasound to check if there are any problems or blockages in the testicles preventing [sperm](https://nabtahealth.com/glossary/sperm/) getting into a man’s ejaculate. #### What is the male [menopause](https://nabtahealth.com/glossary/menopause/)? Men also experience age-related hormonal decline. The ‘male [menopause](https://nabtahealth.com/glossary/menopause/)’ is more a gradual flattening out in [testosterone](https://nabtahealth.com/glossary/testosterone/) and other hormone levels over a number of years, than the dramatic cliff-plunge of female reproductive hormones during [menopause](https://nabtahealth.com/glossary/menopause/). Also called the andropause, age-related low [testosterone](https://nabtahealth.com/glossary/testosterone/), or late-onset hypogonadism, this period of a man’s life is sometimes described as the ‘midlife crisis’. Still, it brings associated physical and emotional health problems for men in their late 40s and into their 50s: * Low moods and depression * Low libido * Erectile dysfunction * Fatigue and low energy levels * Hot flashes or flushes and increased sweating * Loss of muscle mass * Increase in body fat * Dry skin The symptoms of low [testosterone](https://nabtahealth.com/glossary/testosterone/) can have a very real impact on everyday life. If you are concerned, speak to a healthcare professional who will assess your symptoms and may recommend hormone levels testing and possible treatment options. [Testosterone](https://nabtahealth.com/glossary/testosterone/) therapy has its pros and cons, and your doctor will want to weigh up options with you. For any men still reluctant to go to the doctor, at-home [men’s health](https://nabtahealth.com/product/mens-health-test/) and [](https://nabtahealth.com/product/testosterone-test/)[testosterone](https://nabtahealth.com/glossary/testosterone/) tests offer convenient and private testing options. #### Getting started with Men’s Health and Nabta Health [Nabta’s marketplace](https://nabtahealth.com/shop/collections/type/mens-health/) features products to support men wherever they are in their health journeys. At-home [testosterone](https://nabtahealth.com/glossary/testosterone/) level and men’s health tests allow men to screen essential hormone levels in the comfort and privacy of home. While wellness and pampering packages are designed to provide men with that well-deserved lifestyle boost.
 Deciding you want to become pregnant and have a baby can be an incredibly exciting and overwhelming time. Fertility can be affected by many factors and there are ways to increase your chances of conceiving naturally. However, for some trying for a baby may not go as hoped or planned, and they might need further medical assistance to conceive. Wherever you are on your fertility journey, [Nabta Health](https://nabtahealth.com/shop/collections/stage/fertility/) will support you with resources, knowledge, and access to experts. #### How can I increase my chances of getting pregnant naturally? First things first. There are lifestyle steps you can take in the months before you start trying for a baby to prepare your body for conception. * Take **prenatal vitamins**: To ensure your body is nutritionally strong, with all the minerals and vitamins you need for strong fetal development, start taking prenatal vitamins with folic acid at least three months before you try to conceive. * Follow a **balanced diet**: Boost your health with a varied diet covering all food groups. Avoid refined sugars, saturated fats and too much salt. * Maintain a **healthy weight**: Being underweight or overweight can impact fertility. * **Exercise** regularly: Exercise that builds strength, endurance and muscle tone will help your body stay healthy and strong during pregnancy and labour. * Get lots of **rest** and **sleep**: Sleep patterns can affect hormones. Stick to a regular 7-8 hours sleep routine as you prepare your body to conceive. * **Reduce stress**: High stress levels are linked with difficulties getting pregnant. Give yourself a break when you can and take the pressure off. If you’re feeling frazzled, try taking up yoga and practice mindfulness. * **Stop smoking** and **quit drugs**. Limit **alcohol** intake and cut back on **caffeine**. * **Come off contraception**: If you’re on hormonal contraception (the pill, [IUD](https://nabtahealth.com/glossary/iud/), patch, ring implant) it can take some months for your body to readjust and your cycles to return to your personal ‘normal’. Of course, this doesn’t apply if you use condoms or a diaphragm for contraception as they simply act as a barrier to conceiving. * Get a **well-woman health check**: Consider getting a full medical, including a check-up for any sexually transmitted infections (STIs). While this is by no means essential, your healthcare team will help you manage any potential red flags, family medical history or underlying health conditions that could af you getting pregnant naturally or having a healthy pregnancy. #### How do women become pregnant? The traditional way for heterosexual couples to get pregnant is through unprotected sexual intercourse. Pregnancy is a question of timing (among other individual factors). Heterosexual couples who want to get pregnant will need to time sex with [ovulation](https://nabtahealth.com/glossary/ovulation/). The man’s [sperm](https://nabtahealth.com/glossary/sperm/) must meet and fertilise the egg at the right time. Knowing her fertile window and timing intercourse with [ovulation](https://nabtahealth.com/glossary/ovulation/) is one of the most important factors in increasing a woman’s chances of conceiving. #### What is [ovulation](https://nabtahealth.com/glossary/ovulation/)? The [ovaries](https://nabtahealth.com/glossary/ovaries/) release the egg once every cycle, during [ovulation](https://nabtahealth.com/glossary/ovulation/). That egg travels down the [fallopian tubes](https://nabtahealth.com/glossary/fallopian-tube/) and waits to be fertilised by a [sperm](https://nabtahealth.com/glossary/sperm/). The egg can wait for 12-24 hours for a [sperm](https://nabtahealth.com/glossary/sperm/) to successfully push through its outer surface. [Sperm](https://nabtahealth.com/glossary/sperm/) can live inside the female reproductive tract for 3-5 days waiting to fertilise an egg. All being good the fertilised egg makes its way to the [uterus](https://nabtahealth.com/glossary/uterus/) (womb) and implants in the uterine lining. #### How do I know when I’m ovulating? Women typically ovulate around 12 to 14 days before their next period. If you have regular periods (the average menstrual cycle is 28 days but it’s normal for women’s cycles to be anywhere from 21 to 40 days) you can count back from the first day of when you would expect your next period. Fertility experts recommend having sex at least every other day in the [lead](https://nabtahealth.com/glossary/lead/)\-up to [ovulation](https://nabtahealth.com/glossary/ovulation/). [Sperm](https://nabtahealth.com/glossary/sperm/) can survive for several days in the female reproductive tract but once you’ve ovulated your egg has a 12-24 window for fertilisation so for the best chances of conception have enough sex in the time leading up to that brief window. #### What is fertility awareness and natural family planning? Fertility awareness methods (FAMs), also known as natural family planning, is used by women both as a method of contraception and to predict when they are most likely to conceive. Women can monitor several physiological cues alongside tracking menstrual cycle length to determine when they are most fertile: * Checking **cervical mucous**: Understanding how your cervical mucous changes during your cycle. As you near [ovulation](https://nabtahealth.com/glossary/ovulation/) you’ll notice your discharge becomes clear, stretchy, and wet, with the consistency of raw egg whites. This is known as fertile quality mucous and you are now at your most fertile. * Charting your **basal body temperature (BBT)**: There is a small rise in body temperature after [ovulation](https://nabtahealth.com/glossary/ovulation/). Measuring your BBT can help you predict the exact point of [ovulation](https://nabtahealth.com/glossary/ovulation/). Women with regular periods can measure BBT for 3-4 cycles to gain a fairly accurate prediction of when they are most fertile * Monitoring cervical mucous and BBT are non-invasive, easily accessible methods to track fertility. Using these two approaches together is known as the symptothermal method. Other methods for tracking [ovulation](https://nabtahealth.com/glossary/ovulation/) include: * **Calendar method**: This works by recording menstrual cycles on a calendar for 6-12 months and calculating fertile periods. It is most effective as a fertility predictor when combined with cervical mucous and BBT methods. * **[Ovulation](https://nabtahealth.com/glossary/ovulation/) predictor kits**: Over the counter [ovulation](https://nabtahealth.com/glossary/ovulation/) kits work in a similar way to at-home pregnancy tests. The woman pees on a stick measuring luteinizing hormone and a surge in this hormone indicates [ovulation](https://nabtahealth.com/glossary/ovulation/). However, it doesn’t prove an egg has been released and a woman can have the hormone surge but fail to ovulate. * **Period tracker apps**: Smartphone [ovulation](https://nabtahealth.com/glossary/ovulation/) tracker apps, like [OvuSense](https://nabtahealth.com/product/fertility-cycle-monitoring-with-ovusense/), monitor menstrual cycles and predict fertility. If you do choose to use a smartphone tracker app, be sure to read the small print for data collection policies. Fertility awareness, knowing and understanding your body and its menstrual cycles, helps lots of couples to conceive. However, getting pregnant isn’t always as simple as knowing your body and having lots of ‘baby making sex’. Some women want children but either cannot conceive naturally or keep miscarrying. And obviously, there are different considerations for women who have irregular periods due to [endometriosis](https://nabtahealth.com/glossary/endometriosis/) or [PCOS](https://nabtahealth.com/glossary/pcos/), those whose fertility is affected by illness or genetic history, and people who are single, transgender, or in same-sex relationships. #### What affects female fertility? Egg numbers and quality start to decline after 35, increasing the risk of age-related [infertility](https://nabtahealth.com/glossary/infertility/). The risk of pregnancy-related complications also increases with age. Underlying health issues, [endometriosis](https://nabtahealth.com/glossary/endometriosis/), uterine [polyps](https://nabtahealth.com/glossary/polyps/) or [fibroids](https://nabtahealth.com/glossary/fibroids/), polycystic ovarian syndrome ([PCOS](https://nabtahealth.com/glossary/pcos/)), problems with the [fallopian tubes](https://nabtahealth.com/glossary/fallopian-tube/), and ovulatory problems can all affect fertility. #### What affects male fertility? Male fertility problems can be caused by low [sperm](https://nabtahealth.com/glossary/sperm/) count, poor quality [sperm](https://nabtahealth.com/glossary/sperm/), or blockages preventing [sperm](https://nabtahealth.com/glossary/sperm/) moving through the reproductive tract. [Sperm](https://nabtahealth.com/glossary/sperm/) can be vulnerable to lifestyle and environmental factors including raised body temperature, weight gain, exposure to toxins, smoking, heavy alcohol intake and drug use. #### What if I can’t get pregnant naturally? Doctors define [infertility](https://nabtahealth.com/glossary/infertility/) as the inability to conceive after one year or longer of regular unprotected sex. If you are a woman in a heterosexual relationship and struggling to conceive using fertility awareness and natural family planning methods, both you and your partner should seek a medical and physical evaluation. In some situations, if a woman is 35 years or older, doctors may decide to investigate and treat [infertility](https://nabtahealth.com/glossary/infertility/) after 6 months of unprotected intercourse. #### Fertility testing for women Testing will depend on individual health and medical history, but typically initial testing will include **routine blood work to** check for: * Anti-Müllerian Hormone ([AMH](https://nabtahealth.com/glossary/amh/)): Ovarian reserve test to estimate how many eggs a woman has. * Follicle-Stimulating Hormone ([FSH](https://nabtahealth.com/glossary/fsh/)): Hormone stimulates the follicle producing the eggs. * Luteinizing Hormone ([LH](https://nabtahealth.com/glossary/lh/)): Responsible for follicle production and egg maturation. * [Prolactin](https://nabtahealth.com/glossary/prolactin/) (PRL): Hormone released from anterior pituitary gland, raised during pregnancy in preparation for breastfeeding, and in women with infrequent periods. * Thyrotrophin ([TSH](https://nabtahealth.com/glossary/tsh/)): Can indicate an underactive thyroid, linked with irregular periods. * [Estradiol](https://nabtahealth.com/glossary/estradiol/): A form of estrogen, the test measures ovarian function and egg quality. * Androgen: High levels can prevent the [ovaries](https://nabtahealth.com/glossary/ovaries/) from releasing an egg and may indicate polycystic ovarian syndrome ([PCOS](https://nabtahealth.com/glossary/pcos/)). * A **Vaginal ultrasound** will check: 1. Reproductive organ health. 2. [Ovaries](https://nabtahealth.com/glossary/ovaries/) for cysts, [fibroids](https://nabtahealth.com/glossary/fibroids/), [polyps](https://nabtahealth.com/glossary/polyps/), [PCOS](https://nabtahealth.com/glossary/pcos/), [endometriosis](https://nabtahealth.com/glossary/endometriosis/), or any abnormalities. 3. Egg reserve. Sometimes an **X-ray** is also carried out: Hysterosalpingography (HSG): Examines inside of the [uterus](https://nabtahealth.com/glossary/uterus/) (womb) and [fallopian tubes](https://nabtahealth.com/glossary/fallopian-tube/) for blockages or anything that might be stopping the [sperm](https://nabtahealth.com/glossary/sperm/) from reaching the egg. #### Fertility testing for men Blood work for men will check hormone levels and scan for certain infections or a possible genetic cause for [infertility](https://nabtahealth.com/glossary/infertility/). A doctor may request a [sperm](https://nabtahealth.com/glossary/sperm/) sample to assess [sperm](https://nabtahealth.com/glossary/sperm/) count, shape and movement, and a scrotal ultrasound to check if there are any problems or blockages in the testicles preventing [sperm](https://nabtahealth.com/glossary/sperm/) getting into a man’s ejaculate. #### Fertility treatment options Each person’s fertility scenario is unique, and any recommended [infertility](https://nabtahealth.com/glossary/infertility/) treatment will depend on an individual’s own health and medical history. A woman with a blocked fallopian tube or a man who isn’t producing [sperm](https://nabtahealth.com/glossary/sperm/) will be offered procedures to remove the blockage, repair damage or retrieve [sperm](https://nabtahealth.com/glossary/sperm/), before trying other fertility treatments. If appropriate, fertility specialists will often recommend that women start with **clomid**, a **prescribed oral medication for [infertility](https://nabtahealth.com/glossary/infertility/)**. This is also the preferred approach for women with hormonal conditions such as polycystic ovarian syndrome ([PCOS](https://nabtahealth.com/glossary/pcos/)). Clomid works by stimulating an increase in the levels of follicle-stimulating hormones, initiating [ovulation](https://nabtahealth.com/glossary/ovulation/) and increasing the odds of pregnancy. For some women this approach is combined with **intrauterine insemination (IUI)**, in which the male partner’s or donor’s [sperm](https://nabtahealth.com/glossary/sperm/) is inserted directly into the [uterus](https://nabtahealth.com/glossary/uterus/) to increase the probabilities of conception. If that approach doesn’t work, or if it’s clear from a woman’s medical history it won’t work, the next step would be treatments such as **in vitro fertilisation ([IVF](https://nabtahealth.com/glossary/ivf/))**. [IVF](https://nabtahealth.com/glossary/ivf/) involves retrieving eggs from a woman’s body, fertilising the eggs in a laboratory, and transferring the resulting embryo back into her body. The process is lengthy, invasive, and expensive and can take an emotional toll. However, for many women who want children it is their only option. Fertility treatments vary depending on a woman or couple’s situation. People who are single, in same-sex relationships or transgender will have their own fertility journeys and in these cases a woman’s age and fertility status still plays a role. Fertility experts will offer the necessary support and advice for each individual scenario. #### Getting started on your fertility journey with Nabta Health Whatever your personal situation, whether you’re thinking about starting a family, having another child, or you’ve been trying for years without success, [Nabta Health](https://nabtahealth.com/shop/collections/stage/fertility/) will support you on your fertility journey. From health and lifestyle tips for pre-conception and [PCOS](https://nabtahealth.com/glossary/pcos/), to relationship coaching, pregnancy wellness products, and at-home vitamin, thyroid, and fertility testing, Nabta’s fertility marketplace and knowledge resources are designed to accompany you through each stage from pre-conception to birth.
#### **What is [Sperm](https://nabtahealth.com/glossary/sperm/)?** [Sperm](https://nabtahealth.com/glossary/sperm/) is the male reproductive cell. It is produced in the testes from [germ cells](https://nabtahealth.com/glossary/germ-cells/). Upon reaching [puberty](https://nabtahealth.com/glossary/puberty/), a man produces millions of [sperm](https://nabtahealth.com/glossary/sperm/) every day. A [sperm](https://nabtahealth.com/glossary/sperm/) is very small, about 0.05 mm long. A mature [sperm](https://nabtahealth.com/glossary/sperm/) cell contains a head and a short tail. This head has the genetic material of the male. The [sperm](https://nabtahealth.com/glossary/sperm/) is a haploid, which means it contains only 23 [chromosomes](https://nabtahealth.com/glossary/chromosomes/), unlike the 46 [chromosomes](https://nabtahealth.com/glossary/chromosomes/) found in other cells of the body. This is because during fertilisation, the semen fuses with the egg, the woman’s reproductive cell, which is also haploid, to form a [zygote](https://nabtahealth.com/glossary/zygote/) which has 46 [chromosomes](https://nabtahealth.com/glossary/chromosomes/). The [zygote](https://nabtahealth.com/glossary/zygote/) later implants itself in the [uterus](https://nabtahealth.com/glossary/uterus/) of the female, becomes the embryo which, if all is well, will develop into a baby. The process of a germ cell in the testes developing into a fully mature semen cell, capable of fertilising an egg, involves a number of steps and the whole process takes about 2.5 months. #### **Production of [sperm](https://nabtahealth.com/glossary/sperm/) and semen** The testes have a system of tiny tubes called [seminiferous tubules](https://nabtahealth.com/glossary/seminiferous-tubules/). These tubes contain simple round [germ cells](https://nabtahealth.com/glossary/germ-cells/) at birth. Once the male reaches [puberty](https://nabtahealth.com/glossary/puberty/), [testosterone](https://nabtahealth.com/glossary/testosterone/) (the principle male sex hormone), in combination with other hormones, known as [androgens](https://nabtahealth.com/glossary/androgen/), stimulates the development of the [germ cells](https://nabtahealth.com/glossary/germ-cells/) into [sperm](https://nabtahealth.com/glossary/sperm/) cells. Once developed, the [sperm](https://nabtahealth.com/glossary/sperm/) cells move, first into the [epididymis](https://nabtahealth.com/glossary/epididymis/), and then 5 weeks later, into the [vas deferens](https://nabtahealth.com/glossary/vas-deferens/), which is also known as the [sperm](https://nabtahealth.com/glossary/sperm/) duct. The [sperm](https://nabtahealth.com/glossary/sperm/) cells mix with seminal fluid from the seminal vesicles and prostate gland to form semen. The semen is what enters the female body to fuse with the egg for fertilisation when ejaculated. The seminal fluid promotes the survival of the [sperm](https://nabtahealth.com/glossary/sperm/) cells in the female [uterus](https://nabtahealth.com/glossary/uterus/) and provides nutrition to the milt. #### **Impact of [sperm](https://nabtahealth.com/glossary/sperm/) on fertility** Males are [solely responsible](../who-is-responsible-for-infertility) for about 20 – 30% of [infertility](https://nabtahealth.com/glossary/infertility/) cases. There are many factors that can affect the [health of a male’s](../causes-of-male-infertility) [sperm](https://nabtahealth.com/glossary/sperm/), including genetics, [the environment](../environmental-factors-that-contribute-to-male-infertility), hormonal issues, poor semen quality, and structural abnormalities of the male reproductive system. It is important for a male to maintain [sperm](https://nabtahealth.com/glossary/sperm/) health if he is planning to conceive, as [sperm](https://nabtahealth.com/glossary/sperm/) quality not only affects the likelihood of successful conception, but also influences the outcome of pregnancy; with abnormal [chromosomes](https://nabtahealth.com/glossary/chromosomes/),[sperm](https://nabtahealth.com/glossary/sperm/) DNA fragmentation and even lifestyle choices having the potential to affect the viability and health of offspring. #### **Maintaining the health of a male’s [sperm](https://nabtahealth.com/glossary/sperm/)** Measures of [sperm](https://nabtahealth.com/glossary/sperm/) health include [sperm](https://nabtahealth.com/glossary/sperm/) count, [sperm](https://nabtahealth.com/glossary/sperm/) strength and [how well it moves](../low-sperm-motility-asthenozoospermia). Healthy [sperm](https://nabtahealth.com/glossary/sperm/) have a well-rounded head and a strong tail that can help them swim fast. A [healthy](../my-husband-has-a-low-sperm-count-when-is-the-best-time-during-the-menstrual-cycle-to-have-intercourse) [sperm](https://nabtahealth.com/glossary/sperm/) count is about 15 million or more for every milliliter (mL) of semen. Having a high [sperm](https://nabtahealth.com/glossary/sperm/) count increases the chances of one of them making it through the female reproductive system and fertilising an egg. Maintaining [sperm](https://nabtahealth.com/glossary/sperm/) health is important for the individual and for future generations. Here are some lifestyle approaches that can help to keep spunk healthy & strong, and to improve fertility: * Eat well and maintain a [healthy diet](../do-vitamins-and-other-nutritional-products-improve-sperm-count) * Avoid smoking or using illicit drugs * Limit alcohol and caffeine intake * Keep the scrotum cool by avoiding tight trousers * Exercise regularly but not intensely * Try to minimise exposure to pesticides and heavy metals * Minimise physical and emotional stress * Make sure to get enough [zinc](https://nabtahealth.com/glossary/zinc/) and other essential vitamins It can be stressing sometimes not sure what is wrong try Nabta’s [men’s health test](https://nabtahealth.com/product/mens-health-test/) and get to learn more. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#3d445c51515c7d535c5f495c55585c514955135e5250) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Akmal, M., et al. (2006). Improvement in Human Semen Quality After Oral Supplementation of Vitamin C. _Journal of Medicinal Food_, 9(3), pp.440-442. * Blomberg Jensen, M., et al. (2011). [Vitamin D](https://nabtahealth.com/glossary/vitamin-d/) is positively associated with semen [motility](https://nabtahealth.com/glossary/motility/) and increases intracellular calcium in human spermatozoa. _Human Reproduction_, 26(6), pp.1307-1317. * Colagar, A., et al. (2009). [Zinc](https://nabtahealth.com/glossary/zinc/) levels in seminal plasma are associated with semen quality in fertile and infertile men. _Nutrition Research_, 29(2), pp.82-88. * Danielewicz, A., et al. (2018). Dietary Patterns and Poor Semen Quality Risk in Men: A Cross-Sectional Study. _Nutrients_, 10(9), p.1162. * Fullston, T., et al. (2017). The most common vices of men can damage fertility and the health of the next generation. _Journal of Endocrinology_, 234(2), F1-F6. doi: 10.1530/joe-16-0382. * “Male [Infertility](https://nabtahealth.com/glossary/infertility/) – Symptoms And Causes”. _Mayo Clinic_, 2019, [https://www.mayoclinic.org/diseases-conditions/male-](https://www.mayoclinic.org/diseases-conditions/male-infertility/symptoms-causes/syc-20374773)[infertility](https://nabtahealth.com/glossary/infertility/)/symptoms-causes/syc-20374773. * “Male Reproductive System (For Parents) – Kidshealth”. _Kidshealth.Org_, 2019, [https://kidshealth.org/en/parents/male-reproductive.html](https://kidshealth.org/en/parents/male-reproductive.html). * Janevic, T., et al. (2014). Effects of work and life stress on semen quality. _Fertility and Sterility_, 102(2), pp.530-538. * Jensen, T., et al. (2014). Habitual alcohol consumption associated with reduced semen quality and changes in reproductive hormones; a cross-sectional study among 1221 young Danish men. _BMJ Open_, 4(9), pp.e005462-e005462. * Jouannet, Pierre et al. “Semen Quality And Male Reproductive Health: The Controversy About Human milt Concentration Decline”. _APMIS_, vol 109, no. S103, 2001, pp. S48-S61. Wiley, doi:10.1111/j.1600-0463.2001.tb05801.x. * Jóźków, P. and Rossato, M. (2016). The Impact of Intense Exercise on Semen Quality. _American Journal of Men’s Health_, 11(3), pp.654-662. * Vaamonde, D., et al. (2012). Physically active men show better semen parameters and hormone values than sedentary men. _European Journal of Applied Physiology_, 112(9), pp.3267-3273.
According to the World Health Organisation, over 650 million adults worldwide are obese. With prevalence rates increasing rapidly across developed countries, obesity is becoming a major public health concern. Across the Arab world, it is estimated that approximately 30% of the population are obese. Obesity predisposes males and females to many potential health issues, including [infertility](https://nabtahealth.com/glossary/infertility/). #### **How is obesity measured?** A person’s [Body Mass Index](https://nabtahealth.com/what-is-body-mass-index-bmi/) ([BMI](https://nabtahealth.com/glossary/bmi/)) is used to determine whether they are obese. [BMI](https://nabtahealth.com/glossary/bmi/) is a measure of body fat using height and weight measurements; weight in KG divided by height in metres squared (m2): [BMI](https://nabtahealth.com/glossary/bmi/) = KG/m2 The general consensus is that adults with a [BMI](https://nabtahealth.com/glossary/bmi/) in the range of 25 – 29.9 KG/m2 are overweight, and those with a [BMI](https://nabtahealth.com/glossary/bmi/) of ⩾30.0 KG/m2 are obese. Having a high [BMI](https://nabtahealth.com/glossary/bmi/) puts an individual at greater risk of various serious health issues, including type 2 diabetes, high blood pressure, high [cholesterol](https://nabtahealth.com/glossary/cholesterol/) and cancer. It also affects a person’s quality of life, often having a negative impact on their self-esteem and confidence. In females, the effect of obesity on [infertility](https://nabtahealth.com/glossary/infertility/) has been well studied and it is widely known that a high [BMI](https://nabtahealth.com/glossary/bmi/) can result in [menstrual cycle irregularities](https://nabtahealth.com/i-keep-bleeding-between-periods-is-this-normal/). The impact of obesity on a male’s ability to conceive has been less extensively studied. However, it is likely to have an effect as an increased [BMI](https://nabtahealth.com/glossary/bmi/) is associated with lower [testosterone](https://nabtahealth.com/glossary/testosterone/) production, poor [semen](https://nabtahealth.com/everything-you-need-to-know-about-sperm/) quality and reduced fertility. #### **How obesity affects male fertility:** **Endocrine dysregulation** Typically, obese, infertile men have lower [testosterone](https://nabtahealth.com/glossary/testosterone/) levels and higher circulating [oestrogen](https://nabtahealth.com/glossary/oestrogen/). The reduction in [androgens](https://nabtahealth.com/glossary/androgen/), primarily [testosterone](https://nabtahealth.com/glossary/testosterone/), is proportional to the degree of obesity. Increased peripheral aromatisation of [androgens](https://nabtahealth.com/glossary/androgen/) causes higher levels of oestrone and oestradiol. Obesity results in more white adipose tissue, which also increases [oestrogen](https://nabtahealth.com/glossary/oestrogen/) levels. Alterations in the [testosterone](https://nabtahealth.com/glossary/testosterone/)/[oestrogen](https://nabtahealth.com/glossary/oestrogen/) ratio have a negative effect on the hypothalamic-pituitary-gonadal (HPG) axis, disrupting the negative feedback loop and resulting in diminished [](https://nabtahealth.com/my-husband-has-a-low-sperm-count-when-is-the-best-time-during-the-menstrual-cycle-to-have-intercourse/)[sperm](https://nabtahealth.com/glossary/sperm/) counts. Other hormones are also implicated; men with a high [BMI](https://nabtahealth.com/glossary/bmi/) have lower levels of Sex Hormone Binding Globulin ([SHBG](https://nabtahealth.com/glossary/shbg/)). [SHBG](https://nabtahealth.com/glossary/shbg/) is involved in [spermatogenesis](https://nabtahealth.com/glossary/spermatogenesis/) and Sertoli cell function. Obese, infertile men often have elevated leptin and, interestingly, levels are less high in obese men who are not infertile. Leptin is secreted by white adipose tissue into the bloodstream. Therefore, the serum levels of this hormone correlate with the body’s fat stores. High leptin inhibits the production of [testosterone](https://nabtahealth.com/glossary/testosterone/) from the leydig cells. **[Insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/)** Obese men with type 2 diabetes often have secondary hypogonadism due to their [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/). It is thought that [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/) triggers disruption of the HPG axis, although the mechanisms are not fully understood. [Insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/) also results in reduced [testosterone](https://nabtahealth.com/glossary/testosterone/) levels. Obesity is a major risk factor for development of type 2 diabetes, with difficulties in conceiving being just one of the associated health risks. **Oxidative stress** Obesity results in an increase in the production of reactive oxygen species (ROS), which cause damage to the DNA located within [sperm](https://nabtahealth.com/glossary/sperm/) cells. Men with a higher [BMI](https://nabtahealth.com/glossary/bmi/) exhibit increased oxidative stress and, as a result, more ROS. **Metabolic syndrome** Metabolic syndrome (MetS) is triggered, in part by obesity. Other contributory factors include high blood pressure, high plasma glucose and high [cholesterol](https://nabtahealth.com/glossary/cholesterol/). MetS increases the risk of type 2 diabetes, and is also linked to the development of hypogonadism and erectile dysfunction. Not all men who experience erectile dysfunction are infertile, but difficulties in sustaining an erection are more common in men who are struggling to conceive. One study found that 27% of infertile men experienced erectile dysfunction. Furthermore, those who report erectile difficulties are significantly more likely to be overweight or obese. Obese men with MetS frequently present with hyperinsulinaemia and [hyperglycaemia](https://nabtahealth.com/glossary/hyperglycaemia/), which can have a detrimental effect on [sperm](https://nabtahealth.com/glossary/sperm/) quantity and quality. **Hyperthermia** The process of [spermatogenesis](https://nabtahealth.com/glossary/spermatogenesis/) is highly heat sensitive, with the optimal temperature being 34-35°C. Increased adipose tissue in the scrotal area can have a detrimental effect on gonadal temperature and damage the developing [sperm](https://nabtahealth.com/glossary/sperm/) cells. The consequences of this include reduced [](https://nabtahealth.com/low-sperm-motility-asthenozoospermia/)[sperm](https://nabtahealth.com/glossary/sperm/) [motility](https://nabtahealth.com/glossary/motility/) and increased DNA fragmentation, both of which hinder a man’s ability to conceive. **Environmental and psychological factors** There are many [environmental pollutants and](https://nabtahealth.com/environmental-factors-that-contribute-to-male-infertility/) [endocrine disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/) that have been shown to affect male fertility. A lot of toxins are fat soluble and therefore, tend to accumulate in fatty tissue. This suggests that obese men, who have more fat reserves, are at greater risk of suffering the harmful effects caused by a build up of these toxins. Obese men are also more prone to sleep apnea. This is a disorder characterised by pauses in breathing during periods of sleep and one of the consequences is disrupted [testosterone](https://nabtahealth.com/glossary/testosterone/) production. Levels of [testosterone](https://nabtahealth.com/glossary/testosterone/) are particularly low immediately after waking. The condition can also reduce a man’s interest in partaking in sexual activity. It is important not to under-estimate the psychological burden of obesity. Obese individuals are more likely to consider themselves unattractive and undesirable than their non-obese counterparts. They may be emotionally unwilling, or physically unable to engage in regular intercourse. They might experience a lack of desire and implement avoidance strategies, particularly if they find the process uncomfortable or are ashamed of their body. There is limited data suggesting that obese men have intercourse less frequently; however, whether this is due to psychological factors, or a physical barrier, such as erectile dysfunction, is not clear. Further work is needed in order to validate and better understand these findings. To conclude, obesity does appear to contribute to male [infertility](https://nabtahealth.com/glossary/infertility/); probably due to multiple factors interacting and exacerbating the negative effects of lower [testosterone](https://nabtahealth.com/glossary/testosterone/) levels and poorer semen quality in males with a high [BMI](https://nabtahealth.com/glossary/bmi/). Consider Nabta’s [Men’s health test](https://nabtahealth.com/product/mens-health-test/) and get to learn more. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#671e060b0b062709060513060f02060b130f4904080a) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Hammoud, Ahmad O., et al. “Impact of Male Obesity on [Infertility](https://nabtahealth.com/glossary/infertility/): a Critical Review of the Current Literature.” _Fertility and Sterility_, vol. 90, no. 4, Oct. 2008, pp. 897–904., doi:10.1016/j.fertnstert.2008.08.026. * Hofny, Eman R.m., et al. “Semen Parameters and Hormonal Profile in Obese Fertile and Infertile Males.” _Fertility and Sterility_, vol. 94, no. 2, July 2010, pp. 581–584., doi:10.1016/j.fertnstert.2009.03.085. * Katib, Atif. “Mechanisms Linking Obesity with Male [Infertility](https://nabtahealth.com/glossary/infertility/).” Central European Journal of Urology, vol. 68, no. 1, 13 Mar. 2015, pp. 79–85., doi:10.5173/ceju.2015.01.435. * “Obesity and Overweight.” _World Health Organization_, [https://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight](https://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight). * “Managing Overweight and Obesity in Adults: Systematic Evidence Review from the Obesity Expert Panel.” National Heart Lung and Blood Institute, _U.S. Department of Health and Human Services_, [https://www.nhlbi.nih.gov/health-topics/managing-overweight-obesity-in-adults](https://www.nhlbi.nih.gov/health-topics/managing-overweight-obesity-in-adults). * Morrison, Christopher D., and Robert E. Brannigan. “Metabolic Syndrome and [Infertility](https://nabtahealth.com/glossary/infertility/) in Men.” _Best Practice & Research Clinical Obstetrics & Gynaecology_, vol. 29, no. 4, May 2015, pp. 507–515., doi:10.1016/j.bpobgyn.2014.10.006. * Salam, Mohamed Ahmed Abd El. “Obesity, An Enemy of Male Fertility: A Mini Review.” _Oman Medical Journal_, vol. 33, no. 1, Jan. 2018, pp. 3–6., doi:10.5001/omj.2018.02.
Approximately 15% of couples struggle to conceive, and in [up to half of these cases](../who-is-responsible-for-infertility) there is an issue with the male. Although many cases of [infertility](https://nabtahealth.com/glossary/infertility/) are idiopathic, meaning that their cause is unknown, the [biggest contributor to male](../causes-of-male-infertility) [infertility](https://nabtahealth.com/glossary/infertility/) is abnormal [sperm](https://nabtahealth.com/glossary/sperm/) production. Abnormal [sperm](https://nabtahealth.com/glossary/sperm/) production can present as low concentration, low [sperm](https://nabtahealth.com/glossary/sperm/) counts, [poor](../low-sperm-motility-asthenozoospermia) [motility](https://nabtahealth.com/glossary/motility/), or irregularly shaped [sperm](https://nabtahealth.com/glossary/sperm/). The good news is that by adjusting the diet and including certain supplements semen quality can be improved. #### **Which vitamins and supplements are of most use to men with abnormal [sperm](https://nabtahealth.com/glossary/sperm/)?** A recent study systematically reviewed much of the available literature with a view to identifying which dietary supplements could potentially be most beneficial to men with abnormal [sperm](https://nabtahealth.com/glossary/sperm/): * **Selenium** – improved total [sperm](https://nabtahealth.com/glossary/sperm/) concentration, [motility](https://nabtahealth.com/glossary/motility/) and [sperm](https://nabtahealth.com/glossary/sperm/) morphology. Found in brazil nuts, seafood and meat. * **[Zinc](https://nabtahealth.com/glossary/zinc/)** – improved total [sperm](https://nabtahealth.com/glossary/sperm/) concentration and [motility](https://nabtahealth.com/glossary/motility/). Found in high levels in oysters, but also in red meat and poultry. Also found in legumes such as chickpeas, lentils and beans. * **[Folate](https://nabtahealth.com/glossary/folate/)** – improved [sperm](https://nabtahealth.com/glossary/sperm/) concentration. Found in legumes, leafy greens, asparagus and eggs. * **Omega-3 fatty acids** – improved total [sperm](https://nabtahealth.com/glossary/sperm/) concentration, [sperm](https://nabtahealth.com/glossary/sperm/) counts, [motility](https://nabtahealth.com/glossary/motility/) and [sperm](https://nabtahealth.com/glossary/sperm/) morphology. Found in seafood, nuts and seeds, and plant-based oils (flaxseed oil and canola oil). * **Coenzyme Q10** – improved total [sperm](https://nabtahealth.com/glossary/sperm/) concentration, [sperm](https://nabtahealth.com/glossary/sperm/) counts, [motility](https://nabtahealth.com/glossary/motility/) and [sperm](https://nabtahealth.com/glossary/sperm/) morphology. Found in organ meats (heart, liver, kidney), fatty fish and vegetables (broccoli, cauliflower and spinach). * **Carnitines** – improved total [motility](https://nabtahealth.com/glossary/motility/), progressive [motility](https://nabtahealth.com/glossary/motility/) and [sperm](https://nabtahealth.com/glossary/sperm/) morphology. Found in red meat and dairy products. This highlights the value of undergoing a semen analysis early on in the [](../diagnosing-male-infertility)[infertility](https://nabtahealth.com/glossary/infertility/) assessment process, as then the diet can be tailored to suit the particular issue. So, adapting their diet can help men with known ([sperm](https://nabtahealth.com/glossary/sperm/)\-related) [infertility](https://nabtahealth.com/glossary/infertility/) issues, but what about those men who have never considered their fertility before? Should all men consider their diet before they attempt to conceive? It is widely accepted that [women should look at their diet](../how-eating-the-right-food-might-help-you-to-conceive) before attempting to conceive; increasing their intake of foods such as whole grains, fruit and vegetables and maximising their [folate](https://nabtahealth.com/glossary/folate/) intake. It is, however, less common for men to alter their diet in preparation for conception. But with semen quality falling over recent decades and the finding that a good diet can exert a positive effect on various [sperm](https://nabtahealth.com/glossary/sperm/) parameters, it makes sense for a man to also consider what he is taking into his body. #### **The Mediterranean Diet (MedDiet)** A good example of a healthy diet is the MedDiet, rich in fruit, vegetables, legumes and whole grain; low in meat and saturated fatty acids. Men on this diet have demonstrably improved semen quality. For a start, this is a diet rich in antioxidants, including beta-carotene and vitamins E and C. Antioxidants protect against the damaging effects of [free radical](../how-free-radicals-affect-the-skin) accumulation. When present at high concentrations, free radicals adversely affect [sperm](https://nabtahealth.com/glossary/sperm/) function and can result in oxidative stress,which in turn causes cellular and tissue damage. The best way of avoiding this is to balance out the free radical accumulation with increased antioxidants. This diet is also high in [omega-3 fatty acids](../the-good-dietary-fat) and low in saturated and trans fatty acids. Omega-3 is a structural component of the spermatozoa cell membrane. The integrity of the cellular membrane is critical for successful fertilisation to occur. Thus, men with proven fertility have higher levels of omega-3. They also have a lower omega-6:omega-3 ratio than men classified as subfertile. The ideal ratio is 1:1, but sometimes the discrepancy between the two is as great as 40:1 and this is associated with impaired semen quality. The MedDiet is naturally high in foods that are thought to fight [inflammation](https://nabtahealth.com/glossary/inflammation/), including fruit, tomatoes and green leafy vegetables. [Inflammation](https://nabtahealth.com/glossary/inflammation/) not only mediates the production of further free radicals, but also alters the microenvironment in which spermatozoa grow and mature. Consuming a diet that contains these food groups has been shown to improve [sperm](https://nabtahealth.com/glossary/sperm/) quality. In conclusion, consuming the right food and supplementing the diet with suitable vitamins can improve a man’s [sperm](https://nabtahealth.com/glossary/sperm/) count. Try Nabta’s [](https://nabtahealth.com/product/vitamin-d-test/)[Vitamin D](https://nabtahealth.com/glossary/vitamin-d/) and [B Vitamin](https://nabtahealth.com/product/b-vitamins-test/) test and get to learn more from the results. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#bcc5ddd0d0ddfcd2dddec8ddd4d9ddd0c8d492dfd3d1) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Ahmadi, S, et al. “Antioxidant Supplements and Semen Parameters: An Evidence Based Review.” _International Journal of Reproductive Biomedicine_, vol. 14, no. 12, Dec. 2016, pp. 729–736. * Irani, M, et al. “The Effect of [Folate](https://nabtahealth.com/glossary/folate/) and [Folate](https://nabtahealth.com/glossary/folate/) Plus [Zinc](https://nabtahealth.com/glossary/zinc/) Supplementation on Endocrine Parameters and [Sperm](https://nabtahealth.com/glossary/sperm/) Characteristics in Sub-Fertile Men: A Systematic Review and Meta-Analysis.” _Urology Journal_, vol. 14, no. 5, 29 Aug. 2017, pp. 4069–4078. * Karayiannis, D, et al. “Association between Adherence to the Mediterranean Diet and Semen Quality Parameters in Male Partners of Couples Attempting Fertility.” _Human Reproduction_, vol. 32, no. 1, Jan. 2017, pp. 215–222., doi:10.1093/humrep/dew288. * La Vignera, S, et al. “Markers of Semen [Inflammation](https://nabtahealth.com/glossary/inflammation/): Supplementary Semen Analysis?” _Journal of Reproductive Immunology_, vol. 100, no. 1, Nov. 2013, pp. 2–10., doi:10.1016/j.jri.2013.05.001. * Safarinejad, M R, and S Safarinejad. “The Roles of Omega-3 and Omega-6 Fatty Acids in Idiopathic Male [Infertility](https://nabtahealth.com/glossary/infertility/).” _Asian Journal of Andrology_, vol. 14, no. 4, July 2012, pp. 514–515., doi:10.1038/aja.2012.46. * Salas-Huetos, A, et al. “The Effect of Nutrients and Dietary Supplements on [Sperm](https://nabtahealth.com/glossary/sperm/) Quality Parameters: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.” _Advances in Nutrition_, vol. 9, no. 6, 1 Nov. 2018, pp. 833–848, doi:10.1093/advances/nmy057. * “Foods That Fight [Inflammation](https://nabtahealth.com/glossary/inflammation/).” _Harvard Health Publishing_, 7 Nov. 2018, [www.health.harvard.edu/staying-healthy/foods-that-fight-](http://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation)[inflammation](https://nabtahealth.com/glossary/inflammation/).
When a couple fails to fall pregnant despite actively trying for at least 12 months, it is usually suggested that they undergo fertility testing. For the male partner one of the first steps is to submit a semen sample for analysis. The semen sample can be used to check [sperm](https://nabtahealth.com/glossary/sperm/) concentration, [sperm](https://nabtahealth.com/glossary/sperm/) morphology and [sperm](https://nabtahealth.com/glossary/sperm/) [motility](https://nabtahealth.com/glossary/motility/). If these measurements fall outside of the [World Health Organisation’s (WHO) reference values](../diagnosing-male-infertility), it increases the likelihood that a male factor is contributing to the [infertility](https://nabtahealth.com/glossary/infertility/). However, fluctuations in results are common so if a man’s [sperm](https://nabtahealth.com/glossary/sperm/) sample measures below the reference values a second sample will usually be checked before any conclusions are drawn.. [Sperm](https://nabtahealth.com/glossary/sperm/) [motility](https://nabtahealth.com/glossary/motility/) is measured as the percentage of [sperm](https://nabtahealth.com/glossary/sperm/) showing flagellar movement. The recommended reference value according to the WHO is ≥40%. Progressive [motility](https://nabtahealth.com/glossary/motility/), or forward movement in a straight line, has a reference value of ≥32%. In isolation, low [sperm](https://nabtahealth.com/glossary/sperm/) [motility](https://nabtahealth.com/glossary/motility/) does not mean that a man is infertile. It should be looked at alongside the other semen parameters. One large-scale study categorised participants as subfertile, indeterminate-fertile and fertile for each semen parameter (concentration, morphology and [motility](https://nabtahealth.com/glossary/motility/)). If a sample fell into the subfertile category for two or more parameters, it increased the likelihood of [infertility](https://nabtahealth.com/glossary/infertility/). For [sperm](https://nabtahealth.com/glossary/sperm/) [motility](https://nabtahealth.com/glossary/motility/) the categories were split as follows: \[table id=9 /\] It is not always possible to discern what has caused low [sperm](https://nabtahealth.com/glossary/sperm/) [motility](https://nabtahealth.com/glossary/motility/), but sometimes it is due to the presence of anti-[sperm](https://nabtahealth.com/glossary/sperm/) antibodies. Usually arising after trauma or [inflammation](https://nabtahealth.com/glossary/inflammation/), these antibodies are found in the serum, seminal fluid and can also bind directly to [sperm](https://nabtahealth.com/glossary/sperm/). They activate the immune system, block penetration to the [cervix](https://nabtahealth.com/glossary/cervix/) and prevent fertilisation. In some cases, the only physical sign of their presence is low [sperm](https://nabtahealth.com/glossary/sperm/) [motility](https://nabtahealth.com/glossary/motility/). Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#354c54595954755b545741545d505459415d1b565a58) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Cooper, T G, et al. “World Health Organization Reference Values for Human Semen Characteristics.” _Human Reproduction Update_, vol. 16, no. 3, 2010, pp. 231–245., doi:10.1093/humupd/dmp048. * Guzick, D S, et al. “[Sperm](https://nabtahealth.com/glossary/sperm/) Morphology, [Motility](https://nabtahealth.com/glossary/motility/), and Concentration in Fertile and Infertile Men.” _New England Journal of Medicine_, vol. 345, no. 19, 8 Nov. 2001, pp. 1388–1393., doi:10.1056/NEJMoa003005. * Katz, D J, et al. “Male [Infertility](https://nabtahealth.com/glossary/infertility/) – The Other Side of the Equation.” _Australian Family Physician_, vol. 46, no. 9, Sept. 2017, pp. 641–646.
Despite being significantly under-explored, male factors contribute to up to [half of all cases](../who-is-responsible-for-infertility) of [infertility](https://nabtahealth.com/glossary/infertility/). With genetics, abnormal [sperm](https://nabtahealth.com/glossary/sperm/) production, hormonal issues, structural abnormalities and environmental factors all thought to be causative; there is a need for thorough, comprehensive investigations whenever a problem is suspected. The first step for most infertile couples is for both parties to undergo a detailed history and medical examination. This will enable the doctor to identify any potential confounders. As with most medical situations, the lifestyle choices that a person makes, along with the environment they live in, can have a significant impact on their health and well being. This article has been written to explore the specific environmental factors that are thought to impact male fertility. #### **Smoking** Whilst the dangers of smoking are well publicised, many people still do it and the highest prevalence is thought to be amongst men of reproductive age. Most studies have found that smoking has a moderate effect on semen quality, reducing [sperm](https://nabtahealth.com/glossary/sperm/) volume, count and [](../low-sperm-motility-asthenozoospermia)[motility](https://nabtahealth.com/glossary/motility/). However, the association between male smoking and live birth rates remains unclear. Up to 40% of [infertility](https://nabtahealth.com/glossary/infertility/) cases are considered to be idiopathic, meaning the cause is unknown. Men who fall into this category usually have normal looking [sperm](https://nabtahealth.com/glossary/sperm/). One explanation for the unexplained [infertility](https://nabtahealth.com/glossary/infertility/) is damage to the [sperm](https://nabtahealth.com/glossary/sperm/) DNA. The extent of DNA fragmentation seems to be a robust indicator of male [infertility](https://nabtahealth.com/glossary/infertility/); however, it remains, to date, an understudied area of investigation. A DNA fragmentation index (DFI) of greater than 30% is associated with increased [infertility](https://nabtahealth.com/glossary/infertility/). In one study the DFI of infertile smokers was 38%, compared to 19% in infertile non-smokers and 15% in fertile controls. This suggests a strong link between smoking and DNA damage, which is independent of the [infertility](https://nabtahealth.com/glossary/infertility/) caused by other factors. Additional support for this theory comes from understanding the harmful components that make up cigarettes. For example, tobacco which contains reactive oxygen species (ROS) and nicotine which causes double-stranded DNA breaks. ROS are a natural byproduct of cellular [metabolism](https://nabtahealth.com/glossary/metabolism/); however, levels can increase when the cells of the body are exposed to stress, nutrient deficiency, metal toxicity or irradiation. Chemicals, including tobacco also cause a dangerous accumulation of ROS, significantly increasing the risk of cellular damage and injury. Double-strand DNA breaks occur when both strands of the DNA double helix are severed. They can cause irreversible damage to the cell and genomic mutations. Smoking also reduces the levels of antioxidants, which play a vital role in neutralising the effects of harmful [free radicals](../how-free-radicals-affect-the-skin). An excess of free radicals can cause oxidative stress and will compromise normal cellular processes. Smoking has an adverse effect on general health and men who are attempting to conceive should definitely take steps to try to quit. #### **Obesity** It is difficult to state conclusively that a high [BMI](https://nabtahealth.com/glossary/bmi/) impairs fertility, as the studies to date have been slightly conflicting. Certainly, some suggest a link between [obesity](https://nabtahealth.com/how-obesity-can-contribute-to-male-infertility/) and reduced semen quality, reduced [sperm](https://nabtahealth.com/glossary/sperm/) concentration and reduced [motility](https://nabtahealth.com/glossary/motility/). One study found that men with reduced semen quality were three times more likely to be obese. However, other larger, meta-analyses have concluded that there is only a minimal correlation between [BMI](https://nabtahealth.com/glossary/bmi/) and semen parameters and even though obese men have significantly less circulating [testosterone](https://nabtahealth.com/glossary/testosterone/), this does not seem to have any physiological effects. Despite these findings, moderate exercise and weight loss have been associated with improved semen parameters. Obesity is also thought to cause a lower ejaculate volume and increase a male’s risk of experiencing erectile dysfunction. As with smoking, obesity correlates with a high DFI; those men with a higher [BMI](https://nabtahealth.com/glossary/bmi/) are more susceptible to damaged DNA. Whilst the evidence is growing with regards to obesity having a negative effect on reproductive capability, it remains irrefutable that overall health will be improved by the maintenance of a healthy [BMI](https://nabtahealth.com/glossary/bmi/). #### **Heat** Experimental animal models have suggested an adverse link between scrotal temperature and impaired [spermatogenesis](https://nabtahealth.com/glossary/spermatogenesis/); however, in reality the data is limited and insufficient to form a definitive conclusion. One study did identify a lower average [sperm](https://nabtahealth.com/glossary/sperm/) concentration in men who had a higher scrotal temperature, however, the actual value still fell within the WHO’s [normal range](../diagnosing-male-infertility). There is limited evidence that testicular cooling might improve semen quality. It has been proposed that tight underwear, hot baths and a sedentary position can all contribute to increased scrotal temperature and fertility issues, but none of these associations have been substantiated. Men who have abnormal [sperm](https://nabtahealth.com/glossary/sperm/) due to [](../what-are-varicoceles)[varicoceles](https://nabtahealth.com/glossary/varicoceles/) typically have a higher scrotal temperature; however, this is likely to be a secondary effect, rather than a causative factor. #### **[Endocrine Disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/)** Found abundantly, [endocrine disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/) mimic natural hormones and have been shown to have a detrimental effect on both male and female fertility. Some of the most widely studied examples are bisphenol A (BPA) and phthalates, which are both used in the manufacture of plastics. BPA is antiandrogenic and has been linked to erectile dysfunction, whilst phthalates cause reproductive malformations and decreased [sperm](https://nabtahealth.com/glossary/sperm/) production. Unfortunately, despite their detrimental effects, the widespread use of chemicals and products that contain endocrine disrupting agents, makes them very difficult to avoid. #### **Other Factors** Alcohol, psychological stress and caffeine are alternative factors that have been associated with impaired fertility. Whilst, the data on caffeine does not show a positive correlation; excessive alcohol consumption and increased stress both reduce semen quality. In a systematic review looking at socio-psycho-behavioural factors, alcohol correlated most strongly with a reduction in semen volume, and increased stress seemed to cause reduced [sperm](https://nabtahealth.com/glossary/sperm/) [motility](https://nabtahealth.com/glossary/motility/). Thus, men who are struggling to conceive might want to consider lowering their alcohol intake and attempting to avoid stressful situations, to maximise their chances of conception. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#94edf5f8f8f5d4faf5f6e0f5fcf1f5f8e0fcbaf7fbf9) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Barratt, C L R, et al. “The Diagnosis of Male [Infertility](https://nabtahealth.com/glossary/infertility/): an Analysis of the Evidence to Support the Development of Global WHO Guidance—Challenges and Future Research Opportunities.” _Human Reproduction Update_, vol. 23, no. 6, 1 Nov. 2017, pp. 660–680., doi: 10.1093/humupd/dmx021. * Chavarro, J E, et al. “Body Mass Index in Relation to Semen Quality, [Sperm](https://nabtahealth.com/glossary/sperm/) DNA Integrity and Serum Reproductive Hormone Levels among Men Attending an [Infertility](https://nabtahealth.com/glossary/infertility/) Clinic.” _Fertility and Sterility_, vol. 93, no. 7, 1 May 2010, pp. 2222–2231., doi:10.1016/j.fertnstert.2009.01.100. * Elshal, M F, et al. “[Sperm](https://nabtahealth.com/glossary/sperm/) Head Defects and Disturbances in Spermatozoal Chromatin and DNA Integrities in Idiopathic Infertile Subjects: Association with Cigarette Smoking.” _Clinical Biochemistry_, vol. 42, no. 7-8, May 2009, pp. 589–594., doi:10.1016/j.clinbiochem.2008.11.012. * Jung, A, and H C Schuppe. “Influence of Genital Heat Stress on Semen Quality in Humans.” _Andrologia_, vol. 39, no. 6, Dec. 2007, pp. 203–215., doi:10.1111/j.1439-0272.2007.00794.x. * Li, Y, et al. “Association between Socio-Psycho-Behavioral Factors and Male Semen Quality: Systematic Review and Meta-Analyses.” _Fertility and Sterility_, vol. 95, no. 1, Jan. 2011, pp. 116–123., doi:10.1016/j.fertnstert.2010.06.031. * Luccio-Camelo, D C, and G S Prins. “Disruption of Androgen Receptor Signaling in Males by Environmental Chemicals.” _The Journal of Steroid Biochemistry and Molecular Biology_, vol. 127, no. 1-2, Oct. 2011, pp. 74–82., doi:10.1016/j.jsbmb.2011.04.004. * MacDonald, A A, et al. “The Impact of Body Mass Index on Semen Parameters and Reproductive Hormones in Human Males: a Systematic Review with Meta-Analysis.” _Human Reproduction Update_, vol. 16, no. 3, 2010, pp. 293–311., doi:10.1093/humupd/dmp047. * Magnusdottir, E V, et al. “Persistent Organochlorines, Sedentary Occupation, Obesity and Human Male Subfertility.” _Human Reproduction_, vol. 20, no. 1, Jan. 2005, pp. 208–215., doi:10.1093/humrep/deh569. * Sharma, R, et al. “Lifestyle Factors and Reproductive Health: Taking Control of Your Fertility.” _Reproductive Biology and Endocrinology_, vol. 11, no. 66, 16 July 2013, doi:10.1186/1477-7827-11-66. * Wright, C, et al. “[Sperm](https://nabtahealth.com/glossary/sperm/) DNA Damage Caused by Oxidative Stress: Modifiable Clinical, Lifestyle and Nutritional Factors in Male [Infertility](https://nabtahealth.com/glossary/infertility/).” _Reproductive Biomedicine Online_, vol. 28, no. 6, June 2014, pp. 684–703., doi:10.1016/j.rbmo.2014.02.004.
