What's wrong with my sperm? Issues with the sperm - which are they and what causes them?
When a couple is having difficulties conceiving it has 50% of the time something to do with the sperm. And reproductive issues relevant solely to the person with sperm account for 20-30% of infertility cases (1). There are two main issues that’s impacting sperm quality: Sperm production and sperm delivery.
Sperm production issues
Creating enough healthy sperm is the most common cause of sperm-factor infertility. However, Sperm health isn’t static and it takes around 90 days for sperm to be produced. This means that what happened 90 days ago affects the active sperm right now. A semen analysis done in accordance with the WHO guidelines measures the status of the sperm health. And looks at five main factors:
- Semen volume - Semen is the delivery guy, taking sperm to its destination. Both too much or too little semen hampers your sperm’s journey.
- Motility - Sperm moves with its own magic mojo. Higher proportion of sperm motility = higher ability of sperm to reach that final destination.
- Sperm concentration - This ratio of healthy sperm to semen matters in your overall fertility. A healthy concentration = healthy cum.
- Total sperm count - The higher the sperm count, the higher the odds of fertilisation.
- Morphology – The morphology is the size, shape and structure of the sperm. All sizes and shapes are expected in any sperm sample and the higher ratio of “normal” shaped sperm the better.
Sperm delivery issues
As sperm needs to be present for conception to take place and any problems with delivery or ejaculation of the sperm will make it very hard to conceive naturally. Experiencing difficulties with one’s erection, so called erectile dysfunction or the timing of ejaculation, so called premature ejaculation are factors that affect sperm delivery. Premature ejaculation can be a symptom of underlying issues and seeking professional help is possible if this is bothering and is a factor when experiencing difficulties to conceive.
Also, underlying factors such as diabetes, spinal injuries and taking certain medications can cause retrograde ejaculation, that is when semen enters the bladder during orgasm instead of emerging out of the tip of the penis.
Blockage or a missing connection in the reproductive organs can also prevent the delivery of semen and sperm. This can be due to an injury, previous surgery or in some cases, a genetic condition, such as cystic fibrosis where the sperm canals may be missing. Genital infections, caused for example by sexually transmitted infections (STI), may also cause blockade in reproductive ducts.
Factors affecting sperm health
There are two main areas that’s affecting sperm health. Medical and physiological factors and environmental and lifestyle factors.
Medical and physiological factors
A number of medical conditions can be associated with problems with sperm, sperm count and quality:
- Undescended testicles, where the testicle has not landed in the scrotum
- Structural problem with the reproductive ducts – for example, the tubes that carry sperm being damaged or blocked due to illness, or being absent since birth due to a genetic condition
- Testicular tumours
- Genital infections caused by sexually transmitted infections such as chlamydia, gonorrhoea or prostatitis, infection in the prostate gland
- Varicocele, which is the swelling of the veins in the scrotum
- Genetic variations, chromosomal differences affecting single genes
- Problems affecting the reproductive hormones, such as hypogonadism, a reduced hormone production
Environmental and lifestyle factors
Sperm cells are very sensitive to oxidative stress, which can be associated with one or more of the following:
- Chemicals such as close contact with pesticides and radiation
- Certain medical treatments such as testosterone replacement therapy, cancer medications (chemotherapy), some antibiotics and some antidepressants
- Smoking, excessive alcohol consumption, use of recreational drugs (e.g marijuana, cocaine) and long-term anabolic steroid use
- A high amount of body fat may affect reproduction by endocrinologic, thermal, genetic and sexual mechanisms.
- Heat. Some studies link exposure to heat in saunas or hot tubs to reduced semen parameters. Other factors that can raise scrotal temperature (sitting for long periods of time, wearing tight underwear, occupational heat exposure) have also been investigated. However, the available evidence is insufficient and of low quality to conclude that exposure to heat affects fertility (2).