ObGyn Intelligence
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Male Fertility
Not every cause of low sperm is fixable — but several are, and some of the most powerful ones get missed. Here is the list worth your attention, roughly in order of impact.
This is the one most people don't expect: taking testosterone — whether as "T therapy," a gel, an injection, or gym anabolic steroids — tells the body to stop making its own sperm. Many men on testosterone have very low or zero sperm counts.
If you are trying to conceive and taking any form of testosterone or steroids, this is the first thing to discuss with your clinician. Counts often recover after stopping, and there are medicines that help the recovery. Don't start testosterone if you want children soon.
A varicocele is an enlarged vein in the scrotum, a bit like a varicose vein. It is the most common correctable cause of male infertility — found in about 4 in 10 men who come in with fertility problems. It can warm the testicle and lower sperm quality.
Not every varicocele needs fixing, but when it is causing a problem, a minor procedure to repair it can improve sperm and the chance of pregnancy. A urologist can tell you if yours qualifies.
Tobacco and heavy alcohol are linked to lower sperm count and quality. Cutting back — or stopping — is one of the simplest things in your control, and it helps your overall health too.
Carrying extra weight can shift hormones in ways that lower sperm production. Steady, healthy changes in eating and movement can help — this is about feeling better and supporting fertility, not chasing a number.
The testicles work best a little cooler than the body. Frequent hot tubs, long saunas, or a laptop resting on your lap for hours may not help. You don't need to obsess — just ease up where it's easy.
A few prescription and over-the-counter medicines can affect sperm. Never stop a prescribed medication on your own — bring your full list to your clinician and ask whether any could be involved.
A high fever or illness in the last couple of months can temporarily lower a result. It often recovers on its own. Mention any recent fever when you test.