Male fertility accounts for roughly half of the difficulty couples experience conceiving, and somewhere close to none of the conversation.
Think about how it usually goes. She tracks her cycle, takes the folic acid, watches what she eats, books the appointment, and answers the questions. He is asked, eventually, whether he might produce a sample. The whole apparatus of fertility advice is aimed at one person, when the biology involves two.
So this one is about the other half. What sperm health actually depends on, what genuinely improves it, what is being oversold, and how to raise it with your partner without it landing as an accusation.
Half the equation, a fraction of the conversation
The figures are consistent across sources. A male factor is involved in around forty to fifty per cent of couples experiencing fertility difficulties, either as the sole cause or alongside a female factor.
Yet a semen analysis is frequently one of the last tests arranged rather than one of the first, despite being the simplest, cheapest and least invasive investigation available in the entire fertility pathway. Women routinely undergo blood tests, scans and sometimes invasive procedures before anyone asks for a sample.
There is no clinical reason for that order. It happens because fertility is culturally coded as a woman’s concern, and because men are rarely given any framework for thinking about their own reproductive health.
If you are the one reading this, and you are wondering how to bring it up, that in itself tells you something about the imbalance.
What male fertility actually depends on
A semen analysis measures several things, and understanding them in plain language makes results considerably less frightening.
Count, or concentration. How many sperm are present per millilitre. The current reference threshold is around fifteen million per millilitre, though this is a statistical reference point rather than a pass mark. Plenty of men below it conceive naturally.
Motility. How well they move. This matters enormously, since a sperm that cannot swim effectively will not reach an egg regardless of how many there are. Analysis distinguishes progressive motility, meaning purposeful forward movement, from non-progressive.
Morphology. Their shape and structure. A surprisingly small proportion of normally formed sperm is considered acceptable, around four per cent by current criteria, because abnormal forms are simply common in human semen.
Volume. How much fluid, which affects the total number available.
DNA fragmentation. This one is not measured in a standard analysis and is worth knowing about. It assesses damage to the genetic material inside the sperm. Higher fragmentation is associated with reduced fertilisation, poorer embryo development and increased miscarriage risk, and it can be present even when count, motility and morphology all look entirely normal. It is usually tested only if there is unexplained infertility or recurrent loss.
Oxidative stress is the main driver of DNA fragmentation, which is precisely why the antioxidant and lifestyle advice that follows matters.
The seventy-four day window
This is the single most useful and most motivating fact in this article.
Sperm take approximately seventy-four days to develop, with a further couple of weeks to mature and be transported. So the sperm produced today began forming around three months ago.
Two things follow from that, and both are genuinely encouraging.
Firstly, whatever the current picture, it reflects the last three months rather than something permanent. Sperm production is continuous and constantly renewing, unlike eggs, which are present from birth.
Secondly, changes made now will not show up for around three months. This is why men often feel disheartened after a few weeks of effort and no change; the timeline simply does not work that way. It also means that if you are planning to try in three months, starting now is genuinely the right moment.
That renewability is the good news buried in all of this. Male fertility is generally more responsive to lifestyle change than female fertility, because the raw material is being made fresh rather than stored.
What genuinely affects sperm health
Sorted roughly by strength of evidence, since not everything you will read online is equally supported.
Heat, where the evidence is genuinely strong. Testes sit outside the body for a reason: sperm production requires a temperature a couple of degrees below core body temperature. Frequent hot baths, saunas, hot tubs, laptops resting directly on the lap, heated car seats and prolonged sitting all raise scrotal temperature measurably. This is one of the easier things to change and one of the more reliably effective.
Smoking, strongly evidenced. Associated with reduced count, motility and morphology, and with increased DNA fragmentation. Vaping is less studied but not assumed to be neutral.
Alcohol, evidence reasonably strong at higher intakes. Heavy drinking is clearly associated with poorer parameters. Light to moderate drinking has a less clear picture, so the sensible position is moderation rather than necessarily total abstinence.
Weight, reasonably evidenced. Higher body weight is associated with altered hormone profiles, including higher oestrogen and lower testosterone, and with poorer semen parameters.
Sleep, growing evidence. Both short and highly irregular sleep are associated with poorer parameters, likely through testosterone, which is largely produced during sleep.
Stress, moderately evidenced. Associated with reduced concentration and motility. Our article on whether stress affects fertility covers the mechanism, and it applies to both partners rather than just her.
Exercise, with a caveat. Moderate activity is beneficial. Very high volume endurance training, particularly cycling, is associated with poorer parameters, partly through heat and pressure.
Where the evidence is thinner. Tight underwear has surprisingly mixed evidence despite being the most commonly repeated advice. Mobile phones in pockets and laptop wifi are widely discussed but the human evidence remains limited. Neither is worth losing sleep over relative to the items above.
The nutrients that matter
Sperm are particularly vulnerable to oxidative damage, which is why antioxidants feature heavily here.
Zinc. Involved directly in sperm production and testosterone. Found in shellfish, red meat, pumpkin seeds, chickpeas and eggs.
Selenium. Required for sperm structure and motility. Two or three Brazil nuts daily provides plenty, and more is genuinely not better here.
CoQ10. One of the better-researched supplements for motility specifically, supporting the energy production sperm need to swim. Found in oily fish, organ meats and wholegrains.
Folate. Yes, men need it too, for healthy sperm DNA. Leafy greens, legumes, avocado.
Omega-3. Structural components of the sperm membrane, affecting flexibility and function. Oily fish, walnuts, flaxseed.
Antioxidants broadly: vitamins C and E, lycopene from tomatoes, and the polyphenols in colourful vegetables and fruit. A varied, colourful diet does most of this work without any supplements at all.
Vitamin D, given how widely low it is in the UK and its associations with testosterone and motility.
What is oversold
Let me be honest about the supplement industry here, because it targets this space heavily.
There is a large market in male fertility supplements, often expensive, usually combining a dozen ingredients at unclear doses. The evidence is genuinely mixed. Cochrane reviews of antioxidants for male subfertility have found low-quality evidence overall, with some suggestion of benefit but considerable uncertainty.
That does not mean supplements are useless. It means the confident claims on the packaging outrun what the research actually supports.
A sensible position: a good varied diet delivers most of these nutrients. A reasonable-quality supplement containing zinc, selenium, CoQ10, folate and vitamin D is unlikely to do harm and may help, particularly if diet is poor. But it will not compensate for smoking, heavy drinking, terrible sleep or a laptop permanently on the lap.
Be sceptical of anything promising dramatic improvement, particularly at premium prices. And do check anything with a pharmacist if he takes other medication.
Getting a semen analysis
This is the single most useful step, and it is genuinely straightforward.
How to arrange it. Through your GP, who can refer for an NHS analysis. Private options exist if waiting times are long, and at-home postal tests are increasingly available, though a laboratory analysis remains the more reliable option.
What it involves. Abstaining from ejaculation for two to seven days beforehand, producing a sample, and getting it to the lab within about an hour, kept close to body temperature. Most clinics provide a private room; some allow production at home if you live close enough.
Reading the result. The reference values represent the lower fifth percentile of men who conceived within a year, not a cut-off between fertile and infertile. A result slightly below reference does not mean conception is impossible, and a result within range does not guarantee everything is fine.
One result is not a diagnosis. Semen parameters vary considerably between samples, affected by recent illness, fever, stress and abstinence period. An abnormal result should always be repeated, usually after around three months, before any conclusions are drawn.
How to raise it without it landing as blame
This is the part that matters most, and the part almost nothing addresses.
Many men experience any suggestion of testing as a judgement on their masculinity. That reaction is not irrational; fertility and virility are culturally entangled in a way they simply are not for women, and the language around it is loaded.
Some things that genuinely help.
Frame it as both of you, not him. “I want us both to get checked so we know where we are” lands entirely differently from “I think you should get tested.” Preconception preparation is genuinely a shared project, and our preconception checklist covers both partners for exactly this reason.
Lead with the timeline rather than the problem. The seventy-four day fact is useful here, because it makes the conversation about preparation rather than diagnosis. “It takes about three months for changes to show, so if we start now it’s ready when we are.”
Emphasise how much is modifiable. Unlike a lot of fertility news, this is a genuinely hopeful area. Sperm regenerate. Changes work. That framing is far more inviting than a discussion of what might be wrong.
Do it together. If you are both cutting back on alcohol, both taking a supplement, both getting to bed earlier, it is a joint project rather than an intervention aimed at him.
Point out that the test is the easy one. A semen analysis is non-invasive, quick and painless. Compared with what women routinely undergo in fertility investigation, it is genuinely the least demanding step available, and saying so plainly can be persuasive.
Give it time and do not push in a single conversation. Raise it, let it sit, come back to it. Defensiveness usually softens once the initial reaction passes.
Recognise the emotional weight. If results do come back abnormal, many men take it hard. He may need space and support rather than an action plan, at least initially. Our stories of growth page has real experiences from women navigating this territory, which some find helpful to read together.
If results come back abnormal
First, it is not a verdict. Many causes are addressable and many couples with abnormal results go on to conceive, naturally or with support.
Repeat the test after around three months, since variation between samples is genuine and a single poor result may not reflect the true picture.
Investigation may follow, including hormone blood tests, a physical examination looking for things like a varicocele, which is a common and treatable cause, and occasionally genetic testing.
Many causes are treatable. Varicocele repair, hormonal treatment, addressing infection, and lifestyle change all improve outcomes for many men.
Assisted conception works well for many male factor cases. ICSI, where a single sperm is injected directly into an egg, was developed specifically for this situation and has good success rates even with significantly reduced parameters.
The point is that an abnormal result opens a pathway rather than closing one, and knowing sooner gives you more options.
When to see a GP or fertility specialist
Please arrange a referral if you have been trying to conceive for a year, or six months if the female partner is thirty-six or older.
Sooner than that if there is a known history of undescended testicles, testicular surgery or injury, mumps after puberty, chemotherapy or radiotherapy, or if there are symptoms such as testicular pain, swelling, lumps or difficulties with erection or ejaculation.
Any testicular lump warrants prompt assessment in its own right, entirely separately from fertility.
What to hold onto
Half of this is his, and that is genuinely good news, because sperm regenerate every three months and respond well to change.
Get the test done early rather than last, since it is the simplest investigation available and it either rules something out or gives you a direction. Focus on the things with real evidence behind them: heat, smoking, alcohol, sleep, weight and a colourful diet. Be sceptical of expensive supplements promising transformation.
And approach the conversation as a shared project, because it is one. Conception takes two people, and preparing for it should too.
A gentle note
If you would love support preparing for pregnancy together rather than alone, I am here. I offer warm, one-to-one fertility coaching that includes both of you.
Written by
Brydee Thomas
Holistic health coach and founder of Radiant Bloom, supporting women through trying to conceive, pregnancy and the postpartum months. Evidence-based guidance, no programmes and no generic plans.