Infertility, or the inability for a couple to conceive a child, is a common condition in the United States. It's typically diagnosed after both partners have had regular, unprotected sex for at least 12 months without resulting in a pregnancy.
Historically, infertility has typically been perceived as an issue affecting women, namely their eggs. However, male infertility is a significant and often underestimated contributor.
"The biggest myth is that infertility is a woman's problem," Dr. Lucky Sekhon, a board-certified OBGYN, endocrinologist and infertility specialist based in New York City, tells TODAY.com.
In fact, there are a number of lifestyle factors and health conditions that can affect the health of sperm and negatively impact male fertility, Sekhon explains.
About 11% of men of reproductive age in the U.S. experience some type of infertility, according to the U.S. Centers for Disease Control and Prevention.
“We now know that about 50% of cases of infertility involve a (contributing) male factor, and about a third of cases involve a situation where the cause of infertility is solely on the male side,” says Sekhon.
But what causes male infertility? Many people think it's due to habits like keeping a cellphone in your pocket or wearing tight underwear. So, what's the truth?
Myths About Male Fertility
TODAY.com spoke with Dr. Sekhon about common male fertility myths, the top factors and behaviors that actually affect sperm health, and tips for couples trying to conceive.
Myth: Men Don't Have a Biological Clock
The "biological clock" — which refers to the decline in a person's fertility as they age — doesn't only affect women, Sekhon says.
"We're told that women are born with a limited supply of eggs ... but that men are always making new sperm," says Sekhon.
While it's true that men can produce new sperm throughout their lives, their ability to create healthy sperm declines with age, Sekhon notes. “In general, for men this kicks in around 45 and is more pronounced in their 50s, 60s and beyond,” she adds.
In the U.S., the percentage of men experiencing some type of infertility is over 14% in men ages 45-49, compared to less than 8% in men ages 15–24, per the CDC.
What's more, mutations in sperm as men age may also be linked to certain medical conditions in their offspring, Sekhon explains. “That’s one of the theories why there’s an association between advanced paternal age and certain medical conditions in children, including neurodevelopmental issues,” she says.
“It’s something men should know because sperm freezing is an option, and it’s so much cheaper and easier than egg freezing, but it’s dramatically underutilized.”
Myth: Cellphones and Laptops Affect Male Fertility
Another common myth is that carrying a cellphone in your pocket or having a laptop on your lap can harm male fertility.
"There are some studies that have looked at this and exposed men to radiofrequency (RF) from their phones and other devices, and there's some evidence that prolonged heat exposure might affect sperm quality," says Sekhon.
However, there's no scientific evidence showing that normal cellphone or laptop use directly affects male fertility. “The studies aren’t well designed and they’re not conclusive, so by and large, that is more of a myth,” says Sekhon.
It is a good idea to reduce the amount of heat applied directly to the testes — but unless your phone or laptop is unusually hot, this probably won't be an issue.
Tight Underwear Lowers Sperm Count
"Another myth is boxers are better than briefs (for male fertility)," says Sekhon. The theory is that briefs can increase the temperature in the groin area, which can impact sperm production or quality.
"Tighter underwear may limit the body's ability to regulate scrotal temperature slightly," says Sekhon. Sperm thrives slightly below normal body temperature, which is why the testicles are located outside the body.
“If you expose them to excessive amounts of heat, that could be bad for sperm, but I don’t think there’s any strong evidence that choice of underwear is going to influence male fertility in a strong way," says Sekhon.
Ideally, you should wear underwear that's most comfortable and practical for you. "I think if someone has overall healthy sperm production, whether they wear boxers or briefs is probably not going to change anything," Sekhon adds.
Frequent Ejaculation Harms Fertility
"People worry a lot about how often they're ejaculating and feel like if they ejaculate too frequently, they're really reducing their sperm count," says Sekhon.
However, this is another common myth. "For the average male with normal sperm production, frequent ejaculation is usually not going to be a problem," says Sekhon.
There are certain cases where a man may be asked to abstain from ejaculation for a certain time period before a procedure like IVF or an insemination, which requires a sample of sperm.
"Two to seven days is what we normally recommend," says Sekhon, adding that the optimal time period can vary depending on the individual.
But you also don't want to store up for too long, she adds. "There's a sweet spot. If you don't ejaculate for a very long time, you can actually build up sperm that's suboptimal with more fragmented DNA," says Sekhon.
Testosterone Supplements Boost Male Fertility
Testosterone-boosting supplements are often marketed for enhanced mood, building muscle or improving libido and sexual health. However, taking excess testosterone can actually harm sperm production.
That's because it can “fool the brain,” causing it to tell the testes to stop producing more sperm," Sekhon says.
“It’s not always reversible either, so it can have a long-lasting effect on fertility," she adds. "It’s confusing, but testosterone is almost like a form of male birth control."
Similarly, Sekhon cautions against overdoing it with any dietary supplements.
How Is Male Fertility Tested?
Typically, testing for male fertility involves an analysis of a semen sample, which looks at several parameters to measure fertility. "You have to look at all of them together," Sekhon says.
One measure is the overall volume of the semen sample. Another is the number of sperm in a sample — anything over 20 million per milliliter is usually considered a normal concentration.
Another measure is the ability of the sperm to move through the female reproductive tract to reach an egg. At least 40% of sperm should be moving in a forward direction to achieve a pregnancy.
"There's also the shape of the sperm, or morphology. There's a lot of abnormally-shaped sperm, and that's OK, but if at least 4% of the sample appears to have a normal shape, that's considered normal," says Sekhon.
Depending on these measures, doctors will determine how much and which type of intervention is needed.
Factors That Can Affect Male Fertility
Generally speaking, there are two types of factors that lead to male infertility — lifestyle and medical conditions, Sekhon explains. These include:
- Age
- Smoking
- Alcohol consumption
- Obesity
- Hormone imbalances
- Underlying health conditions
- Varicoceles, or enlarged veins in the scrotum
"We know smoking is terrible for sperm. It can reduce the count and the motility. ... That goes for cannabis as well," says Sekhon. Heavy alcohol use can also lower testosterone levels and lead to a lower sperm concentration.
A poor diet, stress and lack of sleep can also impact male fertility. “There is also evidence linking some unhealthy behaviors in men to a higher likelihood of complications during pregnancy (because) so many parental genes contribute to the placenta being formed," Sekhon says.
Obesity can lead to hormone imbalances, which can contribute to erectile or sexual dysfunction and the health of sperm, she adds.
Uncontrolled metabolic disorders can negatively impact male fertility, such as high blood pressure, high cholesterol, diabetes and thyroid disease, says Sekhon. Autoimmune conditions and cancers, as well as the treatments, can also cause issues.
A history of sexually transmitted infections or prior surgeries can lead to blockages and inflammation in the male reproductive tract, which can affect sperm quality and integrity, she adds.
"Some men can also have something called a varicocele, which is like a varicose vein, that can cause problems with sperm production," says Sekon. "Sometimes, it's genetics and you're just born with it."
Always talk to your doctor if you have any questions.
Tips for Male Partners Trying to Conceive
If you're trying to conceive and looking to improve your fertility, Sekhon recommends focusing on the following lifestyle factors:
- Eat a nutritious, balanced diet.
- Maintain a healthy weight.
- Exercise regularly.
- Manage stress.
- Get adequate sleep.
- Avoid excessive heat exposure.
In addition to adopting healthy lifestyle habits, couples should have a "low threshold" to seek a sperm analysis, Sekhon advises.
"It's such a non-invasive, easy test. So if you've been trying for at least six months, it's reasonable to get tested, especially if the female partner is over 35," says Sekhon.
"It is a game changer and can be very helpful."
