We all know it takes a sperm and an egg to make a baby, at least we should know that. Then why is it so unlikely to happen when men release millions of sperm with each ejaculation? According to ASRM, did you know that out of the 1 in 8 couples with infertility, roughly 20% of the time it’s completely due to sperm issues? Sperm problems are also a contributing factor in an additional 30-40% of couples.

10 facts about male infertility that you should know:

1) Causes: Male infertility can be a result of physical, hormonal, genetic, or immunologic problems, a chronic illness or a sexual condition preventing semen from being deposited in the vagina (ICMART glossary). With so many possibilities, no wonder it’s such a common cause of infertility. Most of these issues result in no direct symptoms. This means many couples try for years until they see a fertility specialist and get tested.

2) Speaking of testing, a semen analysis is the first step to see if there is male factor infertility. The semen analysis is a test that looks at volume of ejaculate (the whole sample), number of sperm in each milliliter of ejaculate, the percentage of moving sperm, and the shape of a representative sample of sperm. It basically looks at how many sperm are living and moving, called a “total motile count”. This is a good test but not a perfect one because men with infertility often have low total motile counts but not all men with low numbers are infertile.

3) Getting a sample to analyze. While most guys masturbate into a cup to produce a sperm sample, did you know you could also use a special condom during sex? The sample needs to be collected without contamination from jellies or spermicide so don’t try just any condom, your doctor will have the one designed for the test. This can be an option if you have personal or religious prohibitions against masturbation.

10 Facts About Male Infertility4) Although you are trying for a baby, sometimes it’s best to not have sex; at least abstain for a few days before the semen analysis. The rationale: sperm is continuously made fresh however daily ejaculation results in samples with lower amounts of sperm in each. This could make the results of the analysis look abnormal even though you are making enough sperm.

Waiting too long is not great though. Longer than 5-6 days abstinence for most men results in the number of living sperm to seem low. Why is that? Because sperm are not only being made but they also die in the ejaculate. The semen analysis measures the percentage of sperm that are living and moving and so if more are dead than alive, the sample looks bad.

5) Is this why my doctor said have sex every 2-3 days? In part, but the whole answer is found in the numbers. A typical “normal” number of sperm in one ejaculation is more than 48 million (ASRM). When a guy ejaculates into a woman’s vagina, many of the sperm travel through her cervix into her uterus and then down her tubes. Ejaculated sperm can live in the woman’s tubes for 2-3 days.

This means you don’t need to replenish the sperm supply every day in order to have enough around to fertilize the egg. For many couples, having sex everyday while struggling with infertility is just one more major stressor to add to the list. Keeping it casual can restore some of your sanity without lowering your odds of success, if you have a normal sperm count.

6) Does this mean we shouldn’t have sex every day? Not exactly, but it depends on who you ask. A small study looked at the quality of sperm rather than the quantity in samples taken daily compared to samples produced every other day. It seems that although the amount of living sperm drops with daily ejaculation, the quality of the sperm in those samples seems to be better, suggesting having sex daily is OK. This is debated so take your doctor’s advice as the final word. The take-home message is don’t over think it and just have sex.

7) We are what we eat, and breathe, and drink, inhale… Your health is tied to the quality and quantity of your swimmers. Chronic illness such as obesity, diabetes, and others can impact sperm production, as does smoking and drinking large amounts of alcohol.

The good news is sperm are created new every day. This means improving your health, habits and diet can result in improvements in sperm production, but not right away. It takes 72 days for a sperm to go from a little germ cell to a full grown mature sperm that can fertilize an egg. So when you decide on New Years day its time to become a new man, wait until St. Patrick’s day to get a repeat semen analysis.

8) While the semen analysis is the first test for male infertility, if the numbers are low more advance testing can help uncover the cause. The testicles make sperm but the testes are told to make sperm by the brain. Hormones from the brain signal the testes to make sperm and measuring these hormones can give a clue to the cause of the semen analysis problems.

For some guys, the brain hormones are low meaning the problem is from the top, and this sometimes can be treated with medication. For others, the problem is at the factory and the brain is sending a really loud signal (hormone levels are high) but the testes aren’t responding. This situation calls for finding a new factory (aka using donor sperm).

9) Sometimes you can blame your father but not your mother for your poor sperm count. This may sound one sided but one cause of very low sperm counts (less than 5 million) is a genetic mutation called “Y micro deletion”. The Y chromosome is always passed on from the father to the son (women have two X chromosomes, so daughters get the X from dad). If a small part of the Y chromosome is damaged this can result in very low sperm production and infertility. This is why if your numbers are very low, your doctor may suggest genetic testing before trying to get sperm other ways.

10) Depending on how low your numbers are, different treatments can be used to help you have a baby. With slightly low sperm counts, concentrating the sperm into a smaller volume and placing directly into a woman’s uterus can be an option. This is called an “intrauterine insemination” or “IUI”. This same technique is used with donor sperm for those trying to become pregnant without a partner or who’s can’t provide sperm. If the sperm numbers are very low or the quality is extremely poor, the odds of enough sperm swimming from the uterus to fertilize the egg are very small. In this case the sperm needs to be combined directly with the egg using in vitro fertilization.

Contributed by: Dr. Joseph Davis. Dr. Davis is a member of the RESOLVE Physician Council and is dedicated to improving access to care. As part of this mission he left New York City to open the first fertility center in the Cayman Islands in order to offer patients high quality care in a region of the world that has few fertility specialists. Dr. Davis founded DestinationFertility.org.