Sperm scare leads to confusion about what works

Once or twice a month, a new couple comes into MUSC Health fertility specialist John Schnorr’s office and gets an unpleasant surprise. They learn that the testosterone the man has been taking, thinking it will boost his sperm count, is actually lowering it.

“Your brain knows how much sperm you’re making by measuring your body’s testosterone level because they’re manufactured together. If you give your body testosterone, you’re telling your brain, ‘We are making a lot of sperm. You better slow down,’” Schnorr said.

“The good news is, once we stop the testosterone it will get better. The bad news is, it takes six months to a year. You talk about a mad wife. That is a mad wife who finds he was put on testosterone and they have to wait a year to have a child.”

It’s just one of many misconceptions Schnorr, a reproductive endocrinologist, and MUSC Health urologist Marc Rogers see as men across the country become more conscious of sperm counts and their ability to have a baby. Last year, researchers published a report that analyzed 185 studies and found sperm concentration plunged 50 to 60 percent over the last 40 years.

Schnorr points to a lot of possible factors, including alcohol, marijuana, tobacco, being overweight, stress, not getting enough sleep, vaping and even chemicals in plastic bottles. “We’re realizing we live in a very chemical world,” Schnorr said.

There’s no shortage of over-the-counter kits and remedies that claim to help men address sperm shortages. 

You can find at-home sperm count tests that range in price from $5 to more than $200. “They don’t correlate with a formal semen analysis really well,” Schnorr said. “The kits are not quite mature just yet. I think you probably still need a semen analysis at a reproductive endocrinology center. That’s the only way you know if you have male factor infertility.”

And there are plenty of supplements, too, which Rogers said some of his patients have tried before coming to see him for fertility help. “Most of these things take a bunch of regular over-the-counter supplements, package them together and charge you a fortune for it.”

He said there is some evidence, although it’s weak, that a couple of ingredients in those supplements may help. He cited l-arginine and citrulline. He does not prescribe them for patients but said people who want to try them should just look for those specific amino acids, not supplements that contain a bunch of other stuff that won’t help.

So what does work? Lifestyle changes, hormones and surgery.

Men should avoid drinking too much alcohol and stop smoking marijuana and tobacco, Rogers said. “Marijuana is a known sperm count reducer. Both it and tobacco can be toxic to sperm.”

Men who want to increase their fertility can also exercise and lose weight. 

Beyond that, Rogers said they can be tested to look at their hormone profile. “If they have low testosterone, we can improve that – but not using testosterone.”

Doctors can also look for other physical issues. “If they have certain varicoceles — dilated blood vessels around the testicle — that can be repaired surgically, which can improve sperm counts,” Rogers said.

He said some men are reluctant to get help for infertility. People are used to looking at women when it comes to trouble conceiving. But the fact is, in about a third of all cases of infertility, the problem involves the man alone. Half of all cases involve issues with both the man and the woman.

 They all need to look for science-based solutions, Rogers said. Not hope in a bottle or package.