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You might have gotten the impression from sex-ed that it’s easy to get someone pregnant, but when you’re actually ready to have a kid, the reality is often very different. About 1 in 6 heterosexual couples experience infertility, which can be challenging and emotionally exhausting to navigate.
Another misconception? That infertility is always the female partner’s fault. In fact, about 50% of the time, the guy is contributing to the couple’s infertility.
The good news is that there are things you can do to address your fertility issues.
What is infertility?
Infertility is defined as not being able to conceive after having regular unprotected sex for one year. If your female partner is 35 or older, doctors recommend getting evaluated for infertility after six months. And you might get evaluated even sooner if you have a known risk for male infertility, like a history of cryptorchidism (an undescended testicle), chemotherapy or pelvic surgery.
If you’ve been trying for several months without getting that second pink line, it might be really frustrating, but it’s not yet considered infertility. Take heart in the fact that 85% of people will get pregnant within a year of trying.
If you have been trying for more than a year, don’t despair — you still have many options to increase your chances of having a baby.
“There is a lot of male infertility that’s treatable,” says Tristan Nicholson, MD, PhD, a urologist at the Men’s Health Center at UW Medical Center – Roosevelt and an assistant professor in UW’s Department of Environmental and Occupational Health and the UW School of Medicine’s Department of Urology.
Why it’s important to get evaluated
The first step toward understanding why you and your partner are having trouble is to get evaluated. But don’t just leave this to her — again, half the time, something on your end could be involved.
“Getting both partners evaluated is really important,” says Nicholson. “It’s not uncommon for couples to try for a long time, and then the male partner finally gets an evaluation, and a significant sperm problem is found.”
For the guy, the evaluation starts by getting a semen sample analyzed in a lab where they can see if you’re producing sperm in normal numbers, if your swimmers are a normal shape and if they’re moving the way they’re supposed to. If there is an abnormality with your semen, the next step is to see a male fertility specialist to try to diagnose what’s causing the issue.
“We take a really detailed history and get a sense of what’s going on, get a little bit of information about the partner as well, and determine whether there’s a need for any additional testing,” says Nicholson.
Some of the things fertility doctors look for are genetic causes, hormonal issues, sexual dysfunction and problems with the testicles. Sometimes, there is a relatively straightforward solution, such as a varicocele — an enlarged scrotal vein around the spermatic cord that can be treated with a minor surgical procedure.
“In our visits, we think about, ‘Can we find things that are actionable? An opportunity to improve fertility?’” says Nicholson. “Or sometimes we make a diagnosis of a genetic disease that helps us come up with a treatment plan.”
Other times, there isn’t a clear cause. In that case, the next step is to look outside the body at your lifestyle and environment.
7 things you can do to improve your fertility
When it comes to environmental factors, some are harder to address than others. But you can make lifestyle changes to improve your chances.
One thing to keep in mind, though? It takes your body three months to make sperm, so any change you make will take a little while to show up.
Limit your exposure to harmful chemicals
You might have seen headlines or heard on podcasts that sperm counts are falling globally. Researchers are still debating whether this is really true, and many of the claims made by people panicking about it are overblown. Still, it is the case that chemicals in the environment can affect fertility.
“They are a little tougher to study, and sometimes it can be challenging for people to avoid them, because many of the chemicals are really pervasive in our environment and we’re all being exposed all the time,” says Nicholson.
One of the most prevalent of these is a compound found in plastic called phthalates. You can do your best to limit your exposure by avoiding heating, eating or storing food in plastic, though there is limited evidence on how much that will affect your fertility.
Protect yourself against wildfire smoke
Another source of environmental toxins in Western Washington is wildfire smoke. Last year, Nicholson published a small cohort study that followed 84 individuals undergoing sperm preparation for fertility treatment during and after major wildfire smoke events in the Seattle area and found consistent declines in the concentration and movement of the sperm in their samples.
While more research is needed on the effects of wildfire smoke on fertility, Nicholson recommends doing everything you can to protect yourself from smoke, such as closing your doors and windows, using air filters, wearing a high-quality mask when outside, and avoiding outdoor exercise on smoky days.
Stop smoking
The research is very clear, on the other hand, that smoking both tobacco and marijuana affects fertility.
“We know that tobacco smoking is bad for sperm and can decrease fertility,” says Nicholson. “We also know that cannabis consumption, either through smoking or consuming edibles, also has important impacts on sperm function.”
If Nicholson sees a patient with infertility who smokes cigarettes or uses marijuana, one of the first things she’ll advise is to stop as soon as possible.
Lay off the testosterone
This one is a bit counterintuitive, but it turns out that if you’re taking testosterone, either for a medical condition or as a performance-enhancing drug, it’s affecting your swimmers.
“When you take testosterone, whether you use patches or gels or injections, that will generally signal to your body to stop its own production of testosterone and also suppress its production of sperm,” says Nicholson. “For most people, when they’re on testosterone, that will cause their sperm production to go down, and they may become infertile.”
In most cases, you can work with a fertility specialist to reboot your own production of testosterone and improve your sperm count.
Stay active
If you need another reason to get off the couch, a sedentary lifestyle can contribute to infertility.
“There are randomized trials that show that if people who have normal semen parameters are started on a variety of exercise programs, they make more sperm, their sperm move better, and their sperm have a better, more normal shape,” says Nicholson.
It’s not as clear how much physical activity helps someone who is already struggling with infertility, but Nicholson still recommends 150 minutes per week of regular exercise to all her patients.
“What’s good for your heart is good for your sperm,” she says.
Watch what you eat
Eating a healthy diet is another tried-and-true piece of health advice that applies to fertility, as well. The healthier you eat, the better for your fertility. Nicholson typically recommends a diet rich in whole foods and healthy fats, such as the Mediterranean Diet.
Hit the sauna and hot tub in moderation
A last potential factor has become more relevant in Seattle since saunas have seen a boom in popularity. Testicles hang outside of your body because the optimal temperature for the production of sperm is a few degrees cooler than your body. There is evidence that heating them up, whether in a sauna or hot tub, can affect sperm production.
“I will say that some of the evidence is quite mixed, but if I have a patient who is trying to conceive, I would recommend against routine hot tubs, saunas and other heat exposure during the time that they’re trying to conceive,” says Nicholson.
A path forward
If it’s not possible for you to improve your fertility by addressing an underlying condition or making lifestyle changes, you still likely have options.
“Sometimes the treatment for male factor infertility is technology, and there are a number of different fertility treatments,” says Nicholson.
One is called intrauterine insemination, which involves making a concentrated sample of moving sperm that can be placed into your partner’s uterus at the time that they are ovulating. And, depending on your partner’s situation, in vitro fertilization can also be a treatment for male-factor infertility.
It can be discouraging and isolating to have problems with your fertility that affect you and your partner’s plan to get pregnant. But before you give up hope, talk to a fertility specialist and get evaluated, because there is likely something you can do.
