Male Fertility
A good friend of mine just had his 5th child this past week. Around the same time, I was asked about improving male fertility by another friend who wants to have his 2nd.
Call it synchronicity.
If you want to map the actual bottlenecks in your hormones, fertility, metabolism, and recovery, book a call with Ferta.
Your State of Health is Dynamic. Your Sperm Are Manifest of this State
The quality of sperm reflects the health state of the father. I’ll cite some scientific research for this.
In 2016 a Copenhagen group led by Romain Barrès took sperm from lean men and obese men and sequenced the epigenome.
The DNA methylation patterns and small non-coding RNA content were markedly different between the two groups.
Then they took a separate cohort of morbidly obese men through gastric bypass and sampled again after the weight came off.
The sperm methylome had been dramatically remodeled, with the largest changes at NPY and MC4R, genes that govern appetite regulation in the brain [1].
Obesity results in unhealthy sperm. Unfatting yourself gives you leaner, better sperm.
Moral of the story
You encoding your offsprings future genetics every day. Take this seriously.
Sperm is not just a delivery vehicle for a fixed set of chromosomes. Your metabolic state, inflammation, oxidative load, physical fitness, all of this is being written into your swimmers.
This is why sperm count alone is not a good metric for your virility. Yes you want more, not less, but the quality matters.
How do we improve that?
TO start, get a Semen Analysis Done
Figure out your baseline.
Count
Size
Shape
Structure
Motility
DNA Fragmentation, this is extra and you typically have to request it
All of that gets factored into a Score.
Typical parameters and normal reference ranges include:
Volume ≥ 1.5 mL.
Concentration ≥ 15 million sperm per mL.
Total sperm number ≥ 39 million per ejaculate.
Motility ≥ 40% (with a focus on progressive motility).
Morphology ≥ 4% normal forms.
The clock is 90 days for Sperm Production
Contrary to popular belief, sperm are not produced in 24 hours. The actual process of spermatogenesis takes about 74 days from primordial cell to formed sperm, plus roughly two more weeks of epididymal maturation before a sperm is functional.
Whatever you are doing today wont show up in your ejaculate for another 12 weeks.
There are no overnight fixes.
You can improve semen volume, but the actual sperm themselves are not fast tracked.
If you want to get your wife pregnant, you need to start at least 90 days out.
Both parents’ health at the moment of conception is on the table. Your woman carries the pregnancy. You are writing the opening instructions so to speak as to whether that fertilization will be viable. Or whether your sperm are worth choosing at all.
The fastest sperm is not the winner.
Of the hundreds of millions of sperm in ejaculate, only a few hundred make to the cervix.
Cervical mucus at ovulation organizes into microscopic channels. Sperm with abnormal morphology or non-progressive motility get caught in the mesh and never make the uterus.
Theres more steps after this, but the primary point is that the ONE sperm thats selected is basically genetically screened for health and then pulled into the egg for the actual fertilization.
Metabolic health is fertility health
So how healthy are we talking here?
The first priority is bodycomposition, aka bodyfat.
The largest analysis on this pooled 21 studies and 13,077 men. Compared against normal weight, the odds of oligozoospermia or azoospermia ran 1.11 for overweight, 1.28 for obese, and 2.04 for morbidly obese. Underweight men landed at 1.15 [2].
Whats that mean?
Carry too much fat and you get insulin resistance, aromatase converting testosterone into estrogen, systemic inflammation, sleep apnea, and testicular oxidative stress.
However, get TOO Lean and thyroid drops, cortisol climbs, libido drops, sleep suffers, and the body concludes the environment is unsafe to reproduce in. Reproduction is an energy abundant function.
Obviously for most men, the issue is going to be excess bodyfat, not finding out they are too lean. But if you are super lean, maybe you need to ease off, start bulking, and be more relaxed.
The “Sweet Spot” for Male Fertility is between 12-17%, give or take a point or two
Thats a healthy walk around bodycomposition that doesnt require dieting to maintain.
If you need to unfat yourself FIRST, Get on a GLP (if youre open to it), execute on the BASICS, and work a with Coach
The BASICS of Health
As GLPs and peptides have taken off in popularity (join the telegram if youre curious about them), there has been pushback from fitness people that the general public is neglecting “the basics”. You can also substitute basics for fundamentals, or foundations
Mitochondria rule everything
Sperm motility is ATP-dependent, which makes swimming a mitochondrial powered movement ability.
You dont need to have super iron man endurance to have health sperm, but regular cardiovascular activity is a necessity.
30 minutes 3x a week.
Even better, 30 minutes daily.
Do HIIT once a week
LIFT WEIGHTS. I shouldnt need to tell you this.
Provided youre training is not beating your body down, the strongest, fittest version of yourself is going to produce the healthiest sperm.
Its possible peptides can help with this. MOTSC has data in rodents showing it improve sperm parameters. Experimental in humans obviously.
Eat like your offspring are going to be Warriors
Go caveman, primal, paleo, whatever you want to call it.
Eat eggs, beef, organs, oysters, complex carbohydrates, vegetables, olive oil.
If you’re boozing, STOP.
If you eat like an asshole, STOP.
I dont need to need to write an essay on fried foods and sugar.
You know what to eat. I’m not writing for beginners.
Consume enough minerals. Potassium, sodium, magnesium, zinc, selenium.
If you focus on micronutrients, the macros usually take care of themselves.
Is HEAT a Big Deal?
Depends. A 2013 study out of Padua put healthy men through regular Finnish sauna and documented significant impairment of spermatogenesis: degraded sperm parameters, altered mitochondrial function, and disrupted DNA packaging. Reversible after cessation, and real while it was happening [3].
That said, theres lots of men who use Sauna and hot tubs and they get their women pregnant.
This is an N=1 situation. If sperm health is an issue, refrain from the heat therapy for a few months.
Keep your genitals loose. Loose cotton or bamboo boxers are a cheap intervention available to any man reading this And more comfortable.
If you are on TRT, Get the Sperm test and then determine a strategy
Exogenous testosterone suppresses LH and FSH, thats well established. Spermatogenesis stalls, and roughly 40% of men on TRT go azoospermic.
That said, TRT does NOT mean you are automatically infertile either.
A 2024 cohort out of a single fertility center ran 77 men with a history of testosterone use on 3,000 IU of hCG plus 75 IU of FSH, three times weekly. 74% improved their sperm concentration. The men who stayed on testosterone throughout recovered at the same rate as the men who came off it. Concurrent testosterone did not impede spermatogenic recovery [4].
Its become popular on “TRT X” to recommend HCG for any man on TRT. I think this is a great recommendation. It keeps the testicles functional and prevents atrophy.
hCG mimics LH. It binds the Leydig cells and drives intratesticular testosterone, which builds the local environment sperm production requires.
Serum testosterone tells you nothing about this number; intratesticular concentrations run 50 to 100 times higher than blood, and the gradient is what Sertoli cells respond to. hMG or recombinant FSH hits the Sertoli cells directly and drives production and maturation.
Testosterone keeps the man functional. hCG keeps the testes receiving the intratesticular signal. FSH brings the production line back online.
For some men, coming off is correct. For others, maybe you can stay on, but this is best done with a specialist who understands the axis. Know that suppression is not sterilization.
Supplements can help
Out of all supplements, I think Carnitine has the best evidence. The oral form has been shown many times to improve sperm parameters. Effective dosing is 3 grams daily.
Personally I prefer the injectable. It has much higher absorption and negates any side effects.
Effective dosing is 500-600mg daily.
This is Bro biohacker territory if you elect to do this.
Elite research carries Carnitine
-Many people find Carnitine to also improve fat loss and have a positive effect on libido.CoQ10 has solid evidence in men with idiopathic infertility. It also has cardiovascular health benefits.
NAC also has positive evidence for improving sperm parameters
Zinc is an essential micronutrient and easy to supplement with. Every time ejaculate, you lose zinc
Supplements do not need to be “maxxed” with excess dosing. Take the effective clinical dose. Assess the effects 90 days later.
Not every man needs all of it. Most men need three of them and won’t do the other work.
Peptides and bioregulators amplify a system that has earned them. BPC-157 when gut integrity, tissue repair, endothelial function, or inflammation is dragging, because gut inflammation drives endotoxin, endotoxin loads the liver, a loaded liver damages mitochondria, and damaged mitochondria produce a dirtier testicular environment. KPV when immune and gut inflammation are driving histamine, food reactions, and loose stool. GHK-Cu. SS-31, which acts directly on cardiolipin at the inner mitochondrial membrane. MOTS-c in the right metabolic case. Pineal bioregulator when circadian rhythm and sleep are destroyed. Thymus when immune load and chronic inflammation are high. Testicular when reproductive tissue signaling needs support.
The human fertility trials on those do not exist. I’m reporting what we have used and what we have watched happen across our cases. Weigh it accordingly.
None of it rescues a man who sleeps five hours, drinks every weekend, and eats like a teenager. Advanced tools amplify a foundation. Point them at a broken system and you are paying to optimize dysfunction.
A couple trying to conceive should not only be asking whether his sperm can reach the egg. They should be asking what quality of man is sending the signal.
References
Donkin I, Versteyhe S, Ingerslev LR, et al. Obesity and bariatric surgery drive epigenetic variation of spermatozoa in humans. Cell Metabolism. 2016;23(2):369–378.
Sermondade N, Faure C, Fezeu L, et al. BMI in relation to sperm count: an updated systematic review and collaborative meta-analysis. Human Reproduction Update. 2013;19(3):221–231.
Garolla A, Torino M, Sartini B, et al. Seminal and molecular evidence that sauna exposure affects human spermatogenesis. Human Reproduction. 2013;28(4):877–885.
Optimal restoration of spermatogenesis after testosterone therapy using human chorionic gonadotropin and follicle-stimulating hormone. Fertility and Sterility. 2024.
If you want to map the actual bottlenecks in your hormones, fertility, metabolism, and recovery, book a call with Ferta.
They had their 5th child in a week!? Amazing. ;)
Fr tho, love what you're doing with FERTA.