Part of our guide: Male fertility

When family planning doesn’t go as planned, couples often look at the woman first. Yet men contribute to involuntary childlessness in about half of all cases. The good news: You can considerably improve your fertility, both medically and through deliberate lifestyle changes.

Many men who undergo an andrology evaluation feel uncertain. Some have already received a poor semen analysis result, while others simply want to improve their chances proactively. One thing is true for all of them: Male fertility is not destiny. In most cases, it can be influenced for the better.

What does it mean to improve male fertility?

Men’s hands carefully holding a lab dish for sperm testing

Male fertility rests on three pillars: sperm production, sperm quality, and the transport of sperm cells. When you improve your fertility, you improve at least one of these areas.

Specifically, it comes down to the sperm parameters measured in a semen analysis. The most important are:

  • Concentration: At least 16 million sperm per milliliter, and at least 39 million per ejaculate in total
  • Motility: At least 30% of sperm should move forward, and at least 42% should be motile overall
  • Morphology: At least 4% normally shaped sperm
  • Volume: At least 1.4 milliliters of ejaculate

These are the WHO’s lower reference values from 2021. According to the WHO, they are not a sharp dividing line between fertile and infertile.

The reality in practice

Modern andrology practice with a warm atmosphere for fertility counseling

Many men whose values fall below these reference ranges are shocked because they feel healthy and fit. They exercise, don’t smoke, and still have an abnormal semen analysis. How can that be?

The answer is complex. Fertility depends on many factors that are often overlooked. Being overweight, environmental toxins, a recent illness with fever, or genetic factors can also impair sperm quality.

The positive side: Many problems can be addressed. New sperm take a little over three months to mature. That means improvements to your lifestyle can show measurable results after about three months.

Can you improve sperm quality medically?

Yes, definitely. Modern andrology offers several evidence-based treatment options. Which one is right for you? That depends on the cause of your fertility problems.

Hormonal treatments

Hormone disorders are more common than people think. In a large andrological analysis cited in the guideline of the European Association of Urology (EAU), 10.1% of the men had hypogonadism. Some of these disorders respond well to treatment:

Hypogonadotropic hypogonadism can be treated well with hCG, supplemented with FSH if needed. The hormones can get sperm production going again. If, on the other hand, the testicles themselves are damaged, hormone therapy does not help, according to the EAU guideline.

Hyperprolactinemia is usually treated with dopamine agonists. According to the EAU guideline, this can improve sperm quality.

Surgical procedures

Varicocele surgery is one of the most important procedures in andrology. A varicocele, a varicose vein around the testicle, is found in 35% to 40% of men with fertility problems, according to the EAU guideline.

In men with a palpable varicocele and abnormal values, sperm values usually improve after surgery, and in one meta-analysis motility improved particularly clearly. According to a Cochrane review, the chance of pregnancy also increases.

Support with medication

Antioxidants are meant to protect sperm from oxidative stress. A Cochrane review found evidence suggesting more live births, but the quality of the evidence is very low. A US study (MOXI, 171 couples, ended early) found no improvement in sperm values.

Even so, caution is advisable with dietary supplements. Many men take vitamin supplements at random without addressing the causes. A targeted therapy after thorough diagnostic testing is usually more effective.

Why is male fertility declining?

Sperm quality is declining. Between 1973 and 2011, the mean sperm concentration in men in North America, Europe, Australia, and New Zealand fell by a little over half. The reasons are many. And they often combine.

Environmental factors and lifestyle

Heat is an important disruptor of sperm production. The testicles hang outside the body for a reason: To form sperm, they need to be about 2°C (3.6°F) cooler than normal body temperature.

Common sources of heat in everyday life:

  • Laptops on your lap
  • Heated car seats
  • Frequent sauna visits
  • Tight underwear
  • Excessive exercise in warm clothing

Stress can affect the hormone balance. Whether it directly worsens sperm quality, however, has not been clearly proven.

Being overweight can impair testicular function and reduce sperm production. Fat tissue also converts testosterone into estrogen.

Chemical exposures

Plastic vs. natural materials showing environmental exposure that affects fertility

We encounter pollutants every day, including hormonally active substances (endocrine disruptors):

  • Plasticizers in plastic packaging
  • Pesticides in conventionally produced foods
  • Heavy metals from various sources
  • Solvents in paints and adhesives

If you work with pesticides or solvents on the job, for example in agriculture or the skilled trades, you should mention this during the andrology evaluation.

The effect of age

Men have a biological clock too, but it ticks more slowly. Usually from around age 40, fewer sperm are produced, and their ability to fertilize an egg may decline. DNA damage in sperm also increases with age, and the risk of miscarriage rises.

How steep the decline is varies greatly from person to person.

Medical treatment pathways

Choosing the right therapy depends on your individual findings. After thorough diagnostic testing, a treatment plan is developed together with the andrologist.

Hormone therapy in detail

Testosterone deficiency is not treated directly with testosterone when you are trying to conceive, because that would shut down the body’s own production and completely suppress sperm formation. Instead, the natural production is stimulated:

  • hCG injections twice a week stimulate the Leydig cells, supplemented with FSH if needed
  • Clomiphene taken daily by mouth blocks estrogen receptors in the hypothalamus (not approved for men, used off-label)
  • Aromatase inhibitors for elevated estradiol (also off-label, limited data)

According to the EAU guideline, the semen analysis is checked about every three months to assess success and adjust the dosage.

Surgical treatments

Varicocele repair is now usually done with microsurgery, with fewer complications and recurrences than other techniques. It takes up to two cycles of sperm formation for sperm values to improve. In studies, a spontaneous pregnancy usually occurred six to twelve months after the procedure.

Blockages of the sperm ducts can often be reconstructed. With complete blockages, a TESE procedure is sometimes necessary to retrieve sperm directly from the testicle.

Medication-based approaches

Antioxidants are used mainly when oxidative stress is suspected:

  • Coenzyme Q10
  • Vitamin C
  • Vitamin E
  • Selenium

According to the EAU guideline, it has not been established which substances help at which dose. More is not better: Stick to the maximum amounts for dietary supplements and talk to your doctor before taking them.

Antibiotics for a confirmed bacterial inflammation of the prostate or epididymis. They can improve sperm quality. According to the EAU guideline, however, it has not been shown that this increases the chance of a natural pregnancy.

Costs in Germany, Austria, and Switzerland

This section applies to Germany, Austria, and Switzerland.

Treatment costs vary widely depending on the country, insurance, and therapy. There are no reliable average prices. Some points of reference:

  • Diagnostic testing: For infertility, the statutory health insurance funds in Germany pay for the evaluation in full. You can read what a semen analysis costs when you pay out of pocket in our article on semen analysis cost.
  • TESE: €800 to €2,000, according to familienplanung.de.
  • Dietary supplements: You usually pay for these yourself.
  • Treatments with a medical indication: Clarify coverage with your health insurance fund in advance. Austria and Switzerland have their own rules.

Supportive lifestyle measures

Healthy foods in a kitchen that naturally support male fertility

Alongside medical treatment, lifestyle factors play a central role. Small changes can have a big effect.

Diet for better sperm

In observational studies, a Mediterranean-style diet was associated with better sperm values. However, firm evidence from controlled studies is lacking. Even so, it is a good choice as a foundation.

Helpful foods:

  • Tomatoes (lycopene)
  • Nuts (omega-3 fatty acids)
  • Dark leafy greens (folic acid)
  • Fatty fish (omega-3)
  • Berries (antioxidants)

Problematic foods:

  • Processed meat
  • Trans fats
  • Excessive soy intake
  • Too much alcohol
  • Sugary drinks

Exercise and physical activity

According to a meta-analysis, regular physical activity is linked to better sperm values, both with moderate and with more intense recreational activity. Exercise can also improve the hormone profile.

In practice: Several training sessions per week, ideally a mix of endurance and strength training.

Unclear: Whether very high-volume athletic training is harmful has not been clearly established. Above all, avoid overheating in the groin area.

Stress management

Whether stress directly worsens sperm quality has not been clearly proven. Relaxation does help you cope better with the strain of trying to conceive, though:

  • Meditation (even 10 minutes a day)
  • Progressive muscle relaxation
  • Yoga
  • Regular breaks

Sleep hygiene

Enough sleep is part of a healthy lifestyle and supports the hormone balance.

What helps:

  • Enough sleep each night
  • Regular bedtimes
  • A cool, dark bedroom
  • No screens for 1 hour before bed

Reducing environmental toxins

Small changes in everyday life can noticeably reduce your exposure to harmful chemicals:

  • Glass bottles instead of plastic bottles
  • Organic foods, especially fruits and vegetables
  • Use natural cosmetics
  • Air out living spaces regularly
  • When renovating, choose low-pollutant materials

Frequently asked questions

How quickly can sperm quality improve?

New sperm take a little over three months to mature. That means improvements to your lifestyle will show up in a semen analysis after about three months at the earliest.

With hormone therapies, too, success is usually checked every three months with a semen analysis. After varicocele surgery, it takes up to two cycles of sperm formation for values to improve. So patience is important.

Can dietary supplements really help?

Yes, but only for confirmed deficiencies or specific indications. Many men take vitamin supplements at random without knowing their levels.

Dietary supplements make sense for:

  • A confirmed vitamin D deficiency
  • Suspected oxidative stress
  • An unbalanced diet
  • Chronic inflammation

A targeted blood test before supplementing is important. Too much of certain vitamins can even do harm.

What does it cost to improve male fertility?

Costs vary widely depending on the cause and the treatment chosen:

Diagnostic testing: For infertility, the statutory health insurance fund pays for the evaluation in full. As a self-pay patient, a semen analysis with a consultation costs from around €37 under the German fee schedule for physicians, and the Fertility Information Portal (Informationsportal Kinderwunsch) gives €80 to €200 for the privately billed test. Hormone testing and ultrasound may come on top.

Lifestyle changes: Practically free, provided you skip expensive dietary supplements and eat a balanced diet instead.

Medical treatment: The costs depend heavily on the therapy. According to familienplanung.de, a TESE costs €800 to €2,000.

With a medical indication, health insurance funds cover many treatments, but clarify coverage in advance. Germany has its own rules for assisted reproduction: The statutory health insurance fund pays 50% for up to three attempts for married couples.

When should I see an andrologist?

An andrology evaluation makes sense if:

  • You and your partner have been having unprotected intercourse for over a year without a pregnancy
  • You already know that your sperm quality is impaired
  • You have risk factors (undescended testicle, chemotherapy, varicocele)
  • You want to optimize your fertility preventively

Early diagnostic testing can save time. The EAU guideline recommends evaluating both partners at the same time. Many couples wait too long. And lose valuable time.

Can you still improve your fertility at 40+?

Yes. Even though sperm quality usually declines from around age 40, healthy habits are worthwhile at any age. According to the EAU guideline, losing weight, exercise, quitting smoking, and drinking less alcohol can improve values.

The key is consistent follow-through. The older you are, the more important each individual optimization becomes.

Your fertility is not entirely in your hands, but you have more influence over it than you might think. The combination of medical diagnostic testing, targeted treatment, and deliberate lifestyle changes can make a big difference.

If you want to take concrete steps to optimize your fertility, start with our Fertility Clinic Finder. It helps you find suitable fertility clinics near you. You can find more about andrology diagnostics in our andrology overview.

Sources

FE

About this article

Fertilio Editorial Team

The Fertilio Editorial Team researches fertility topics using specialist sources such as the German IVF Registry (Deutsches IVF-Register, D.I.R.), medical guidelines, and statutes. The sources are listed at the end of each article. The content does not replace medical advice.