Sperm: The Sixth Vital Sign

Stanford University’s Director of Male Reproductive Medicine and Surgery, Dr. Michael Eisenberg, shares his thoughts on the importance of sperm count.

When you think about standard medical tests you probably think blood pressure, cholesterol, glucose, etc.  These are general tests that physicians rely on to flag potential underlying conditions such as risk of heart attack or stroke.  These tests do not confirm that you have a medical problem, they simply indicate a higher statistical likelihood of a problem existing and perhaps warranting a deeper look by your practitioner and guiding future treatment decisions.

You probably don’t think about measuring your sperm count as part of a standard medical evaluation, but someday soon you may.

I am one of a growing number of male reproductive health specialists investigating the link between men’s semen quality and overall health.  Compared to many other health “biomarkers”, semen remains relatively poorly understood outside of fertility outcomes (i.e. higher sperm count being tied to better chances of conception).  But there’s a growing body of evidence indicating that the body’s ability to produce sperm may be a harbinger of longer term health conditions.

A few examples:

  • From semen analysis results of 501 couples trying to conceive, we found that obese men are 20 times more likely to have a low sperm count than men with a healthy weight (BMI 18.0 – 25.0).(1)
  • In a study of over 9,000 men, we found that men with more medical problems had worse semen quality(2)
  • In looking at databases of over 12,000 male fertility patients, we found that men with more semen defects had over twice the risk of death as men with normal semen quality.(3)
  • Other population studies have linked male factor infertility with higher rates of cancer,(4-6) diabetes,(7) and cardiovascular disease.(7)

While we may be several years away from semen analysis being included in a man’s annual physical, the research is supporting the utility for more routine testing and the medical community is headed in the right direction.  The American Urology Association (AUA) recommended practice guidelines for male fertility emphasize semen analysis as the cornerstone of medical evaluation in part because “male infertility may occasionally be the presenting manifestation of an underlying life-threatening condition.”

I don’t want you to read this and get alarmed.  A low sperm count does not mean that you have a chronic health condition, just like a high blood pressure reading does not mean you’re going to have a heart attack.  There are many reasons for suboptimal sperm quality, and many of them are treatable and correctable.  In general, anything that’s good for the heart is good for sperm production (e.g. diet, exercise, maintaining a good body weight).  If you’re reading this blog you’re likely way ahead of the curve and thinking about your sperm and future health than most people and should be commended.

I’m a big fan of increasing a man’s engagement with his reproductive health and products like Trak can help. I’ve never had a patient come in “excited” to get their semen analysis.  It’s admittedly an awkward experience – most guys would much rather get their blood drawn.  And for that reason most guys aren’t getting tested at all.  But it’s an important test – not only for your fertility, but potentially for your health as well.

Our scientific understanding of sperm and health will improve as we gather and analyze more data.  Let’s take it one step at a time – if you’re curious where you stand get a semen analysis. Trak is an easy and private option for measuring your sperm count which may tell you more than just your fertility.

  1. Eisenberg ML, Kim S, Chen Z, Sundaram R, Schisterman EF, Buck Louis GM. The relationship between male BMI and waist circumference on semen quality: data from the LIFE study. Human reproduction 2014;29:193-200.
  2. Eisenberg ML, Li S, Behr B, Pera RR, Cullen MR. Relationship between semen production and medical comorbidity. Fertility and sterility 2015;103:66-71.
  3. Eisenberg ML, Li S, Behr B, Cullen MR, Galusha D, Lamb DJ et al. Semen quality, infertility and mortality in the USA. Human reproduction 2014;29:1567-74.
  4. Jacobsen R, Bostofte E, Engholm G, Hansen J, Olsen JH, Skakkebaek NE et al. Risk of testicular cancer in men with abnormal semen characteristics: cohort study. BMJ (Clinical research ed 2000;321:789-92.
  5. Walsh TJ, Schembri M, Turek PJ, Chan JM, Carroll PR, Smith JF et al. Increased risk of high-grade prostate cancer among infertile men. Cancer 2010;116:2140-7.
  6. Eisenberg ML, Li S, Brooks JD, Cullen MR, Baker LC. Increased risk of cancer in infertile men: analysis of U.S. Claims data. The Journal of urology 2015;193:1596-601.
  7. Eisenberg ML, Li S, Cullen MR, Baker LC. Increased risk of incident chronic medical conditions in infertile men: analysis of United States claims data. Fertility and sterility 2015;105:629-36.