Dr. Jamin Brahmbhatt is a urologist and robotic surgeon at Orlando Health and an assistant professor at the University of Central Florida College of Medicine.
There are two times I see men become hyper-focused on their health: when they have erection problems and when they have trouble having babies.
Those with fertility issues tend to be younger and arrive with their partner. The concerns are different, but both can open the door to a broader health debate.
When an abnormal semen analysis or fertility issues trigger a visit, I spend a lot of time sorting through the things patients have heard about sperm and fertility in general. One of the fears they often bring up is learning that sperm counts are declining around the world. Men and their partners worry less about why this is happening and more about what, if anything, they can do about it.
The more I heard this concern, the more I started to think: Are sperm counts really declining around the world? And wait. Should I, as a man, be worried too?
Why are we talking about a drop in sperm count? The alarm was raised after a major global analysis published in 2022 estimated that average sperm concentration fell by about half between 1973 and 2018 among men not selected on the basis of fertility. The overall analysis combined 223 studies involving more than 57,000 men from 53 countries.
This type of research, called meta-analysis, combines the results of multiple studies to look for an overall trend. These analyzes can strongly influence how doctors and patients understand a problem and what advice is given to the general population.
The researchers estimated that the average sperm concentration fell by 51.6% and the total sperm count fell by 62.3%. Concentration measures the number of sperm per milliliter of semen and total count measures the number in an entire ejaculate. These findings have raised alarms among researchers, doctors and patients.
When you look at the numbers, these results seem alarming. These figures also raise concerns about what might be affecting sperm production. For me and others in my field, they raised another question and another opportunity: Could sperm measurements provide a window into a man’s overall health?
I had a patient who was so stressed about low sperm counts that he worried about his future children and generations to come. For him, the study sounded like a countdown before men would no longer be able to reproduce. It’s a scary thought but one that goes beyond what the study can tell us. Other research also gives us reasons wondering if the same decline is happening everywhere.
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Sperm concentration showed no overall change in the initial analysis of samples collected from 1970 to 2018, according to a 2025 review and meta-analysis. It covered 58 studies involving 11,787 American men without known infertility problems.
After adjusting for geographic region and fertility status, the researchers found a slight annual decline in sperm concentration. In other words, the answer changed depending on who was studied and how the numbers were analyzed.
These results do not negate the concern raised by the 2022 analysis. They make the picture more complex than a simple global decline. For my worried patient, this study was not a countdown on his chance to become a father. I told him what I’m telling you: the sperm count is good, for now.
A doctor may usually order a semen analysis as part of a fertility workup or after a vasectomy to ensure that no sperm remains in the ejaculate. It can reveal a lot, but it cannot answer every question about fertility. The test measures several things, including the number of sperm present, their ability to move, and the percentage that has a typical shape. The World Health Organization says the comparison figures used to interpret the results should not be treated as an absolute line separating fertile from infertile men.
Another complicating factor is that if a man took a sperm sample every day for a week, the numbers would not be the same every day. Length of abstinence, recent illness, medications, stress, collection conditions, and differences between laboratories can all affect results. This is why the American Urological Association recommends at least two tests, ideally one month apart, especially when the first result may be abnormal.
I’ve seen men worry because their first test showed low motility, which meant the sperm weren’t moving well. I’ve also seen men with low or no sperm stay calm and simply ask, “OK, what can I do to make this better?” A test can tell you where to look. Repeated tests, interpreted alongside a medical history and examination, help develop a plan.
I once treated a patient whose sperm count and shape seemed good, but whose motility or ability to move was poor. He exercised, didn’t smoke, and barely drank. When we spoke, he talked about work stress and poor sleep. Six months later, after improvement in both cases, his sperm circulation was better. He reported no other changes in his diet or lifestyle.
Such a result does not prove that better sleep and less stress caused the improvement. Sperm results fluctuate. But his test results started a conversation about aspects of his health that deserved attention, whether his sperm had improved or not.
Most people hear counting sperm and think of fertility and pregnancy. In my line of work, doctors view this as part of the larger picture of a man’s health. Men suffering from infertility or abnormal sperm results have higher rates of certain medical conditions, and urology guidelines recommend counseling them on this link.
An abnormal semen analysis is not a diagnosis of heart disease, diabetes, or premature death. This is a reason to look under the hood: check the man’s history, examine him, review his medications and determine if another health problem has been missed.
Sperm health can be affected by some of the conditions I discuss during a routine exam, including medical problems, smoking, lack of sleep, heat, and current medications.
Science backs me up: Obesity, diabetes, and metabolic syndrome have been linked to poorer sperm quality and sperm DNA damage in a review of 112 studies.
Men who slept less than six hours a night were about 40% less likely to get their partner pregnant in a given month than men who slept eight hours, according to a 2018 study of 1,176 couples.
Smoking can affect sperm quality. In a study of infertile heavy smokers, sperm concentration and total sperm count improved three months after quitting.
Lower sperm concentration and count were associated with exposure to heat waves in a study of men undergoing routine semen analysis in Argentina. The testicles are outside the body for a reason. Sperm production works best below normal body temperature, and therefore chronic exposure to heat can interfere with this process.
What about drugs like testosterone? I tell all men who want to have children, now or in the future, to avoid testosterone replacement therapy. Guidelines warn that it can suppress sperm production, sometimes to zero. If you’re concerned about the symptoms of low testosterone, learn about other options for preserving fertility.
Higher total testosterone levels were associated with GLP-1 medications, according to a 2026 systematic review. Better sperm measurements in men who were obese or had low testosterone have been reported in other studies.
These results are encouraging, but I am cautious about labeling or prescribing GLP-1 drugs as fertility drugs. These medications help men lose weight and manage chronic health conditions, which may explain the benefits seen in testosterone and sperm quality. Whether these changes improve the chances of pregnancy still requires further study.
When a man asks me if he should take GLP-1 medications, I encourage him to discuss with his primary care physician whether they are appropriate for his weight and health. My goal is to inspire her to improve her overall health rather than prescribing GLP-1 to help her have a baby. I also remind him that if he becomes a father, taking care of him now can help him stay healthy and active as his children grow.
What I say to men and their partners
I’ll start with a simple piece of advice: don’t panic when faced with a result. If a semen analysis is abnormal, we will usually repeat it and review your medical history.
Gn Health
