Facilitated

19| Swimmers & Shooters: The Male Side of Fertility

• The Facility Denver • Episode 19

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Men contribute to roughly 40% of fertility challenges, making male reproductive health a vital yet often overlooked component of successful conception. We explore how sperm quality, measured through total motility count, morphology, volume, and concentration, influences fertility outcomes.

• Heat exposure from laptop computers, cell phones, tight underwear, and hot tubs can damage sperm mitochondrial DNA
• Stress significantly impacts testicular function, potentially reducing sperm motility by up to 50%
• Ejaculation every 2-3 days maintains optimal sperm quality, with more frequent ejaculation (every 1-2 days) recommended during the fertile window
• Zinc and selenium support sperm production and reduce DNA damage
• Glutathione protects sperm DNA and supports both morphology and swimming capability
• Moderate exercise improves sperm parameters while excessive exercise can be detrimental
• Environmental toxins like phthalates, pesticides, and bisphenols disrupt hormone function
• Optimizing gut health improves nutrient absorption essential for sperm production
• A three-month preconception health focus can dramatically improve sperm parameters

At-Home Male Sperm Test: meetfellow.com
Explore Comprehensive Male Blood Testing: thefacilitydenver.wellproz.com

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Stay curious, stay proactive, and we’ll catch you next time!

Mitchell:

Welcome to Facilitated, where we bring you real stories, strategies and science from the world of functional medicine. I'm Dr Mitchell Rasmussen, a functional medicine practitioner.

Kate:

And I'm Kate Daugherty, a certified nutritionist. We are the owners of the Facility, a functional medicine clinic here in Denver, Colorado.

Mitchell:

We help people improve their biology and get out of their own way. We help people improve their biology and get out of their own way. In my view, our work is about getting to know the person with the condition much more than it's about understanding which condition the person has. As I always say, diagnose the biology, not the disease.

Kate:

On this podcast we break down complex health topics, share real patient cases anonymized, of course and explore cutting-edge wellness strategies so you can make informed decisions about your health. Quick heads up before we dive in this podcast is for education and general information only. We're here to share insights, not to diagnose or treat. So if you're dealing with a health issue, chat with a qualified healthcare provider before making any changes. All right, let's get into it.

Mitchell:

I was thinking wouldn't it be crazy if I showed up with a full set of hair?

Kate:

I mean, I would call you Kevin all day long.

Mitchell:

Hairpiece Kevin.

Kate:

Ashton Kutcher.

Mitchell:

I don't mention it.

Kate:

Is it Kevin Malone or Ashton Kutcher?

Mitchell:

Quicksilver is apparently going to come out with a peptide for the scalp. You know I'm not into the current options, the DHT blockers and all that but if there's a peptide I could rub on my scalp I might have a full set of hair in a few months.

Kate:

We'll be watching.

Mitchell:

Yeah, that would be so fun. My hair is curly when it's long. I have pictures of me in middle school, kind of a flowy mane, so it's a dream of mine I hope you can achieve it thanks.

Kate:

Let's do a little follow-up from last week yeah, we're not just here to shoot the breeze. We're gonna talk about shooting sperm shooting loads wasn't that a good transition?

Mitchell:

Yeah, it was great. You were a little bummed out that we didn't mention caffeine last time.

Kate:

I just was surprised I guess it's more when we start thinking about actual conception, but I think it's part of the preconception is starting to minimize caffeine consumption, switching to a half-calf or a decaf, because and a lot of it's just because it's a terrible transition to do while you're already dealing with first trimester pregnancy symptoms.

Mitchell:

And I mean that goes into the blood sugar and the stress that we talked so much about. But here's your moment. You can mention caffeine. There it is.

Kate:

But I think about it for sperm health too.

Mitchell:

Yeah.

Kate:

Alcohol and caffeine.

Mitchell:

Alcohol is probably a little bit worse.

Kate:

A little bit.

Mitchell:

I'm bullish on coffee, so it's a hill I'm going to die on, I guess. So it's a hill I'm going to die on, I guess. Well, as we talked about last week, a lot of fertility concerns can be chalked up to the male partner having a massive role. What did you say?

Mitchell:

Almost 10%, it's 8% Are strictly male-based, male only, and then about a third are a combination of male female, so it's a massive part. Ideally, when someone comes into the clinic, almost always it's the want-to-be mom that comes in, but occasionally actually this year we've had a few of the husbands come in and then they end up sending in their wives afterward. The husbands come in and then they end up sending in their wives afterward, but often it is the woman and it takes a little coaxing to get that guy to realize that he has more of a role than just one night. Make it happen, right?

Mitchell:

Yep, there's a really good stand-up special about this with Andrew Schultz. Have you heard of him? Yeah, he had a pretty heartwarming special. I've actually watched it twice. I watched it with one of my mom's best friends, kind of awkward at times if it wasn't her because she's super chill, but talking so much about how he thought he was the man and he would have no issues, and ended up being some serious low semen motility, low semen volume. That led he and his wife to struggle for a long time and they ended up having to do IVF. But it was funny, it's called Life on Netflix. Check it out.

Mitchell:

I'll find it for the show notes if you're easily offended, well, it's stand-up comedy, so maybe it's not for you. There's my disclaimer.

Kate:

Great, but it's also heartwarming okay, let's talk about sperm health.

Mitchell:

All right, yeah where do we start?

Kate:

where do we start?

Mitchell:

I mean, I I think when we run a sperm test, the most likely, most important factor will actually be the total motility count for a sperm sample. You know, that just shows how many of these suckers are swimming. And keep in mind your sperm have. One sperm has about 50 to 75 mitochondria, which are how organs produce energy within them. They're all focused mostly around the tail and make sense because the tail needs to move. And I find this interesting when you study mitochondria sidebar. Oh my gosh.

Mitchell:

We inherit our mitochondrial DNA from our mother. If an embryo inherits any mitochondrial DNA from the father, that embryo cannot survive. So we get our energy from our mama and our sperm. Our mitochondria are interesting because we have DNA in our cells that is called nuclear DNA within the nucleus of the cell, but then we also have a certain amount of DNA that's actually within the mitochondria itself that are separate. It's so unique that our mitochondria have their own DNA and the problem is this relates to things like heat exposure and oxidative stress. With sperm, Mitochondrial DNA are not as protected as nuclear DNA. So when we have these mitochondria along the tail of a sperm cell, they're highly prone to oxidative stress, much more so than an egg than the mother's egg. The sperm mitochondria are so susceptible, especially things like hot tubs, saunas.

Kate:

Heat exposure Heat exposure, heat exposure.

Mitchell:

I mean even tight underwear, anything that causes heat in the scrotum, even something as simple as a varicose seal, which is a big bag of distended veins within the scrotum. Those will heat up the testicle and that absolutely has a massive birth control effect by essentially killing those sperm cells.

Kate:

And EMFs fit into that category as well.

Mitchell:

Yeah, I mean we had a recent guy. He came in first, wife came in after, but a big thing he was doing was computer on the lap during work and cell phone in the pocket constantly. And that was a small change. But seeing how EMFs have such a big effect, I think it had a massive benefit to his actual sperm health. I mean, we saw his. His motility count went way up. His morphology Remember the first test I think was one percent morphology and within a couple of months it was up over 10 yeah, I'm gonna back you up.

Kate:

Oh sorry, you got hot real fast heat, okay. Um, let's go back to all of the metrics for semen analysis first, for sperm analysis first. So the total count, total volume, motility, morphology, like what are all of the things we're looking at?

Mitchell:

yeah, I mean. The first, probably most important part is looking at the total motility count. The labs we use typically say we want you over 40 million. I think 60 to 80 million would be probably more optimal there.

Mitchell:

Another less important piece of the puzzle is your actual sperm volume. We know that you want at least a couple of milliliters of sperm in each ejaculate and according to the, the world health organization, the average volume for an ejaculation is about three and a half milliliters, which is like less than a teaspoon, which is kind of insane. But we can see it even as high as like 10 or 12 milliliters in bigger samples. A big factor for that is timing or frequency of ejaculation. Obviously, if you take more time off between ejaculations you have plenty of time to create more fluid. But then we also see diet and smoking have massive impacts with sperm volume and it's going to be higher when you're younger. Obviously we see as we get above our mid-30s that volume tends to go down. Another marker we look at is your actual concentration of sperm. We want to see, I would say, at least ideally, 75 million sperm per ml.

Kate:

And this concentration is looking at total volume of ejaculate and the concentration of semen within that ejaculate.

Mitchell:

Of sperm within the semen. Got it, thank you, yep. And when you have a low sperm count, obviously that's going to decrease the odds that the egg will become fertilized. One thing I see here that's actually important is exposure to solvents can lower sperm count. That can actually reduce concentration, motility and the shape of the sperm itself. You think about like oh, he must have a lead paint as a kid or paint just gonna say what is this exposure?

Kate:

you mean like Like inhaled exposure.

Mitchell:

Yeah, I mean, even if you're doing a lot of home projects you're staining floors, painting walls, things like that That'll have a massive impact. And that goes back to the oxidative stress, to those really delicate mitochondrial DNA. Big one that we also consider and, by the way, a test we often use is the meat fellow.

Kate:

It's a great at-home sperm test, affordable, a good price for what you get out of it.

Mitchell:

Yeah, absolutely you can order it yourself.

Kate:

You don't need a practitioner. You just go on their website and order it and can do it at home. It gives a lot of great information.

Mitchell:

Another thing we really want to see is a high motility. You know what percent of these sperm are actually moving around. We want to see, you know, 45% to 55% motility for that, and when we're doing a test we're not just seeing are the sperm swimming in a straight line? Maybe they're swimming in circles, but that is all part of you know it's called non-progressive movement, but that will still be contributing to your total motility count. We see, as we get older that will go down, peaks in the mid-20s and then gradually goes down over time. We also see seasonal variations. I think that has a lot to do with temperature changes in the environment.

Mitchell:

So take a sperm test in the winter, nothing okay here's a little fun fact I wrote down sperm can travel only a quarter inch a minute and they have to move like seven inches to get to an egg. So it would take like a half hour if the female's reproductive tract didn't assist that movement wow that's not interesting to you I guess I'll take that part out.

Mitchell:

And then again we're looking at the total motility count. Normal is considered over 40. Higher will be better with that and that again is probably the most important factor for conception from the male perspective. If you exercise, have good testosterone levels, you will have higher sperm motility what else do you think about?

Kate:

Have we covered morphology?

Mitchell:

We should Okay, we kind of mentioned it with that fellow that was able to get his from 1% to 10%. This is just the morphology is looking at the shape of the head of the sperm. And keep in mind you're making 1,500 of these guys a second, so you're bound to have some weird shaped heads okay and it takes 70 to 80 days for a sperm to mature.

Mitchell:

So we're constantly turning over this tissue and this goes back to like we talked about last time. We really like this three month get healthy from both perspectives, both the male and the female perspective, so that we can have the best chance of having a higher morphology. And the cool thing with the work we do is we see that number come up drastically through through lifestyle change. You know, again, it's normal to have some misshapen sperm. I mean we'll see two tails, uh, two heads, a tail that is too short. I mean that's all pretty normal. Again, you're probably looking at in an ideal world, 85% of your sperm have a weird shaped head. It only takes one.

Kate:

So in an ideal world you would say 15% is an optimal.

Mitchell:

I think that would be amazing, that's amazing, I'd say over 10. Okay, Typically, you know a lot of IVF clinics will say even 4% is maybe normal but Optimal, more like 14. Yeah, and we know that sperm that have better shaped head sections will likely have less DNA imperfections. Makes sense, yeah, yeah, so more likely to conceive.

Kate:

So we've got volume, we've got how good of swimmers they are, motility, and we've got how pretty they are morphology.

Mitchell:

And we've got concentration.

Kate:

How many good ones within the total?

Mitchell:

Yep, exactly. Let's talk about how stress impacts sperm health.

Kate:

Yeah, we mentioned some of this in the female fertility podcast, but I want to revisit the risk factors and lifestyle factors that you can control for optimal sperm health.

Mitchell:

Yeah, I mean, within the testicles we have multiple different cell types, right, We've got the Sertoli cells, we've got the Leydig cells. These cells help produce testosterone as well as sperm and we know that glucocorticoids so cortisol, mainly what we're talking about with stress glucocorticoids impact these cell types in the testicles and that will lead to poor testicular function. That leads to poor hormone output as well as poor sperm production. So stress has a massive impact directly within the testicle itself. So we've even seen you might, if you're really stressed during the sample, which could be stressful, right, you're probably taking this for a reason. We've seen motility go down by maybe 50% just due to the effects of acute stress.

Mitchell:

So most people that we're working with are chronically stressed. They've turned sex into a chore. I mean, how many times do we talk about timing of ejaculation and when around ovulation this should be happening and how many days should we take off? And it becomes so non-spontaneous, you know, and your sperm can live multiple days within the reproductive tract. But, as we talked about last time, for optimal vaginal microbiome health we want a very acidic ph. If a woman has a more acidic ph, the sperm won't live quite as long. But sperm can live three to five days.

Kate:

Yeah, do you want to get into that ejaculation schedule? I think it's relevant, go ahead. I mean best case scenario. We want ejaculation every two to three days outside of the fertile window because sperm buildup can decrease the motility. But we also want to avoid more than five days because that's going to reduce the quality. I'm going more than five days without ej. Five days because that's going to reduce the quality. Going more than five days without ejaculation because that's going to reduce the quality During the fertile window. Shooting for every one to two days.

Mitchell:

Shoot in.

Kate:

That's the best verb for this. And then, of course, prioritizing the two days before ovulation and ovulation day, knowing this survival length of time, I think cardiovascular exercise has a massive part here.

Mitchell:

We know that cardiovascular VO2 training or Peloton or even inclined treadmill walking has a massive improvement for inflammatory markers and that will actually decrease the DNA fragmentation within the sperm. Same with sleep. Not really sure how this is affected. I would assume it has a lot to do with circadian disruption and high glucocorticoids. But we know that if a man's sleeping less than six hours a night, glucocorticoids. But we know that if a man's sleeping less than six hours a night he will have reduced fertility.

Kate:

The exercise one is interesting, though, because it is a fine line when we're thinking cardiovascular benefit and jiggling the balls. I was gonna say stress oh excessive stress. We want exercise, but not excessive exercise or excessive, I would even say, hit training yeah it's kind of redlining you well that's.

Mitchell:

You know, that's elevating your body temperature and it's actually putting pressure on the groin right. So there is a there's definitely a window there. That makes sense. And last time we talked a lot about melatonin for egg health as a mitochondrial antioxidant. This is where sleep, I think, has another issue. We know that increases in melatonin actually improve testosterone, so normal circadian rhythm will lead to better melatonin production, which will have a positive benefit for the sex steroids.

Kate:

How about minerals?

Mitchell:

I don't think minerals are very important. Stop Well zinc.

Kate:

Someone's going to soundbite that.

Mitchell:

They don't know what they're talking about. Yeah, I mean, we know that things like zinc and selenium have big benefits for sperm production and reduce DNA damage within the sperm, as well as enhancing motility.

Kate:

I see zinc as the top supplement on almost every fertility handout. If a female's going to the clinic for fertility, they hand them a handout and say here's what your partner should take. Zinc is always on the top of that list.

Mitchell:

Yeah, and then mitochondrial support. Right, there's urolithin A. It's a fascinating compound. It enhances mitochondrial function. A lot of animal research and preclinical human research right now showing, absolutely like within cows, there's benefits to sperm production. It's safe. It has benefits for mitochondria generally. We can't totally make that loop right now to say urolithin A absolutely improves sperm production. But if I can improve your mitochond mitochondria, your sperm energy and motility will get better. And, like I said, it's a safe compound. But that's when we look at even pqq. If you have elevated blood sugar, we will really go into alpha lipoic acid. And then something we didn't mention last time, but we love for this creatine oh yes creatine.

Mitchell:

it's not about body building, it's about human building. It's about brain function, it's about mitochondrial function and ATP reserves.

Kate:

That energy availability.

Mitchell:

That'll be the hot topic of 2026 for fertility. I believe I've been pretty good. The last, like four years, you asked me my health trends. The next year I was reflecting on that. It was like four years ago it was going to be all about mitochondria. Remember that.

Kate:

I know.

Mitchell:

I forget what it was last year. It might have been glutathione two years ago.

Kate:

Acromantia was in there somewhere, acromantia.

Mitchell:

Yeah, and I'm kind of I'd say I'm doing pretty well with my takes for what the mainstream is Fortune telling the wellness trends.

Mitchell:

Yeah, um. So those are big nutrients we look at. And then obviously omega-3, vitamin E, tocotrienols it's a fat soluble vitamin. We know that it can penetrate fatty tissues. Testicles are rich in fat. Knowing that DNA fragmentation is a real concern due to environmental exposures and stress and alcohol and all that stuff, we really rely a lot for our male members of for this piece to do to really lay into tocotrienols testosterone right. Zinc activates hormone receptors. Having normal thyroid function helps have normal levels of sex hormone binding globulin. We see that whether it be hypothyroid or hyperthyroid has impacts on that shbg. The more shbg around, the less free testosterone around. So absolutely optimizing testosterone, keeping prolactin low which is why I think managing nicotine intake preconception could be important because we know that nicotine can raise prolactin levels in some people. So another aspect of that back to the stress is brain right, lh and FSH. The signaling to the gon is brain, lh and FSH.

Kate:

The signaling to the gonads.

Mitchell:

Yeah, lh tells the body to make testosterone.

Mitchell:

Fsh tells the body to make sperm. That all comes from the brain. So if I want healthy sperm production and libido and I want optimal testosterone and sperm production go upstream to the brain, I must have adequate LH and FSH. We really love herbs for this. If lifestyle is not enough, we can get some pretty good signaling improvements with things like Tongkat Ali. I love that Potentially DHEA.

Mitchell:

Another big aspect we see is environmental overload. Things like phthalates, pesticides, as you mentioned, emfs, bisphenols, parabens I mean all of that stuff is a known endocrine disruptor and it drives oxidative stress. If you're thinking about what we talked about last week, with unexplained fertility largely being a consequence of increased oxidative stress. We have to manage environmental load. And then something that I don't think is talked about enough is the gut microbiome. You know, the more inflamed your GI tract is, the more inflamed your body is.

Mitchell:

I always say this an inflamed gut becomes an inflamed body every time. An inflamed body always, eventually, every time, becomes an inflamed brain. The more inflamed your brain is, the poorer signaling is out to the body. But on top of that, just thinking about the gut, the more inflamed my gut is, I am going to struggle to absorb nutrients. It doesn't matter how many pills and capsules and potions and powders I'm taking. If that shag carpet within the villi of the GI tract is more damp and flattened and less absorptive because it's irritated either by foods that we're eating that we shouldn't, or alcohol, or too much ibuprofen, high stress, dysbiosis all of those things will impact nutrient absorption. And then, from an oxidative stress perspective, beyond vitamin E I really, really love anybody who knows me glutathione that's a standalone episode. Glutathione actually protects sperm DNA to support the morphology as well as the swimming capability.

Kate:

The shape and the ability.

Mitchell:

Yeah, Glutathione gold star. I would like to do a whole podcast on glutathione, I know. Okay, here's what you need to know.

Mitchell:

Oxidative stress leads to a reaction in the body known as the Fenton reaction, F-E-N-T-O-N. The Fenton reaction catalyzes the production of free radicals, the most damaging one in biology being the hydroxyl radical and oxygen how many times have you heard this? And oxygen and a hydrogen with a negative charge. Anything with a negative charge is highly reactive in the body. So glutathione actually quenches that free radical by donating a hydrogen and an electron. So it turns this horribly damaging compound this O, this H, and this negative charge into water H2O Magic. I call it biological alchemy. We're literally turning poison into water that we can either use or disperse of. And knowing that mechanism is so fundamental to sperm health and I mean health in general glutathione is one of the first things that we will give somebody who is struggling with sperm parameters. And then obviously vitamin C has a role here as an antioxidant. Vitamin C and glutathione kind of work together helps recycle it, so typically we'll try to give that together.

Kate:

Okay, so we've covered the semen analysis pretty well. Beyond that, there are other lab markers we can look at. What are some of those?

Mitchell:

Yeah, absolutely. A big, easy organic acid marker that we can test within the urine is a marker called 8-OH-DG, which is a marker of oxidative DNA damage. Another one that's common is pyroglutamic acid, which is a marker of glutathione status. I think that's helpful. We could run a DNA fragmentation index. Those are hard to find. We recently had a guy that we did get that on. He's in his early 40s and just really wants to make the perfect golden sperm, so that is something that we're getting for him. And then, on top of that, again, looking at micronutrients, we can easily test your coq10 within your blood, your b12 levels, your folic acid, your zinc all of those are readily available. And then, obviously, your hormones sex and stress and brain hormones, thyroid function vital is the master regulator liver health. What do we know? If your liver is not working, you're going to have weird sex hormones. So that's a big aspect that we like to look at blood sugar balance all the basics too. So how do we wrap it up?

Kate:

are you trying to be funny?

Mitchell:

not wrap it up. How do we wrap up this episode?

Kate:

I think big picture is let's see what the swimmers are doing. Let's tackle the easy interventions first, the lifestyle interventions first. Let's get curious about minerals and brain function and essentially all the things we do for optimal health.

Mitchell:

Anyway, let's turn your swimmers from doing Into Phelps, Michael Phelps.

Kate:

Oh my gosh, I was going to say teach your swimmers from doing the doggy paddle to doing the butterfly.

Mitchell:

All right, you must have a swimmer in the house. Both of those sound like very adequate swimming styles.

Kate:

The doggy paddle. Yeah, yeah, you would do the doggy paddle, it's effective.

Mitchell:

Yeah, and bottom line you've got to stop smoking if you're trying to produce healthy sperm. We have to maintain a healthy body weight. We can't be too thin or too overweight. That has a massive impact on fertility for men and women. We've got to cut down on alcohol, get an antioxidant-rich, diverse, fiber-rich, protein-rich, balanced diet. We've got to be exercising, get to sleep at night, stay away from heat and EMF exposures. I mean, those are really the big things that you can do today to make a massive improvement.

Kate:

For you and your future generation. Okay, as usual, I will make sure to find relevant resources and put them in our show notes. You can always check out our website for more information about our new patient process and our direct order labs. Follow us on Instagram at the facility Denver, and that's all I've got for you. Go facilitate your own health and we'll see you next time.