If you and your partner have baby-making on the brain, chances are you’ve had at least one talk about your sperm. Having healthy sperm is important for fertility but what does healthy sperm look like?
You can look for certain indicators of sperm health on your own, but the only way to truly know if your swimmers are Phelps-level champs or just doing the doggy-paddle while you’re doing it doggy-style is lab testing. “A semen analysis is the only way to thoroughly evaluate how healthy your sperm are,” says Neil Paulvin, D.O., a New York City–based family and regenerative medicine physician.
Sperm-analysis tests can determine sperm quantity, quality, and motility. If you’re considering starting a family, testing may be worth it, since recent research has suggested that sperm counts have been plummeting for decades.
A 2017 study found sperm counts dropped by more than half between 1973 and 2011 in men from North America, Europe, Australia, and New Zealand (1). The study was updated in 2022 to include more recent sperm analyses, as well as those from men from Central and South America, Asia, and Africa. The newer findings were essentially the same as those in the prior study.
Some researchers say these studies’ findings signal a general decline in men’s health. Others think that sperm analysis techniques are just far more sophisticated now than in decades past. Until experts know more, pay attention to lifestyle factors since they have a big impact on your overall health, and the health of your sperm.
What Does Healthy Sperm Look Like, Anyway?
When semen analysis experts are looking at your sperm under the microscope, they’re looking at markers of health.
Healthy sperm cells have normal morphology, or shape, and motility, or ability to move, says James Elist, M.D., a Los Angeles–based urologist.
“Sperm health is important for male fertility, as healthy sperm are better able to fertilize an egg and create a viable pregnancy,” Elist says.
Quantity matters, too. “A man with good sperm health will have a large quantity of sperm per ejaculation, strong movement and a regular shape,” said Paulvin.
A healthy sperm count contains between 15 million and 200 million sperm per milliliter of seminal fluid. A low sperm count falls below 15 million per milliliter or less than 39 million total sperm per ejaculation.
“An irregularity or abnormalities in any of these categories—density, shape, or motility—can lead to infertility issues,” Paulvin said.
What Impacts Sperm Health?
Factors such as diet, exercise, sleep, and use of tobacco, alcohol, or drugs can all impact sperm health. But other elements may also play a role in healthy semen, including some medical conditions and medications, Elist said. Here are a few common ones:
- Varicocele: A varicocele is a swelling of the veins that drain the scrotum. Experts aren’t entirely sure what causes it to develop, but it is a common cause of male infertility. It can reduce sperm production and affect sperm quality.
- Hormonal imbalances: Low levels of testosterone or high levels of the hormone prolactin can impact sperm production and quality.
- Medications: Chemotherapy drugs, anabolic steroids, some antidepressants, and certain antibiotics may hinder sperm production and reduce sperm count and quality (2). (If you’re concerned, don’t stop these medications on your own; always follow your doctor’s medical advice.)
- Genetic disorders: Klinefelter syndrome and Y-chromosome microdeletions can cause infertility by affecting the production or function of sperm.
- Diabetes: Diabetes can cause damage to blood vessels and nerves, which can decrease the ability to achieve and maintain an erection and reduce sperm count.
- Chronic illnesses: Kidney disease, liver disease, and cystic fibrosis can all have a negative impact on sperm production and quality.
- High blood pressure: Men hypertension (high blood pressure) are more likely to have semen abnormalities including lower semen volume, lower sperm mobility, lower total sperm count and more abnormal sperm structure than men with normal blood pressure, according to a 2017 review of research (2).
Signs You Have Healthy Sperm
Again, a semen analysis is the only sure-fire way to know how healthy your sperm are. Other supplemental tests may provide more information about fertility and male reproductive health, including scrotal or transrectal ultrasounds, blood tests to measure hormone production from the testes and pituitary gland, or post-ejaculation urinalysis to determine if your sperm are moving backward into your bladder instead of forward out of your penis.
If you’re waiting for your labs to come back, here are some clues into normal semen and healthy sperm.
Your spunk is snowy white
Normal, healthy semen color is clear, gray or white, says Paulvin. A yellow or red tint may indicate the presence of blood (doctors call this hematospermia) which could be caused by an STI, prostate inflammation, genital injury, or internal bleeding. (Get that checked out by your doc.) Green semen can be caused jaundice or infection.
You have a smaller waist
In one study, researchers found that the higher the BMI and/or larger waist circumference, the lower the ejaculate volume. They also found an association between larger waist circumference and total sperm count (3).
Another study, published in 2021, using data from couples undergoing fertility treatments, found when men’s waist size increased from the median 96 centimeters (just under 38 inches) by 5 centimeters (roughly 2 inches), sperm concentration decreased—even among men whose BMI was in the “normal” range (4).
You avoid plastics
“Exposure to pesticides, heavy metals, and other toxins can harm sperm, so it’s important to minimize exposure whenever possible,” Elist says.
Microplastics—tiny, shed bits that seep into the soil and water and enter the food chain as larger plastics break down—may have a negative impact on semen quality and overall male fertility, per research in the American Journal of Men’s Health (5).
The CDC has also identified chemicals that pose a risk to sexual health and particularly reproductive health, which include some used in the production of plastic.
Some chemicals that are associated with increased risk for male sexual dysfunction, such as BPA, are endocrine disruptors, which mimic or interfere with certain hormones and are linked with developmental, reproductive, brain, immune, and other problems.
Environmental plastics are tough to avoid, but choosing non-plastic packaging and storage, buying unlined canned goods, skipping single-use plastics, and reheating food only in microwave-safe containers may help improve the help of sperm cells.
You eat sperm-friendly foods
A healthy diet is key to healthy sperm. One small study found participants who ate higher amounts of antioxidant-rich fruits and veggies — particularly green leafy vegetables and beans (legumes) — had higher sperm concentrations and better sperm motility compared to men who ate less of these foods.
Eating more swimmers may also help your swimmers: While the research isn’t conclusive, one small study linked higher amounts of fish consumption with better sperm motility. The benefits may stem from the high concentration of omega-3 fatty acids in fish. And since research links eating processed red meat with lower sperm count and altered sperm motility, fish may be a safer way to hit your protein goals if you’re concerned about reproductive system health.
You take your vitamins
Incorporate vitamin B-12, C and D into your supplement intake. “These vitamins are all known to help with testosterone levels and sperm motility,” Paulvin said.
A review of studies, published in 2019, found a significant association between improved fertility in male participants and a higher level of vitamin D in their blood (6).
How To Improve Sperm Health
Healthy lifestyle choices can help keep your sperm in tip-top shape. Here’s what the experts recommend:
Avoid the usual suspects
“Tobacco, alcohol, and drug use can harm sperm and reduce fertility,” Elist said. That includes anabolic androgenic steroids.
“Tight underwear can produce excessive heat and pressure affecting sperm health. Aim for loose boxers or boxer briefs,” Paulvin said.
Have safe sex
“ Sexually transmitted infections, including HIV, HPV, and chlamydia, can damage sperm quality,” says Pauvin (7).
Some evidence has associated being overweight with poorer sperm quality, as well as being sedentary—which can also negatively affect the sperm (8).
A 2019 study found higher levels of self-reported physical activity was associated with better sperm motility (9). But intense levels of exercise, such as cycling and running (five hours or more per week or more than 108 km per week, respectively), may have a negative effect on sperm (10).