How to improve sperm quality for fertility with Dr. Keith Jarvi, Urologist

An exclusive interview with Dr. Keith Jarvi, Head of Urology at Mount Sinai Hospital in Toronto, Canada

Male infertility is a topic that is often overlooked in fertility discussions, yet it plays a crucial role in a couple’s ability to conceive. On EP52 of My Fertility Podcast welcome Dr. Keith Jarvi, a Lunenfeld-Tanenbaum Senior Clinician Scientist, Head of Urology at Mount Sinai Hospital, and Director of the Murray Koffler Urologic Wellness Centre, the largest male infertility clinic in Canada. He is working to develop less invasive ways to identify and treat male infertility. His expertise spans microsurgical reconstruction techniques, operative sperm retrieval, and the study of genetic abnormalities related to male infertility.

In this exclusive interview, Dr. Jarvi offers insights into the causes of male infertility, lifestyle changes, medical treatments, and what couples can do to optimize sperm health.

Welcome back, Dr. Jarvi! We’re thrilled to continue our conversation. Last time, we covered the topics of semen analysis and sperm DNA fragmentation. Today, let’s delve deeper into your research and ways to improve sperm health for fertility.

Dr. Jarvi: Thank you for having me! It’s great to be back and to continue our conversation.

Understanding the Goal: A Couple’s Perspective

Dr. Jarvi, when couples come to you with concerns about male infertility, where do you begin?

Dr. Jarvi: At the end of the day, the ultimate goal of any couple facing infertility is the same: to conceive a child. From a urologist’s perspective, the focus may be on identifying reversible causes of male infertility and improving sperm quality, but the couple’s shared goal should remain central.

For example, if a man’s sperm count is slightly low but his partner is 41 years old, it may be more appropriate to move directly to in vitro fertilization (IVF) rather than spend time investigating the male factor in detail. IVF, which involves fertilizing an egg outside the body and transferring the embryo into the uterus, can offer good to excellent success rates.

Still, whenever possible, urologists aim to:

1. Improve sperm quality.
   
2. Identify underlying health risks for the man.
   
3. Avoid IVF if a natural or less invasive solution is feasible.

Confirming the Problem: The Semen Analysis

Let’s talk about diagnosis. If a semen analysis shows low sperm counts or poor motility, what’s the next step?

Dr. Jarvi: First, you have to confirm the problem. When sperm counts or motility appear low, confirmation is essential, Ie. via a repeat semen analysis test. Semen analysis results can fluctuate, so I always recommend at least two tests, sometimes even three, before we draw conclusions. Once we know the low count is consistent, we look for causes.

What Is a Semen Analysis?

A semen analysis (also called a semen evaluation) is a laboratory diagnostic test used to assess male fertility. Its purpose is to measure various physical and functional characteristics of a man’s ejaculate (semen and sperm), to help determine whether there are abnormalities that might impair the ability to conceive or contribute to infertility. (Source: PubMed)

What Parameters Are Measured

Here are the main features that are typically assessed in a semen analysis, along with definitions and medical context, especially from recent fertility literature:

Parameter	What It Is	Why It Matters
Volume	The total amount of ejaculate fluid. (Source: PubMed)	Adequate volume is needed to transport sperm through the female reproductive tract; very low volume can suggest issues like blockage or ejaculatory dysfunction. (Source: cuaj.ca)
Sperm Concentration (or Count)	Number of sperm per milliliter of semen, and/or total sperm count in entire ejaculate. (Source: PubMed)	A key measure. Very low counts (e.g. <5 million/mL) are strongly associated with infertility, may prompt additional investigations including genetic testing. (Source: PubMed)
Motility	The proportion of sperm that are moving, and the quality of their movement. (Source: PubMed)	Good motility is essential for sperm to reach the egg. Poor motility reduces the chances of natural conception. (Source: PubMed)
Morphology	The shape and structure of sperm (head, midpiece, tail), with attention to how many sperm are “normal” in form. (Source: PubMed)	Abnormal morphology can impair sperm function (e.g. ability to penetrate the egg). However, morphology alone doesn’t always predict fertility; it’s one part of a bigger picture. (Source: PubMed)
Other tests / advanced parameters	Sometimes further assessments are done, such as sperm DNA fragmentation, or sperm function tests. (Source: PubMed)	These can uncover deeper functional defects not obvious in the standard analysis. They are increasingly used when conventional results are abnormal or in unexplained infertility. (Source: PubMed)

How a Semen Analysis Test is Done (Methodology & Best Practices)

To obtain reliable semen analysis results, the test must follow certain protocols. Deviations can lead to misleading results. Some best‐practice elements, supported by the fertility / andrology literature, include:

• Abstinence period before sample: Usually 2 to 5 days without ejaculation before giving the sample. (Source: Cambridge University Press & Assessment)
• Proper collection: By masturbation into a sterile container, avoiding contamination. If produced off-site, the sample should be delivered to the lab within a defined time (typically within an hour). (Source: Cambridge University Press & Assessment)
• Repeat tests: Because semen parameters can fluctuate with time (due to illness, recent fever, lifestyle, etc.), doctors typically recommend at least two separate semen analyses (sometimes three) separated by several weeks to a few months to confirm whether abnormalities are consistent. (Source: PubMed)

Limitations of Semen Analysis

While semen analysis is the foundation of male fertility assessment, there are important caveats:

• It doesn’t capture all functional aspects of sperm, like the ability to fertilize an egg under in vivo conditions. Functional tests (DNA fragmentation, etc.) may provide more insight but they’re not perfect. (Source: PubMed)
• There can be significant variability between labs (inter‐observer/inter‐technician) and even within the same individual at different times. (Source: PubMed)
• Reference ranges (what’s “normal”) are based on population studies (e.g., WHO reference values), and what is “normal” doesn’t always guarantee fertility. Some men with borderline or even “below normal” parameters can still conceive. (Source: PubMed)
  

What Role Dr. Keith Jarvi Has Played in Research on Semen Analysis

Dr. Keith A. Jarvi, based in Toronto at Mount Sinai Hospital and the University of Toronto, has been part of multiple studies that involve semen analysis, sperm parameters, and male fertility. Here are some relevant examples:

1. Effect of Ethnicity on Semen Parameters.
   In a study published in the Canadian Urological Association Journal, Jarvi and colleagues examined how ethnicity correlates with semen parameters (volume, count, motility, morphology, vitality) and hormone levels among infertile men. (Source: cuaj.ca)
2. Low Semen Volume Investigation.
   Jarvi co‐authored with Matthew Roberts an article titled “Steps in the investigation and management of low semen volume in the infertile man”. This examines causes (structural, functional, etc.) of low ejaculate volume, how volume fits into the semen analysis, and what diagnostic steps to take if volume is low. (Source: cuaj.ca)
3. Proteomic / Biomarker Work in Seminal Plasma.
   Jarvi has also worked on identification of biomarkers in semen or seminal plasma, which in turn relate to sperm function or cases like azoospermia (absence of sperm). For instance, the Journal of Proteome Research article “Analysis of Seminal Plasma from Patients with Non-obstructive Azoospermia …” included Jarvi as an author. While that work goes beyond the standard semen analysis, it builds on the same foundation of measuring sperm presence / absence and semen characteristics. (Source: ACS Publications)

Summary

• A semen analysis is the primary test for evaluating male fertility. It measures multiple parameters (volume, concentration/count, motility, morphology, viability, etc.).
• The test must follow standardized procedures, including abstinence, proper sample collection, and repeat measures, to be reliable.
• It has limitations—especially around functional capacity of sperm, lab variability, and that “normal” values don’t guarantee fertility—but it remains essential.
• Dr. Jarvi’s work contributes to refining how semen parameters are understood (volume, morphology, etc.), and also exploring deeper biomarkers when conventional measures may fall short.

Sperm Quality: Identifying Reversible Causes

What are some of the common causes of poor sperm quality?

Dr. Jarvi: We start with things that are reversible. Once low sperm count or motility is confirmed, the next step is to search for reversible causes. These may include:

• Lifestyle factors – Smoking, poor diet, obesity, or heat exposure near the testicles.
  
• Infections – Often treatable with antibiotics or medical intervention.
  
• Hormonal problems – Hormonal imbalances affecting sperm production.
  
• Anatomical issues – The most common being varicoceles (swollen veins in the scrotum).

The goal is to identify something correctable, thereby improving sperm production and quality.

Varicoceles: A Leading Cause of Male Infertility. Learn more about male fertility testing at Markham Fertility Centre.

You mentioned varicoceles. Can you explain what they are and how they affect fertility?

Dr. Jarvi: A varicocele is an enlargement of the veins around the testicle. Normally, veins carry blood away from the testicle with the help of one-way valves. In varicoceles, these valves are damaged, and blood flows backward, increasing pressure and heat in the scrotum.

Men often describe a sensation like a “bag of worms” above the testicle. This extra heat negatively affects sperm production. Varicoceles are actually a common contributor to male infertility, found in about 40% of infertile men.

How are varicoceles treated?

Dr. Jarvi: There are two common approaches:

1. Embolization, where we insert a coil through a vein in the neck to block the abnormal veins.
2. Microsurgical repair, where we make a small incision in the groin and tie off the problematic veins under a microscope.

Both methods preserve the healthy veins while blocking the faulty ones. This cools the testicle by a few degrees, improving sperm production.

What kind of improvements can couples expect after repair?

Dr. Jarvi: It depends on the baseline sperm count. For example:

• If a man starts with 10 million sperm per milliliter, about 70% of the time, counts return to normal after repair. In that situation, the couple has around a 60% chance of natural conception—if the female partner is under 35.
• But if the man starts with 1 million sperm per milliliter, repair might raise it to 3 million. That’s still too low for natural conception, so the couple would need IVF. In such cases, doing the repair only wastes valuable time, especially if the female partner is in her late 30s or older.

So the decision to repair must balance sperm count improvements with the partner’s fertility and their bigger family plan.

When to Consider Genetic Causes

At what point should couples consider genetic testing?

Dr. Jarvi: When sperm counts drop significantly—especially below 5 million per milliliter—the risk of genetic abnormalities rises. These may affect both the man’s health and the potential child’s health.

• Karyotype testing: Examines the overall structure of chromosomes to detect missing or rearranged pieces. A condition called balanced translocation may appear, affecting about 1 in 30 infertile men with low sperm counts.
  
• Y chromosome microdeletion testing: Identifies missing sections of the Y chromosome that may impair sperm production.
  
• Cystic fibrosis gene testing: Relevant because some mutations cause congenital absence of the vas deferens, leading to infertility.

These tests help ensure that risks to future children are identified before conception.

Sperm Quality: Diet and Lifestyle: The Foundation of Fertility

What role do diet and lifestyle play in sperm health?

Dr. Jarvi: A huge role. The testicles are like the “canary in the coal mine.” If your sperm quality is poor, it may signal other health issues.

I recommend following the Canada Healthy Food Guide:

• Eat more fruits and vegetables.
• Limit red meat.
• Consider a Mediterranean-style diet.
• Avoid smoking.
• Maintain a healthy weight—even a 2–5% weight loss in overweight men can significantly improve sperm quality.

Marijuana and Sperm Health

How does marijuana use affect sperm health?

Dr. Jarvi: The evidence is limited, and most studies look at heavy users. For occasional or social users, we don’t have strong data. Still, I advise men to stop using marijuana during fertility treatment. It may not be proven harmful, but stopping carries no risk and there may be a benefit.

The Role of Supplements

Many men turn to supplements. Which ones actually help?

Supplements are a common first-line option for men seeking to improve sperm health. Some with the strongest evidence include:

• Coenzyme Q10 (CoQ10): May improve sperm motility and reduce DNA damage.
• L-carnitine: Effective in high doses, supports sperm energy metabolism.
• Vitamin C and Vitamin E: Antioxidants shown to improve sperm quality.

These supplements are generally safe, inexpensive, and low-risk, though not all men will benefit equally.

What to avoid:

• Testosterone therapy: Despite common misconceptions, testosterone supplementation reduces sperm production and is sometimes used as a male contraceptive.
• Unregulated “test boosters” from gyms: May be contaminated with testosterone or other harmful substances.
• Black-market supplements: Risk of contamination and unpredictable effects.

Hormonal Therapy

When do you consider hormonal therapy for men?

Dr. Jarvi: When lifestyle and supplements are not enough, hormonal therapy may be considered. Hormonal therapy is useful when we think the testicles can respond. The most common option is Clomid (clomiphene citrate), which boosts LH and FSH to stimulate sperm production. Other options include FSH and hCG injections.

Clomid effectiveness depends on the patient:

• Men with low counts but good motility often respond well.
• If baseline FSH is already high, it usually won’t help.
• Clomid may improve DNA fragmentation but rarely improves motility.

The challenge is time. You need 9–12 months of treatment to see the best results. Some couples don’t want to wait that long, especially if the female partner is older.

Many people assume that because sperm takes about three months to develop, Clomid should only take that long to work. Is that accurate?

Dr. Jarvi: Not quite. While sperm does take three months to mature, it often takes longer for improvements to show up in pregnancy outcomes. That’s why we recommend nine months to a year of therapy before evaluating success.

Stress and Fertility

One of the most common questions couples ask is whether stress causes infertility. What’s your perspective on this?

Dr. Jarvi: For men, there’s no solid evidence that stress directly alters sperm counts or motility. But stress can cause unhealthy behaviors—like poor diet, smoking, or drinking—that indirectly affect fertility.

Also, stress can make it harder for men to provide a semen sample when needed. But physiologically, stress itself doesn’t damage sperm quality the way people sometimes think.

Key Takeaways for Men Seeking to Optimize Sperm Quality

What final advice would you give to men trying to optimize their fertility?

Dr. Jarvi: First, don’t underestimate the impact of lifestyle. Follow the Canada Healthy Food Guide, maintain a healthy weight, and avoid smoking. Second, don’t be afraid of the fertility workup. Infertility in men is sometimes linked to serious health conditions, including testicular cancer. Getting evaluated protects your health and helps your partner.

Supplements can be a low-risk way to help, but avoid testosterone. And finally, remember that treatment decisions—whether varicocele repair, hormones, or IVF—must always take into account the female partner’s age and fertility timeline.

Recap:

1. Don’t underestimate lifestyle. Following a balanced diet, exercising, avoiding smoking, and maintaining a healthy weight make a real difference.
   
2. Get evaluated. Infertility may signal underlying health issues such as testicular cancer or genetic conditions.
   
3. Supplements may help. While not a cure-all, CoQ10, L-carnitine, and antioxidants are safe first steps.
   
4. Avoid testosterone therapy. It suppresses sperm production.
   
5. Consider treatment timelines. Decisions about varicocele repair, hormonal therapy, or IVF should always account for the female partner’s age and fertility window.
   
6. Don’t fear the fertility workup. It not only guides treatment but may also protect men’s long-term health.

Conclusion

Male infertility is complex, but as Dr. Jarvi explains, there are many avenues for diagnosis, lifestyle improvements, and treatment. While some couples can conceive naturally with the right interventions, others may need IVF. Either way, men should take an active role in their fertility journey—not only for their partner’s chance at parenthood but also for their own long-term health.

For some couples, lifestyle and medical treatments can make natural conception possible. For others, assisted reproductive technologies like IVF remain the best option. The most important thing is that men take an active role in the fertility journey—both for their own health and for their partner’s chance at parenthood.

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