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What are sperms?

Sperm cells, also called spermatozoa or sperms, are made by the man's testes. Production of sperms happens all the time, and it takes about 72 days for a man to produce a sperm. After the sperms get mixed with fluid made by the seminal vesicles and the prostate gland, that mixture is called the ejaculate or semen. In order to improve the chances of pregnancy, there have to be sufficient amount of sperm present.

How long can sperm live?

Outside the body most sperm usually die within minutes. Studies have shown that inside the vagina most sperm die within hours after intercourse. Sperm moving up the cervix and into the uterus can survive in the female genital tract up to several days, though fertilization is more likely if sperms are deposited close to ovulation.

What is a normal sperm count?

A normal sperm count or spermanalysis is between 20 and 250 million per milliliter, there should be at least 2 milliliter of ejaculate, and the sperms have to be healthy and move well. Getting the sperm tested is suggested to make sure the male has a normal sperm count.

What is a normal sperm evaluation?

There have to be enough sperms (more than 20 million per milliliter), the ejaculate has to have sufficient volume (more than 2 milliliter), the ejaculate's consistency must be adequate, and sufficient sperms need to move adequately and look healthy.

What happens with the sperm/ejaculate during intercourse?

If there is ejaculation during unprotected intercourse into the vagina, the ejaculate is first deposited inside the vagina, close to the cervix. The sperm moves up the cervix into the uterus and up into the Fallopian tubes. Fertilization occurs when a sperm joins with the egg, this usually happens within hours after intercourse.

How long should we keep abstinence before we do the sperm analysis count test and before trying to get pregnant?

Doctors have long suggested being abstinent for 5-7 days prior to attempting to get pregnant. However, more recent studies and reviews suggest otherwise, and that a one-day abstinence is better than longer abstinence. 

One study from 2005 found that men with male infertility should not be abstinent for longer than one day to collect the sample. Israeli researchers examined 9,489 semen samples. They found that in men with normal sperm count there was a significant decrease in sperm motility and morphology the longer he was abstinent. The researchers suggested that men with male infertility collect the semen after no more than one day of abstinence and that longer abstinence would worsen the test results. [Levitas et al: Fertility and Sterility Volume 83, Issue 6 , June 2005, Pages 1680-1686]

Recent studies and reviews suggest that when trying to conceive a one day abstinence is better than a longer abstinence.

A publication from 2018 found that "...the weight of the evidence suggests that the decline in semen volume and sperm concentration with shorter abstinence periods is accompanied by a substantial improvement in sperm motility characteristics, especially progressive motility and velocity weight of the evidence suggests that the decline in semen volume and sperm concentration with shorter abstinence periods is accompanied by a substantial improvement in sperm motility characteristics, especially progressive motility and velocity." (Ayad: Int J Fertil Steril. 2018 Jan;11(4):238-246)

And a 2019 study concluded that "..Ejaculatory abstinence periods of >4 days have a detrimental effect on sperm DNA and intracytoplasmic sperm injection outcomes. One day of ejaculatory abstinence significantly improves implantation rate and tends to increase pregnancy rate, compared to 2, 3 and 4 days of ejaculatory abstinence.." (Borges et al. Andrology. 2019 Mar;7(2):213-219.)

It seems his ejaculate is not enough. What should we do?

There is a wide variation in the amount of his ejaculate, his sperm volume. Oftentimes there is no clear relationship between his volume and his fertility. A sperm analysis can help you answer whether he is fertile or not.

Can I get pregnant if he sperm/ejaculates outside the vagina?

That's not such a great way of trying to prevent pregnancy. You can get pregnant even if he ejaculates outside but close to the vagina, though chances are lower than if he ejaculates inside your vagina. It only takes one sperm to make it up the vagina into the uterus and meet the egg.

My ejaculate looks clear. Does that mean I am infertile?

A clear ejaculate could be normal. Only a semen analysis can answer whether a man is fertile or not.

My husband has an 8-year old daughter. Does that automatically mean he is OK and fertile?

A lot can happen in 8 years. Just because he got someone pregnant 8 years ago does not mean that he is fertile now. Doing a sperm analysis will quickly tell you whether he is fertile or not.

Can my husband's medication affect his sperm count?

Any medical condition and/or medication could have a negative effect on the sperm count. The only way to accurately determine if something has affected male fertility is by doing a sperm analysis. Everything else is just speculation.

How long do washed sperm survive?

Washed sperm have usually a shorter survival time in the woman's uterus as compared to unwashed sperm. Washed spermatozoa can live in the woman's genital tract, usually the cervix, up to 24 hours with an average of 6-12 hours. Unwashed sperm live on average two to three days, and up to five to six days. Optimally, IUI is done within six hours of ovulation.

Read More: 
How Long Does Sperm Survive?
Male Fertility Testing
How to Increase Sperm Count
How to Produce a Semen Sample
Men's Health Guide