Are sperm counts really dropping worldwide? A urologist explains why it’s complicated

Dr. Jamin Brahmbhatt is a urologist and robotic surgeon with Orlando Health and an assistant professor at the University of Central Florida’s College of Medicine.

There are two times I see men get hyperfocused on their health: when they’re having issues with erections and when they’re having issues making babies.

Those with fertility concerns tend to be younger and arrive with their partners. The concerns are different, but both can open the door to a bigger conversation about health.

When an abnormal semen analysis or fertility concerns trigger a visit, I spend a lot of time sorting through things patients have heard about semen and general fertility. One fear they often mention is hearing that sperm counts are falling worldwide. 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 dropping worldwide? And wait. Should I, as a man, also be worried?

Why are people talking about falling sperm counts? Alarms went off 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 a meta-analysis , combines results from multiple studies to look for an overall pattern. These analyses can strongly influence how doctors and patients understand an issue and what guidance to give the general population.

Sperm counts may be declining globally, review finds, adding to debate over male fertility

Researchers estimated that average sperm concentration fell 51.6% and total sperm count fell 62.3%. Concentration measures the number of sperm per milliliter of semen, and total count measures the number in an entire ejaculate. These findings triggered alarms for researchers, doctors and patients.

When you look at the numbers, these findings do appear alarming. The numbers also raise concerns about what might be affecting sperm production. For me and others in my field, they raised another question and opportunity — could sperm measurements give a window into a man’s overall health?

I had a patient who was so stressed about dropping sperm counts that he worried about his future children and generations beyond. To him, the study sounded like a countdown to men no longer being able to reproduce. It’s a scary thought but goes beyond what the study can tell us. Other research also gives us reasons to question whether the same decline is happening everywhere.

Sperm concentration showed no overall change in the initial analysis of samples collected from 1970 through 2018, according to a 2025 review and meta-analysis . It covered 58 studies involving 11,787 American men without known infertility issues.

After adjusting for geographic region and fertility status, researchers found a modest annual decline in sperm concentration. In other words, the answer changed depending on whom was studied and how the numbers were analyzed.

These findings do not negate the concern raised by the 2022 analysis. They do make the picture more complex than a single worldwide decline. For my worried patient, that study was not a countdown clock on his chance to become a dad. I told him what I am telling you — sperm counts are fine, for now.

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A doctor may commonly order a semen analysis as part of a fertility workup or after a vasectomy to ensure no sperm are left in the ejaculate. It can reveal a lot, but it cannot answer every question about fertility. The test measures several things, including how many sperm are present, how well they move and what percentage have a typical shape. The World Health Organization says its comparison numbers 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 dropped off a semen sample every day for a week, the numbers would not be the same each day. Length of abstinence, recent illness, medications, stress, collection conditions and differences among labs can all affect the results. It’s why the American Urological Association recommends at least two analyses, ideally a month apart, especially when the first result may be abnormal.

I’ve seen men worry because their first test showed low motility, meaning the sperm were not moving well. I’ve also seen men with few or no sperm stay calm and simply ask, “OK, what can I do to improve this?” One test can indicate where to look. Repeated tests, interpreted alongside a medical history and examination, help make a plan.

I once treated a patient whose sperm count and shape looked fine but whose motility, or ability to move, was poor. He exercised, did not smoke and barely drank. When we talked, he opened up about work stress and poor sleep. Six months later, after improving both, his sperm movement was better. He reported no other changes to his diet or lifestyle.

Such a result does not prove better sleep and less stress caused the improvement. Semen results fluctuate. But his test results started a conversation about parts of his health that deserved attention regardless of whether his sperm improved.

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Can stress affect sperm? What men should know about fertility

Most people hear sperm count and think about fertility and having kids. In my line of work, doctors see it as one part of a man’s broader health picture. Men with infertility or abnormal semen results have higher rates of some medical conditions, and urology guidelines recommend counseling them about that connection.

An abnormal semen analysis is not a diagnosis of heart disease, diabetes or an early death. It is a reason to look under the hood: Check the man’s history, examine him, review medications and consider whether another health problem is being missed.

Sperm health can be affected by some of the same conditions I discuss during a routine checkup, including medical issues, smoking, lack of sleep, heat and current medications.

Science backs me up: Obesity, diabetes and metabolic syndrome were linked with poorer semen quality and damage to sperm DNA 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 any given month compared with men who slept eight hours, according to a 2018 study of 1,176 couples .

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Coping with ‘male menopause’: How lifestyle plays a role

Cigarette smoking can affect semen quality. In one study of infertile heavy smokers , sperm concentration and total count improved three months after they quit.

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 sit outside the body for a reason. Sperm production works best below normal body temperature, and hence chronic heat exposure can interfere with that process.

What about medications such as testosterone? I tell every man who wants children now or in the future to avoid testosterone replacement therapy. Guidelines warn that it can suppress sperm production, sometimes to zero. If symptoms of low testosterone are a concern, ask about alternate options that preserve fertility.

Higher total testosterone levels were associated with GLP-1 drugs, according to a 2026 systematic review . Better semen measures in men with obesity or low testosterone have been reported in other studies.

These findings 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 then explain the benefits seen in testosterone and sperm quality. Whether these changes improve the chances of pregnancy still needs more study.

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Scientists say GLP-1s improved male testosterone levels and sperm count

When a man asks me if he should get on GLP-1 drugs, I encourage him to discuss whether they are appropriate for his weight and health conditions with his primary care doctor. My focus is on inspiring him to improve his overall health rather than prescribing a GLP-1 to help him make a baby. I also remind him that if he does become a father, taking care of himself now may help him stay healthy and active as his children grow.

I start with one simple piece of advice: Do not panic over one result. If a semen analysis is abnormal, we will usually repeat it and look alongside your medical history. Some causes are treatable , and in some men, the workup can uncover more serious underlying health problems. Tell your doctor about medications, cannabis and any nicotine products you use. Knowing what you use helps doctors give you better advice.

While we arrange more testing, I focus on the habits that support overall health: Do not smoke, avoid heavy drinking, exercise, work toward a healthy weight, get enough sleep and manage chronic conditions.

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Sperm quality linked to living longer, new study finds

Health habits start with what you’re eating. I tell guys all the time: If you love fast food, it’s probably not helping your fertility. A Mediterranean-style diet has been linked with better semen measures . Evidence that it improves the chances of pregnancy is less certain, so think long-term health plan, not quick fertility fix.

You will also need to give your body time. Changes in habits or treatment take time to show up in sperm measurements, so there’s often a reassessment after about three months. Doing so is different from repeating an initial abnormal test to confirm the result period. A few days will not indicate whether a new routine is working.

The worldwide debate over sperm counts will continue. In my office, the next step continues to be more personal. We’ll clear out any misconceptions, review results, address any issues we find, and build habits that support overall health and longevity. A fertility concern can be the start of taking better care of yourself, whether having children is in the plan or not.

Jamin Brahmbhatt 博士是奥兰多健康中心的泌尿科医生和机器人外科医生，也是中佛罗里达大学医学院的助理教授。

我发现男性在两种情况下会过度关注自己的健康：一是勃起出现问题的时候，二是生育出现问题的时候。

有生育问题的人往往比较年轻，而且通常会和伴侣一起前来就诊。虽然他们的担忧各不相同，但两者都可以开启关于健康的更深入讨论。

当精液分析异常或存在生育问题时，我会花很多时间了解患者对精液和生育能力的各种说法。他们经常提到的一个担忧是，听说全球精子数量都在下降。男性及其伴侣不太关心精子数量下降的原因，更关心的是他们能做些什么来应对这种情况。

我越是听到这种担忧，就越开始思考——全球精子数量真的在下降吗？等等，作为一名男性，我是否也应该感到担忧呢？

为什么人们都在讨论精子数量下降的问题？2022年发表的一项大型全球分析报告引发了广泛关注。该报告估计，在1973年至2018年间，非生育能力人群的平均精子浓度下降了约一半。这项综合分析纳入了来自53个国家的223项研究，涉及超过57000名男性。

这种被称为荟萃分析的研究方法，将多项研究的结果结合起来，以寻找总体规律。这些分析结果能够深刻影响医生和患者对某个问题的理解，以及应该向公众提供哪些指导。

一项研究发现，全球男性精子数量可能正在下降，这加剧了关于男性生育能力的争论。

研究人员估计，平均精子浓度下降了51.6%，精子总数下降了62.3%。精子浓度是指每毫升精液中的精子数量，精子总数是指一次射精中精子的数量。这些发现引起了研究人员、医生和患者的警觉。

从数据上看，这些发现确实令人担忧。这些数据也引发了人们对可能影响精子生成的因素的担忧。对我以及我所在领域的其他研究人员来说，这些数据引出了另一个问题和机遇——精子数量能否反映男性的整体健康状况？

我有个病人，因为精子数量下降而焦虑不已，他担心自己未来的孩子，甚至子孙后代的生育能力。对他来说，这项研究就像是男性丧失生育能力的倒计时。这想法固然可怕，但远不止这项研究所能揭示的。其他研究也让我们有理由质疑，这种生育能力的下降是否普遍存在。

根据2025年的一项综述和荟萃分析，对1970年至2018年间收集的样本进行初步分析后发现，精子浓度总体上没有变化。该分析涵盖了58项研究，涉及11787名没有已知不育问题的美国男性。

在调整了地理区域和生育状况等因素后，研究人员发现精子浓度每年略有下降。换句话说，结果会因研究对象和数据分析方法的不同而有所差异。

这些发现并不能消除2022年分析提出的担忧。它们确实使情况变得更加复杂，而不仅仅是全球范围内的单一下降趋势。对于我那位忧心忡忡的病人来说，那项研究并不是在倒计时他能否成为父亲的期限。我告诉他的，也是我现在告诉你们的——就目前而言，他的精子数量正常。

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医生通常会在生育力评估或输精管结扎术后安排精液分析，以确保射出的精液中没有残留精子。精液分析可以提供很多信息，但并不能解答所有关于生育力的问题。这项检查会测量多种指标，包括精子数量、活力以及正常形态精子的比例。世界卫生组织指出，用于解读检查结果的比较数据不应被视为区分生育能力正常男性和不育男性的绝对标准。

另一个复杂因素是，如果男性连续一周每天都提交精液样本，每天的检测结果都不会相同。禁欲时间的长短、近期疾病、药物、压力、采集条件以及不同实验室之间的差异都会影响检测结果。因此，美国泌尿外科协会建议至少进行两次分析，理想情况下间隔一个月，尤其是在第一次检测结果可能异常的情况下。

我见过一些男性因为第一次检查结果显示精子活力低而焦虑不安，这意味着精子游动能力差。我也见过一些男性精子数量很少甚至没有精子，却能保持冷静，只是简单地问：“好吧，我该怎么做才能改善这种情况？”一次检查可以指出问题所在。多次检查，结合病史和体格检查结果，有助于制定治疗方案。

我曾接诊过一位患者，他的精子数量和形态都正常，但活力（即运动能力）较差。他坚持锻炼，不吸烟，也很少喝酒。我们交谈时，他坦白说自己工作压力大，睡眠不足。六个月后，在改善了这两个方面之后，他的精子活力明显提升。他表示，他的饮食和生活方式没有其他改变。

这样的结果并不能证明睡眠质量的提高和压力的减轻是精液质量改善的原因。精液检查结果会有波动。但他的检查结果引发了一场关于他健康状况的讨论，无论精子质量是否有所改善，其他一些健康问题也值得关注。

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压力会影响精子数量吗？男性应该了解哪些关于生育能力的知识？

大多数人一听到精子数量，就会想到生育能力和生孩子。但在我的工作中，医生们认为这只是男性整体健康状况的一部分。不育或精液检查结果异常的男性患某些疾病的风险更高，泌尿科指南建议就此对他们进行咨询。

精液分析异常并非心脏病、糖尿病或早逝的诊断结果，而是需要进一步检查的原因：了解男性的病史，进行体格检查，审查用药情况，并考虑是否遗漏了其他健康问题。

精子健康可能会受到一些我在例行检查中讨论过的相同因素的影响，包括医疗问题、吸烟、睡眠不足、高温和当前服用的药物。

科学也支持我的观点：一项对 112 项研究的回顾表明，肥胖、糖尿病和代谢综合征与精液质量下降和精子 DNA 损伤有关。

2018 年一项针对 1176 对夫妇的研究显示，每晚睡眠时间少于 6 小时的男性，其伴侣在任何一个月内怀孕的可能性比每晚睡眠 8 小时的男性低约 40%。

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应对“男性更年期”：生活方式的影响

吸烟会影响精液质量。一项针对不育重度吸烟者的研究表明，戒烟三个月后，他们的精子浓度和总数均有所改善。

一项在阿根廷进行的针对接受常规精液分析的男性的研究发现，精子浓度和数量降低与暴露于热浪有关。睾丸位于体外是有原因的。精子生成在低于正常体温的环境下最为有效，因此长期暴露于高温环境会干扰这一过程。

那么，像睾酮这样的药物呢？我会告诉所有想要孩子（无论现在还是将来）的男性，避免使用睾酮替代疗法。相关指南警告说，这种疗法会抑制精子生成，有时甚至会抑制到完全停止。如果担心出现低睾酮症状，请咨询医生是否有其他可以保留生育能力的替代方案。

根据2026年的一项系统评价，较高的总睾酮水平与GLP-1类药物相关。其他研究也报道，肥胖或低睾酮男性服用GLP-1类药物后精液指标有所改善。

这些发现令人鼓舞，但我对将GLP-1类药物贴上“生育药物”的标签或将其作为处方药持谨慎态度。这些药物可以帮助男性减轻体重并控制慢性疾病，这或许可以解释其在提高睾酮水平和精子质量方面所展现出的益处。但这些变化是否真的能提高怀孕几率，还需要进一步研究。

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科学家表示，GLP-1能提高男性睾酮水平和精子数量。

当有男士问我是否应该服用GLP-1类药物时，我会鼓励他先和家庭医生讨论这类药物是否适合他的体重和健康状况。我的重点在于引导他改善整体健康状况，而不是为了帮助他怀孕而给他开GLP-1类药物。我还会提醒他，如果他将来真的当了父亲，现在好好照顾自己或许能帮助他在孩子成长过程中保持健康和活力。

首先，我给您一个简单的建议：不要因为一次检查结果就惊慌失措。如果精液分析结果异常，我们通常会重复检查，并结合您的病史进行分析。有些病因是可以治疗的，而且对于某些男性来说，检查还能发现更严重的潜在健康问题。请务必告知您的医生您正在服用的药物、大麻以及任何尼古丁产品。了解您的使用情况有助于医生为您提供更专业的建议。

在我们安排更多测试的同时，我专注于有助于整体健康的习惯：不吸烟、避免酗酒、锻炼身体、努力保持健康体重、保证充足睡眠并控制慢性疾病。

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一项新研究发现，精子质量与寿命延长有关

健康习惯始于饮食。我经常跟男士们说：如果你爱吃快餐，那很可能不利于你的生育能力。地中海式饮食与精液指标改善有关。但它能否提高怀孕几率尚无定论，所以要着眼于长期健康计划，而不是短期内提高生育能力。

你还需要给身体一些时间。生活习惯或治疗方案的改变需要一段时间才能在精液检查中体现出来，因此通常需要在三个月左右进行复查。这与重复进行初次异常检测以确认结果不同。几天的时间并不能表明新的方案是否有效。

关于精子数量的全球性争论还将继续。在我的诊所，下一步将更加注重个人层面。我们会澄清任何误解，解读检查结果，解决发现的任何问题，并帮助您养成有益于整体健康和长寿的生活习惯。无论您是否计划生育，生育问题都可以成为您开始更好地照顾自己的契机。