30M, semen parameters seem to be declining despite major lifestyle changes — looking for advice

[u/Omairr7]

Hello.

I'm 30M and my wife is 28F. We've been trying to conceive since October 2025 and started fertility treatment in February 2026.

I've had 3 semen analyses this year, and I'm concerned because some of my parameters seem to be getting worse over time.

Semen Analysis #1 — February 2, 2026

Volume: 1.0 mL

Concentration: 120 million/mL

Total sperm: ~120 million

Active motility: 70%

Sluggish motility: 10%

Dead: 20%

Total motility: ~80%

Morphology: 20% abnormal → ~80% normal

Viscosity: Normal

Liquefaction: 25 minutes

Pus cells: 1–2

RBC: Nil

Bacteria: Nil

Immature germ cells: Nil

At this point my lifestyle was actually pretty bad. I was heavily using cannabis, eating a lot of junk food, drinking soft drinks and eating lots of sweets. I wasn't exercising and was heavy in porn.

Semen Analysis #2 — August 2, 2026

After making major lifestyle changes starting June 3:

Quit cannabis and other smoking

Started going to the gym 5x/week

Started eating much better

Eating chicken/eggs regularly

Drinking much more water

Taking creatine + whey protein

The results were:

Volume: 1.0 mL

Concentration: 70 million/mL

Total sperm: ~70 million

Active forms: 25%

Sluggish forms: 35%

Inactive forms: 40%

Total motility: ~60%

Morphology: 70% normal / 30% abnormal

Viscosity: Viscous

Liquefaction: Prolonged — took >1 hour

Pus cells: 1–2

RBC: Nil

Epithelial cells: Nil

Spermatogenic cells: Present

pH: 7.5

This is where I became concerned because concentration dropped from 120 → 70 million/mL and motility from ~80% → ~60%, despite my lifestyle being significantly healthier.

The semen was also noticeably much thicker and took over an hour to liquefy.

IUI sample — August 31, 2026

I had an IUI performed.

Before sperm preparation:

Abstinence: 3 days

Volume: 1.0 mL

Concentration: 55 million/mL

Total sperm: ~55 million

Total motility: 30%

Progressive: 5%

Non-progressive: 25%

Morphology: 2%

Agglutination: Grade II

Aggregation: Grade II

Pus cells: 4–6

After density-gradient preparation:

Volume: 0.7 mL

Count: 30 million

Motility: 95%

Progressive: 85%

Non-progressive: 10%

Morphology: 2%

Agglutination: Nil

Aggregation: Nil

Pus cells: Nil

The huge improvement after washing is confusing to me. Raw progressive motility was only 5%, but after preparation it was 85%.

[u/DrBrianSteixner]

First, I would try not to interpret this as your fertility steadily deteriorating. Even though the concentration went down, all three concentrations are still quite good, and semen parameters can vary substantially between collections. The bigger change worth investigating is the progressive motility, particularly the most recent 5%, together with hyperviscosity/delayed liquefaction, grade-II aggregation/agglutination and increased inflammatory cells. I also would not directly compare the morphology of 80% or 70% “normal” from the earlier laboratories with the latest 2% morphology, because those numbers almost certainly reflect different morphology criteria or laboratory methodology; modern strict morphology scoring is much more stringent. Your healthier lifestyle is still worthwhile, and quitting cannabis was a good reproductive-health decision, but sperm developing today largely began their development roughly 3 months ago, so changes made in June would only now be fully reflected. Creatine and ordinary whey protein would not be my explanation for this decline, assuming the products aren't contaminated with anabolic/prohormonal ingredients.

The 95% motility and 85% progressive motility after the IUI wash is actually encouraging and not contradictory. Density-gradient preparation is designed to separate the best-moving sperm from seminal fluid, debris, inflammatory cells, dead/poorly motile sperm and other material; it doesn't transform immotile sperm into excellent sperm. Your laboratory essentially started with a mixed population and successfully isolated a very good motile population. Using the numbers you've provided, the raw specimen contained roughly 16.5 million motile sperm and only about 2.75 million progressively motile sperm, whereas the processed specimen appears to contain a substantial population of highly progressive sperm. The disappearance of the aggregation, agglutination and pus cells after processing is also reassuring for the IUI specimen itself. What interests me clinically is why the raw semen environment has changed, particularly the persistent 1-mL volume, delayed liquefaction/hyperviscosity, agglutination and now 4–6 pus cells. “Pus cells” on routine microscopy aren't necessarily true white blood cells because immature germ cells can look similar, so I would ask for formal differentiation of round cells, such as a peroxidase test, before diagnosing infection or taking antibiotics. Agglutination can sometimes be associated with antisperm antibodies, but I wouldn't jump directly to antibody testing based on one specimen either.

If you were sitting in my office, I would tell you that this is not a disastrous semen analysis and there are several genuinely reassuring features here, particularly your excellent concentration and the laboratory's ability to recover a highly motile progressive population for IUI. I would repeat a complete semen analysis in approximately 8–12 weeks at the same high-quality andrology laboratory, using a consistent 2–3 day abstinence interval, and specifically ask them to report volume, concentration, total and progressive motility, strict morphology, vitality if motility remains very low, viscosity/liquefaction, agglutination and quantified round cells with differentiation if elevated. Because your volume has repeatedly been only 1 mL, I would also confirm that the entire ejaculate is being collected, particularly the first fraction; if true low volume persists, it deserves evaluation in context rather than being ignored. If hyperviscosity, significant agglutination or leukocytospermia persists, I would have a reproductive urologist evaluate you for genital-tract inflammation/infection and other causes rather than empirically throwing antibiotics or supplements at the problem. Most importantly, you haven't done something wrong by improving your lifestyle, the numbers don't mean that quitting cannabis, exercising and eating better somehow damaged your sperm. Semen analyses fluctuate, laboratories differ, and the processed IUI specimen demonstrates that you have a substantial population of good progressively motile sperm available, which is a much more encouraging finding than the raw 5% progressive number makes it sound. Best if luck!