Why Every Fertility Workup Should Include Both Partners (And Why Male Fertility Is Too Often Overlooked)
If You've Been Told "Everything Looks Normal," This Might Explain Why You're Still Not Pregnant
If you've been struggling to conceive or have experienced multiple pregnancy losses, you've probably heard some version of the following:
"Everything looks normal."
"Just keep trying."
"It's time to visit a fertility clinic to discuss your options."
The first two responses deserve an eye roll. 🙄
And while a referral to a fertility clinic can absolutely be appropriate, conversations around IUI or IVF are often initiated far too soon before a thorough investigation into why pregnancy isn't happening.
One of the biggest gaps I see is that the male partner is often overlooked entirely.
Fertility Is a Couple's Health Issue
Many couples spend months or even years focusing almost exclusively on the woman's body.
Meanwhile, the male partner may receive little more than a basic semen analysis (or oftentimes no evaluation at all.
This is a huge missed opportunity.
Male factors contribute to nearly 50% of infertility cases, whether as the sole cause or in combination with female factors. Yet many men never receive a comprehensive fertility evaluation before couples move on to fertility treatments.
If we're trying to understand why pregnancy isn't happening or why pregnancies aren't progressing as they should we have to evaluate both sides of the equation.
Why Male Fertility Matters Even If You're Able to Conceive
One of the biggest misconceptions surrounding fertility is that sperm only matter for getting pregnant.
In reality, sperm quality influences much more than fertilization.
Healthy sperm contribute to:
embryo development
placental development
implantation
healthy fetal development
ongoing pregnancy success
Poor sperm quality has been associated with increased risk of miscarriage, failed embryo implantation, and poorer IVF outcomes.
Something that I find so remarkable is that eggs are able to repair damaged sperm! But they have their limits, which heavily relies on egg quality. The healthier the egg, the greater her capacity for repairing sperm.
Can Sperm Quality Improve?
The encouraging answer is yes – but it’s not an overnight fix.
Sperm regenerate approximately every 72 days.
That means the sperm your partner has today are largely a reflection of his nutrition, lifestyle, environmental exposures, sleep habits, and overall health over the last two to three months.
This is one reason I love working with couples before they pursue more invasive fertility treatments.
Small changes made consistently today can begin improving sperm quality within a matter of months.
What Tests Should a Man Have During a Fertility Workup?
This is one of the most common questions I receive.
Unfortunately, there isn't one universal "male fertility panel."
A thorough workup should be individualized, but it often includes far more than a semen analysis.
Some of the areas worth evaluating include:
Nutrition
Vitamin D
Vitamin B12
Folate
Zinc
Iron status
Omega-3 intake
Overall dietary quality
Metabolic Health
Poor metabolic health can negatively impact sperm production and quality.
This may include evaluating:
fasting glucose
fasting insulin
HbA1c
inflammation markers
Hair tissue mineral analysis (HTMA)
Lifestyle Factors
Sleep quality
Exercise habits
Alcohol intake
Marijuana use
Nicotine
Heat exposure
Chronic stress
Environmental Exposures
Potential exposures may include:
pesticides
plastics (BPA)
heavy metals
mold
endocrine-disrupting chemicals
These aren't always the cause—but they deserve consideration, especially when conception has been difficult.
Is a Semen Analysis Enough?
A basic semen analysis is a starting point.
It evaluates:
semen volume
sperm concentration
motility
morphology
While these markers are valuable, they don't tell the whole story.
A man can have "normal" semen parameters and still struggle with fertility, especially in cases of recurrent loss.
That's because conventional semen analysis doesn't assess one particularly important marker...
DNA fragmentation.
What Is Sperm DNA Fragmentation?
DNA fragmentation refers to damage within the DNA carried by sperm cells.
Think of it as damage to the instruction manual that sperm deliver to the egg.
Research has associated elevated DNA fragmentation with:
infertility
recurrent miscarriage
poorer embryo quality
lower implantation rates
reduced IVF success
High DNA fragmentation has been linked with oxidative stress, inflammation, smoking, obesity, certain environmental exposures, varicoceles, advanced paternal age, and other factors.
What’s encouraging is that most of these factors are modifiable.
What Semen Analysis Results Are Considered Optimal?
Rather than asking whether results fall within conventional laboratory reference ranges, I prefer to evaluate them through an optimal fertility lens.
Some of the markers I look for include:
Semen volume >3 mL
Sperm concentration >75 million/mL
Total motility >61%
Progressive motility >55%
Morphology >15% normal forms
DNA fragmentation ideally <5% (and generally <15%)
Optimal isn't about perfection. It's about identifying opportunities to improve fertility potential before pursuing more invasive interventions.
Why I Use Functional Lab Testing
Every couple's story is different.
That's why I don't believe in handing everyone the same protocol.
Instead, I combine a thorough health history with targeted functional lab testing to uncover potential root causes.
Depending on the situation, this may include:
Comprehensive blood work
Stool testing to evaluate gut health, infections, inflammation, and immune activity
Hair Tissue Mineral Analysis (HTMA) to evaluate mineral status and cellular metabolism
We also examine:
medications
supplements
stress
sleep
environmental exposures
nutrition
exercise
overall health history
The goal is to gather as much information as possible to create a truly personalized fertility plan.
Before IVF, Ask These Questions
If you're considering IUI or IVF, here are a few questions worth asking your healthcare team:
Has my partner received a comprehensive fertility evaluation?
Has he had DNA fragmentation testing?
Have we investigated potential nutritional deficiencies?
Have we assessed inflammation and metabolic health?
Could lifestyle or environmental factors be contributing?
Are there treatable root causes we haven't explored?
For some couples, assisted reproductive technologies are absolutely the right next step.
But many others deserve a more complete evaluation before jumping straight to treatment.
It Really Does Take Two
If you've been told everything looks normal but feel in your gut that there’s more to the story, there probably is.
I see over and over again, when both partners receive a thorough evaluation, we often uncover opportunities to optimize fertility that otherwise would have been missed.
A Starting Place for Answers
That's exactly why I created the It Takes Two Fertility Bundle.
This program helps both partners investigate the nutritional, metabolic, and lifestyle factors that may be impacting fertility without committing to months of coaching.
Inside the bundle you'll receive:
Foundational fertility labs for both partners
A 90-minute fertility strategy session
A personalized fertility action plan
A 60-minute follow-up session
Four weeks of direct chat support
Access to The Girls' Room – my educational platform on nutrition and lifestyle strategies for hormone health and fertility
If you're ready to stop guessing and start investigating the root causes behind your fertility struggles, I'd love to help.