In 2017, a major analysis of sperm parameters from a number of published studies found that sperm counts across the Western world have fallen by more than 50% since 1973. If you find those numbers alarming, you’re not alone. GQ covered the story under the headline “Sperm Count Zero,” and the lead author on the study, Dr. Hagai Levine, was quoted elsewhere as saying that “the human species is like the Titanic a moment before the collision, or maybe already after.”

Perhaps as a result of this “Titanic moment,” men are increasingly turning to at-home sperm testing kits, such as Dadi, Trak, and Yo.

At Celmatix, we’re champions of anything that gets people to think more carefully about their fertility, and this is especially important with male factor infertility. Issues impacting the concentration (number), motility (movement), morphology (shape), or function of sperm account for 40–50% of all infertility amongst heterosexual couples, yet most of the conversation about infertility is still focused on women.

That said, alarmist headlines obscure some complicated — and important — truths. If you’re wondering whether “Spermageddon” is coming for you, here are five things to consider before deciding how and when to do a semen analysis.

1) The history of “Spermageddon”

In 1992, Niels Skakkebaek of the University of Copenhagen published a meta-analysis of semen data recorded in 61 papers published between 1938 and 1991. He and his team performed what’s called a linear regression analysis — a method of applying a single straight trend-line to scattered data — and observed that sperm counts had declined sharply (about 50%) in the previous five decades.

“The problem is,” says Dr. Dolores Lamb, Vice Chair of Weill Cornell’s Department of Urology, “the numbers were all over the place throughout the entire study. If their analysis was correct, that line suggested that by 2010, all men would have no sperm. That hasn’t occurred.”

The probable reason for the “all over the place” numbers? Meta-analyses combine data from many previously published studies. When testing methods aren’t standardized, inaccuracies in one dataset can impact the analysis overall.

Given the major advances in testing methods made between the late 1930s and early 1990s, skepticism of the results is well-founded. “Even in the late 1980s,” Dr. Lamb notes, “there was no such thing as proficiency testing for semen analysis, in which small fractions of the same sample are sent to many different labs that should test the sample and get the same results. Without this level of rigor, there was no accountability for accuracy.”

In spite of these limitations, Skakkebaek’s work drew a frenzy of attention and led to additional studies. One such study, a Danish research project begun in 1996 that was meant to follow 5,000 military draftees for 25 years, released preliminary results in 2010 showing no indication of diminished semen quality whatsoever. Despite questions about the data, and how it was released, this study directly contradicted Skakkebaek’s work.

Fast-forward to 2017, when the “Titanic-moment” results were released. According to the study’s press release, sperm concentration and count declined by 52% and 59%, respectively, among men from North America, Europe, Australia, and New Zealand, though no decline was seen in men from South America, Asia, or Africa.

To be clear, this study is heralded as the most comprehensive and rigorously vetted to date. That said, it may be impacted by some of the same limitations that colored Skakkebaek’s study, namely that data across 185 studies spanning nearly four decades may not be equally accurate.

More importantly, a population-level trend may not impact you at all.

2) Sperm count isn’t the only measure of a man’s fertility

A full semen analysis in a medical setting examines multiple factors that may influence a man’s fertility. These may include:

• Sperm concentration: The number of sperm present in a 1ml sample of semen. (>15 million/mL is in the normal range*).
• Total sperm count: The total number of sperm present in the sample. (>39 million/ML is in the normal range*)
• Volume: The total volume of the sample.
• Morphology: The size, shape, and appearance of the sperm.
• Motility: The percentage of sperm that are moving in the sample.
• Progression: The motion and forward progress of the sperm.
• pH levels: The level of acidity in the sample should be 7.2 or higher
• Viscosity: The consistency of the sample.
• Vitality: The percentage of sperm that are living.
• Other cells: The presence or absence of white, red blood cells, or immature sperm.

(*=Values obtained from the National Institute for Health Care and Excellence, 2014)

While clinical guidelines establish “normal” ranges, none of these factors are diagnostic of infertility. After all, it takes a single sperm to fertilize an egg, and under some conditions ten million might get the job done just as easily as ninety million.

“If you compare a large group of men who successfully conceived to a group of men who’ve been diagnosed as infertile, you can’t distinguish the fertile from infertile based upon their sperm count unless there are absolutely zero sperm present,” said Dr. Lamb.

Fertility potential is complicated, as it reflects the combined characteristics of both the male and female partners. It can be influenced by age, genetics, lifestyle, past health history, and environmental factors. That makes things confusing, but it’s good news, too. Just because a man has a low sperm count doesn’t mean he’s infertile. There are steps he can take to improve his sperm, and if his partner is highly fertile they might conceive together quite easily.

3) Collection is key

When it comes to collecting a semen sample, method matters. Here are the rules, whether you’re collecting at a fertility clinic or in the privacy of your home:

• Abstinence: Abstain from sex and masturbation for between 2–5 days prior to collecting each sample.
• No lubricants: Some lubes contain spermicides and even those that don’t may lead to an inaccurate semen analysis.
• Only use the cup provided: Collect the sample only in the sterile cup provided by your doctor or the testing company.
• Collect the initial part of the sample: The first part of the ejaculate contains the highest concentration of sperm.
• Put a lid on it: If you’re using an at-home test that reads your sample right away it’s imperative that you close the sample cup quickly. Computer-assisted semen analysis may count dust and other debris as sperm.

These important rules lead some specialists to be wary of at-home testing. “Did you spill? Did you drop? Did you drip? Did you keep your abstinence?” asks Dr. Lamb. “if you’re not in a doctor’s office with an expert to ask you all of these questions, chances are you aren’t going to get an accurate report.”

4) Not all samples are analyzed equally

A lack of standardization across testing equipment has plagued semen analysis for years. When lab technicians analyze your sample, for instance, they deposit it into a chamber that holds a specific amount of liquid before inspecting it with a microscope. While the gold standard for such chambers used to be highly-accurate glass slides called hemocytometers, they aren’t often used due to breakability, the necessity for cleaning and drying, and expense.

“Today, most labs use disposable counting chambers, but counting chambers from different manufacturers don’t always provide the same results,” said Dr. Lamb. “A sample deemed to be within the normal ranges in one chamber may seem to have lower counts in another or vice versa.”

Another important factor is the time between collection and analysis. When a sample is taken in a clinic, the semen must be analyzed within one hour of collection. If you’re using a service that requires you to ship your sample to a lab for testing, be sure to package and ship the sample immediately after collection, as directed.

5) You may not like the results

While it’s exciting that technology exists to test male and female reproductive health at home, do keep in mind that there’s the possibility of receiving less-than-ideal results.

Remember, male fertility isn’t determined by sperm count alone. If you’re taking an at-home test, you’ll get results without the benefit of a fellowship-trained urologist who can guide you through all of the nuances, averages, and distinctions that impact your fertility. Some people may be just fine with this. Nevertheless, the interpretation of results may be challenging, so others may prefer to have a urologist present.

Regardless of your testing method, you should always review your results with a reproductive urologist before taking the next step. This expert can take a look at the report, run a comparative test, and counsel you on what to do next.

Should we be freaking out about sperm counts? was originally published in Celmatix on Medium, where people are continuing the conversation by highlighting and responding to this story.

…And all of your other vendors too

It’s no secret that Instagram has become the new Pinterest when it comes to social media shopping experiences, but did you know that many brides-to-be use Instagram to search for and discover vendors?

While wedding aggregator services like TheKnot and WeddingWire can be helpful, they quickly become overwhelming and are seldom up-to-date. When I started my venue search, I knew that Instagram would be a reliable source to find photos of recent weddings from professional photographers in my target area of Greater Philadelphia.

Here are my tips for using Instagram to find your dream venue:

1. Follow relevant hashtags

Search for hashtag results that include your “location” + “wedding” like #austinweddings or #bostonbrides. I searched for and followed a ton of content with the following hashtags:

• #PhillyWedding
• #PhiladelphiaWedding
• #PhillyBride
• #PhillyLove

2. Follow relevant Instagram accounts

I scrolled through my hashtags and quickly found a plethora of accounts devoted to showcasing weddings in the Philadelphia area. The beauty of these accounts is that they typically tag every photographer, florist, makeup artist, hair stylist, and event designer who participated in the wedding or photo shoot they’re showcasing. These posts are gold for discovering new vendors. From my search, I found:

• @PhillyinLoveBlog
• @PhilaWedding
• @PhillyDIYWedding
• @PhillyWeddings

3. Follow wedding photographers in your area

From the general wedding accounts you’ve followed based on location, scroll through their posts and bookmark the images that speak to your aesthetic. These posts will lead you to the photographers who captured weddings that are closest to your style. Usually, they’re tagged in the post or listed in the comments.

For my own search, this method led me to:

• Pat Robinson Photography (who I ended up booking!)
• Emily Wren Photography
• Redfield Photography
• Bartlett Pair Photography

4.) Take a look at the venues listed in these photographer’s posts

As I scrolled through Pat Robinson’s gorgeous Instagram page, I saw an awesome image of a bride and groom at Welkinweir Estate surrounded by ferns. I Googled Welkinweir and learned that it’s an amazing venue surrounded by gorgeous greenery, with a unique ceremony setting, a huge tent, and a beautiful stone estate, all in a remote location. Welkinweir is part of Jam Catering’s group of venues, and they have so many unique settings, most of which I wouldn’t have found if I left my venue search solely to Knot reviews.

I followed this formula to find most of my other vendors, including hair and makeup artists (Capelli & Trucco and Jessica B. Beauty), DJ (Scratch Weddings), bakery for our rehearsal dinner desserts (Frosted Fox).

The vendor search process can seem daunting, but starting on Instagram led me to a ton of options in a short amount of time.

Today is the 7th Annual #GivingTuesday, founded by the 92nd Street Y in 2011 as a global day of charitable giving. This year, we’d like to shine a spotlight on some incredible nonprofit organizations that work tirelessly to advocate for, support, and improve women’s health, wellness, and reproductive rights.

We encourage you to find an organization with a mission that inspires you and help them out by donating today.

Cade Foundation

The Tinina Q. Cade Foundation allows those who have experienced and overcome infertility to support others who are still on their fertility journey. In addition to educational resources, the Cade Foundation also provides grants to help families offset the costs of fertility treatments and adoption. Learn more and donate to the Cade Foundation here.

Callen-Lorde

Callen-Lorde provides quality health care and health services to New York’s LGBTQ communities, regardless of financial capability. As the global leader in LGBTQ healthcare, Callen-Lorde provides education and wellness events, resources, and advocates, as well as pioneering research initiatives to promote LGBTQ health. Learn more and donate to Callen-Lorde here.

Creating a Family

Creating a Family is a national infertility, adoption, and foster care education and support nonprofit. Their work includes a diverse collection of resources for those struggling with infertility, pre- and post-adoptive families, and foster care families. In addition to educational resources, Creating a Family also provides a support network via social media, message boards, Facebook groups, and weekly radio shows for families to share their experiences and connect with one another. Learn more and donate to Creating a Family here.

Endometriosis Foundation of America

Donating to the Endometriosis Foundation of America (EndoFound) will help to improve endometriosis advocacy, provide physicians with expert training, and fund groundbreaking endometriosis research. Learn more and donate to EndoFound here.

Every Mother Counts

Every Mother Counts was founded by Christy Turlington Burns after the release of her documentary film “No Woman, No Cry” in 2010. The organization is dedicated to understanding the maternity care challenges faced by women around the world and developing new programs for improve care and activate global maternal health advocates. Learn more and donate to Every Mother Counts here.

Global Girls Alliance

The Obama Foundation started the Global Girls Alliance to bring attention to the 98 million girls around the world who are not in school. The alliance aims to connect adolescent girls with grassroots leaders who can increase awareness, access, and support of community programs, spark global discussions, and shed light on the barriers the keeps girls from reaching their educational goals. Learn more and donate to the Global Girls Alliance here.

Human Rights Campaign

The Human Rights Campaign (HRC) was founded by Steve Endean in 1980 as one of the the nation’s first gay and lesbian political action committees. In 2007, the HRC established the Healthcare Equality Index scoring, a national benchmarking tool that evaluates healthcare facilities’ policies and practices related to LGBTQ equity and inclusion. Today, more than three million members support HRC’s mission to achieve equality for lesbian, gay, bisexual, transgender and queer Americans. Learn more and donate to the HRC here.

National Women’s Health Network

Help the National Women’s Health Network change the conversations about women’s health in Washington and help to shape policies. Their work holds federal regulatory and funding agencies accountable for their actions and mobilizes grassroots campaigns that support women’s health. Learn more and donate to the National Women’s Health Network here.

Path2Parenthood

Path2Parenthood is a nation-wide resource for infertility prevention, reproductive health, and alternative family building. The organization’s extensive online library of resources serve to educate and support straight and LGBTQ parents-to-be on their family building journey. Learn more and donate to Path2Parenthood here.

PCOS Awareness Association

Join the Polycystic Ovary Syndrome Awareness Association’s #IPledgeTeal campaign and help the organization educate the public about PCOS symptoms, build resources for women to get tested, and ensure that every person diagnosed with PCOS can receive the support they need. Learn more and donate here.

Planned Parenthood

For more than 100 years, Planned Parenthood clinics have served as safe and reliable centers for accurate health information, reproductive health services, and affordable medical care. Each day, Planned Parenthood clinics serve more than 8,000 patients. Donate to Planned Parenthood here and ensure that these patients continue to receive the quality care they need.

RESOLVE: The National Infertility Association

This year, RESOLVE’s goal is to raise $10,000 on #GivingTuesday to ensure that every person who wants to create a family has access to the treatment options and support they need. Help them achieve their goal by donating here.

Women’s March

Women’s March is a women-led movement to enact transformative social change in our communities through events, trainings, outreach programs, and resources. The foundational pillars of the Women’s March organization include advocating for ending violence, reproductive rights, LGBTIA rights, worker’s rights, civil rights, disability rights, immigrant rights, and environmental justice. Learn more and donate to the Women’s March 2019 #WomensWave here.

The good news is that there are many incredible nonprofit organizations and foundations out there that need your support, through both financial donations and volunteering time. Take a moment this #GivingTuesday to find an organization you love, offer your support, and encourage others to do the same.

Have an organization you’d like to feature? Add a link to their donation page in the comments section!

How to support women’s health this #GivingTuesday was originally published in Celmatix on Medium, where people are continuing the conversation by highlighting and responding to this story.

While the love and support of friends and family members is crucial when you’re trying to conceive (TTC), there’s a special compassion and understanding that comes from speaking with women who are going through similar experiences. Chiemi Rajamahendran found herself facilitating groups and online programs within the TTC community, which aimed to provide love, support, and guidance to women fighting infertility.

In today’s Advocate Spotlight, we talk with Chiemi about how she turned her passion for providing TTC women with support and guidance into the thriving online community now called Miss.Conception Coach.

Celmatix: Tell us a little about what led you to found Miss.Conception Coach.

Chiemi: It was really something that came about after my own personal experience with infertility and navigating those tough emotions. I witnessed the lack of emotional support for women specifically going through loss and started my own support site at a grass roots level that centered around real-time interaction when women need it most. If someone is having a miscarriage or just learned their fertility treatment was unsuccessful and they are sitting in their car or on their bathroom floor crying, they need to connect with someone immediately… not a week from now. Just having a single outlet like that is so important.

Celmatix: How does your background in psychiatric nursing help you when speaking with women who are experiencing infertility?

Chiemi: A professor once said to me, “You have to meet everyone where they are, not where you think they should be.” That has always stuck with me and is something that I think we need to remind ourselves on a daily basis. You have to meet your emotions where they are today, right now. Let’s sit in the fear, pain, sadness together. No one should feel rushed out of those emotions.

Celmatix: Since you founded Miss.Conception in 2014, have you seen any changes in the way women are talking about infertility?

Chiemi: Yes, absolutely! Women in our community share that they don’t feel alone anymore and that their emotions are validated. Social media has enabled someone who might have felt totally alone to now feel like part of a support system, with a sense that others are always there. There’s nothing I love more than getting feedback from pieces I write and share. When someone tells you the community is what keeps them hopeful and stops them from giving up… there are no words.

Our private Facebook groups are also a wonderful place for this sort of support and sharing. They are made up of women supporting other women going through the same thing and experiencing similar emotions and fears. To be able to just share anytime and know someone you trust and who truly cares about you is there is priceless and life-changing.

I like to keep these groups small in size because I want everyone involved to get to know each other and hear each other’s stories. When groups get too large, that intimacy and feeling of authentic connection can get lost, and when women are sharing such intimate details it’s crucial to maintain that trust.

Sometimes it’s hard to balance wanting to take in new members and keeping it a tight-knit group. It’s not about numbers, it’s about creating a safe, healing, supportive connection. We’ve even created a new group called “Bump To Bottles” for women who have successfully conceived and would like to continue to connect with others they’ve met in the Facebook group.

Celmatix: Your social media platforms look different than other fertility advocates’ in that you usually post deeply personal and inspirational stories. What inspired you to take this approach?

Chiemi: Sometimes people assume that sharing raw, intimate, and personal stories will be upsetting to others, but I see it as the opposite. By sharing these stories, other women are able to read them and say, “been there too.” Inspiration can come from rock bottom experiences and true inspiration comes from witnessing the strength and courage it takes to move forward and through those emotions. Sharing these emotions it validates them for others. By validating them, you help take away someone’s shame.

Celmatix: What goals do you have for women who find your site?

Chiemi: I hope that they feel like they’ve finally found a safe home to share their emotions and that they are reminded that they are doing ‘enough.’ I hope the stories on the site remind them that they need support during this time of their life more than ever, and that this fight they are fighting daily demands respect and empathy from family and friends.

When women are pregnant, people rally around them, and then after they have the baby everyone wants to help and checks in with them. I want this site to give the same level of understanding and support to women with infertility who are fighting desperately to become mothers.

Celmatix: What other social media accounts or sites do you recommend for women who are looking to become part of a community?

Chiemi: For anyone recently diagnosed with infertility, I’d strongly recommend RESOLVE and to ultimately really trust your doctor and build a strong relationship with your team of medical experts. Also advocate for yourself the best you can!

As an extension of Miss.Conception Coach, Chiemi recently launched a line of all natural body care products specifically designed for women who are trying to conceive called Bloom Essentials.

You can learn more about Miss.Conception Coach on their site and join the conversation by following @MissConceptionCoach on Instagram.

Advocate Spotlight: Chiemi Rajamahendran, founder of Miss.Conception Coach was originally published in Celmatix on Medium, where people are continuing the conversation by highlighting and responding to this story.