Improving Male Fertility: Expert Advice from Mr Jonathan Ramsay
By Colette Assor FBAcC
Male fertility plays an equal role when trying to conceive, yet it’s often overlooked particularly during IVF and fertility treatment planning. Too often couples begin IVF without a thorough evaluation of the male partner's reproductive health. This can lead to, repeated IVF failure, emotional stress and a diagnosis of "unexplained infertility".
I recently had the honour of meeting with Professor Jonathan Ramsay, a world-leading Consultant Urologist and pioneer in male fertility care, to explore the current landscape of male reproductive health.
In this interview, we discuss:
- The most common causes of male infertility.
- Why standard semen analysis is often insufficient.
- Sperm DNA fragmentation
- The ongoing misdiagnosis of "unexplained infertility"
- How Acupuncture can support fertility care by addressing stress, emotional wellbeing and overall reproductive health.
What is Urology?
Urologists are trained to evaluate and treat the organs responsible for sperm production, including the testicles, vas deferens, epididymis, and prostate, all of which can significantly impact fertility. Mr. Ramsay says, "One cannot assess sperm without a comprehensive understanding of the structures that produce them," emphasising the integral relationship between male fertility and urology.
What are the key factors that impact sperm quality ?
The following Factors all adversely affect sperm quality:
- Smoking
- Excessive alcohol consumption,
- Poor dietary choices,
- Obesity
- The intake of processed foods
Additionaly, less apparent influences can impede sperm production including:
- The use of steroid-laced gym supplements
- Hair growth products
- Frequent sauna visits
There are also structural and medical conditions, such as:
- Varicoceles (enlarged veins in the scrotum),
- Undiagnosed infections,
- Imbalances in the genital microbiome, which may remain undetected without specialist evaluation.
How Important Is DNA Fragmentation Testing?
The Sperm DNA Fragmentation Test is of paramount importance. Mr. Ramsay explains that standard semen analysis alone often fails to provide a comprehensive understanding of sperm quality. DNA fragmentation tests offer critical insights at a molecular level. Two types of tests currently available are:
ExACT: The standard DNA fragmentation test.
ExTEND: An advanced test that identifies double-stranded DNA breaks, representing a more severe form of damage that is often not influenced by lifestyle changes or treatment of varicoceles.
“This advanced test elucidates why some couples may produce numerous eggs but only a limited number of viable embryos, or why they may experience failed implantation or miscarriage,” he asserts. “It is an essential tool for understanding embryo quality.”
Should clinics proceed with IVF without addressing sperm quality ?
Mr. Ramsay advises that such decisions should be based on individual circumstances. If the female partner is young and the fertility journey is brief, a single round of intracytoplasmic sperm injection (ICSI) may be warranted. However, he generally recommends assessing and addressing sperm quality prior to proceeding with IVF. "Knowledge is empowering. The more information available regarding sperm, the greater the potential to enhance IVF outcomes or even to avoid the need for IVF entirely."
What Specific Interventions Can Improve Sperm Quality?
- Varicocele repair — particularly for large and palpable varicoceles.
- Lifestyle modifications— including improvements in diet, exercise, weight management, and the avoidance of harmful substances.
- Treatment of infections and inflammation — addressing conditions such as prostatitis or microbiome imbalances.
- Management of chronic stress — Mr. Ramsay notes, “Chronic stress affects sperm health. This impact is expected as it is known to affect ovulation, and it likely extends to spermatogenesis as well.”
- Varicocele repair — particularly for large and palpable varicoceles.
- Lifestyle modifications— including improvements in diet, exercise, weight management, and the avoidance of harmful substances.
- Treatment of infections and inflammation — addressing conditions such as prostatitis or microbiome imbalances.
- Management of chronic stress — Mr. Ramsay notes, “Chronic stress affects sperm health. This impact is expected as it is known to affect ovulation, and it likely extends to spermatogenesis as well.”
The role of Acupuncture in fertility care
Mr Ramsay states:
“Acupuncture serves a vital role in assisting patients with managing stress, facilitating lifestyle changes, and providing emotional support. It ensures a continuity of care that is often lacking in conventional medical practices.”
He adds:
“I have not encountered a patient who has not benefited from acupuncture.”
Mr Ramsay strongly advocates for acupuncture as a valuable support during fertility treatment — particularly for managing the emotional and psychological demands of the IVF process. While acupuncture is not a direct treatment for conditions such as varicoceles or genetic causes of infertility, it can offer powerful complementary support.
Fertility Acupuncture is widely used throughout the fertility journey — from IVF preparation to stress reduction, minimising treatment side effects, and enhancing emotional wellbeing. Studies suggest it may help to regulate hormones, improve blood flow, and reduce inflammation — all of which can contribute to reproductive health.
It’s important to note that while the body of research is growing, scientific evidence on acupuncture remains inconclusive. Nevertheless, many patients report meaningful improvements in wellbeing when acupuncture is part of their care plan.
Why does " Unexplained Infertility" remain a common diagnosis ?
The primary reason is that inadequate investigation is often conducted. Mr. Ramsay says, “Unexplained infertility represents a failure to diagnose. Through thorough investigations—employing proper sperm testing, physical examinations, and ultrasounds—appropriate explanations invariably emerge.” He adds that the “NICE guidelines, which are followed by many NHS clinics, were predominantly shaped by gynaecologists and do not include essential male fertility evaluations such as DNA fragmentation or microbiome analysis.”
How do you see the evolution of male fertility care?
Private practices are leading advancements in this area. “As diagnostic capabilities improve—particularly with DNA and genetic markers—the justification for the 'unexplained' categorisation diminishes. Ultimately, the NHS will need to adapt accordingly.” Nonetheless, many couples currently navigate a frustrating cycle of receiving “unexplained” diagnoses accompanied by repeated IVF attempts, often without a thorough assessment of the male partner's health.
What Guidance Would You Offer to Couples Experiencing Male Factor Infertility?
“Do not accept ‘unexplained’ as a conclusive diagnosis. Avoid assuming that IVF represents your only option. Seek a practitioner who will conduct a comprehensive investigation of both partners,” “It may not be necessary to pursue another IVF cycle; a proper diagnosis might be the key.”
Key Takeaways: Male Fertility and Integrative Care
Male fertility is often overlooked in IVF, despite its significant impact on treatment success.
Mr Jonathan Ramsay is leading the conversation on advanced sperm testing and thorough evaluation of the male partner.
Many couples only undergo advanced sperm testing after several failed IVF cycles, which can result in avoidable emotional, physical, and financial costs.
Acupuncture practitioners can help bridge the gap between complementary care and medical treatment offering a holistic and integrated approach to fertility care.
An integrated approach — combining acupuncture, nutrition, lifestyle support, and timely medical evaluation — offers a more holistic model of care.
Collaboration between acupuncturists, nutritionists, and fertility clinicians is essential for personalised, evidence-based support.
Early referral for testing can lead to more informed treatment plans and improved outcomes.
Colette’s North London Acupuncture clinic regularly sees couples who were unaware of an underlying male factor. — a reminder to prioritise both partners in every fertility journey
In my clinic, I regularly see how male fertility is often overlooked. Many couples I refer to Mr Ramsay and Miss Claire Mooney at Fertility Solutions come only after multiple failed IVF cycles, often without having undergone any detailed sperm assessment. This discussion has reinforced the importance of prioritising male fertility, and the powerful outcomes that come from integrating urological insight with integrated/holistic care.
I want to extend my heartfelt thanks to Mr Ramsay for his time and generosity in sharing his insights. Please read The importance of Male fertility with Miss Claire Mooney
To contact Mr Ramsay or Miss Claire Mooney
Visit: www.jonathanramsay.co.uk
Email: info@fertilitysolutions.org.uk
Contributor Biographies
Mr Jonathon Ramsay
Mr Ramsay is a world-renowned Consultant Urologist and leading expert in the investigation and treatment of male fertility. With over 30 years of clinical experience, he has played a pivotal role in transforming how male fertility is understood and managed. As one of the few Consultant Urologists in the UK Mr Ramsay is recognised as a pioneer in the field. His collaborative approach with fertility clinics and patients alike has made him a trusted authority in both clinical practice and research.
Website: www.jonathanramsay.co.uk
Colette Assor
Colette Assor is a Fellow of the British Acupuncture Council and a clinician with over 26 years of experience. Based in London, specialist interests in fertility, women’s health, and stress-related conditions. Colette is passionate about integrating professional acupuncture into mainstream healthcare and currently serves on the MSC committee at the British Acupuncture Council, helping to shape the future of the profession.
How to find a qualified Acupuncturist
The British Acupuncture Council (BAcC) is the leading professional organisation for acupuncture in the UK. Both the HFEA and the NHS recommend choosing an acupuncturist who is a member of a national acupuncture organisation on an accredited register.
Members of the BAcC have a professional-level degree qualification and belong to a register that is regulated and approved by the Professional Standards Authority for Health & Social Care (PSA).
The PSA protects the public by overseeing the registration of healthcare professionals, including statutorily regulated professions like the Nursing and Midwifery Council. Accredited registers like the BAcC offer a recognised quality mark for high training standards, safe practice, and professional conduct.
This article was Published in IVF Babble and adapted for Colette Assor at Acupuncture Works London blog.