WITH DR. PHILIP WERTHMAN · MALE FERTILITY
It takes two.
We only test one.
In roughly half of infertility cases, a male factor is involved. And male partners, on average, are tested last. We sat down with our Medical Advisor, Dr. Philip Werthman, one of the most recognized male fertility specialists in the world, to change where the conversation starts.
adults experience infertility in their lifetime
WHO, 2023 – 17.5% global prevalence
decline in sperm count globally over 46 years
Levine et al. meta-analysis, 2022
of infertility cases involve a male factor
RESOLVE / ASRM
THE 50-50 REALITY
Infertility is not a her problem.
When most people hear the word "infertility," they picture a woman. The medical system treats it the same way. The female partner is evaluated first. IVF cycles and hormone protocols begin. Months pass. And the male partner, on average, is one of the last people in the room to get tested.
The numbers don't support that sequence. Across multiple meta-analyses and professional society statements, a male factor is the sole cause of infertility in roughly 20 - 30% of cases, and a contributing cause in another 30 - 40%. Together, male factor is involved in about half of all infertility cases. In Dr. Werthman's own breakdown from our conversation, the split looks like this: roughly 35 - 40% solely male, 40 - 45% solely female, and 20 - 25% percent a combination.
"Fertility, it's not just a woman's problem. It takes two to tango. Sperm are half the equation."
Dr. Philip Werthman, MD · Hugh & Grace Medical Advisor
The testing gap matters because treatment options widen the earlier male factor is identified. A semen analysis is one of the simplest, least invasive diagnostic tests in reproductive medicine. Yet only about 44% of couples complete fertility testing at the same time. The male partner's evaluation is often delayed until expensive, invasive interventions are already underway on the female side.
Why this matters: If a male factor is present, finding it early changes what the couple does next. Sometimes the answer is a lifestyle change that works in 90 days. Sometimes it's a minor clinical intervention. Either way, it's information that belongs at the start of the process, not the end.
THE HOPEFUL WINDOW
What you change today shows up in three months.
Sperm don't work like eggs. Men aren't born with a fixed lifetime supply. Sperm production begins at puberty and continues in cycles, a new cohort roughly every 72 to 90 days. That biological reality is one of the most underappreciated facts in all of fertility medicine, because it means lifestyle changes made now can meaningfully change what shows up in a sample three months from now.
"Sperm development is very, very sensitive to what's going on in a man's environment, both externally and internally. Anything that impacts a man within a 30 to 90 or 100 day time frame before they're trying to conceive can be reflected in the outcome. What that does is give opportunity to potentially make changes."
Dr. Philip Werthman, MD
The asymmetry here is worth sitting with –for the female partner, fertility interventions are often measured in expensive, invasive months and years. For the male partner, lifestyle changes can measurably impact sperm quality inside of a single quarter. That's not a complete solution, there are structural issues Dr. Werthman treats clinically, but for most men, the first layer of intervention is changes you can make starting tomorrow.
"The sperm don't have to be perfect. They just have to be good enough."
Dr. Philip Werthman, MD
WHAT HURTS SPERM QUALITY
The through-line is oxidative stress.
Most of what damages sperm, whether structural, chemical, or environmental, operates through a single mechanism. The body generates reactive chemicals as a byproduct of normal metabolism and environmental exposure. Under normal conditions, the body's antioxidant systems neutralize them. When the load exceeds the system's capacity, those chemicals damage the DNA and membranes of developing sperm. That's oxidative stress. It is the common enemy behind most of what follows.
01
Smoking
Burning organic matter sends chemicals and toxins throughout the bloodstream. They reach where sperm are stored and cause free-radical damage. This is the single largest modifiable risk factor for men who smoke, and reversible.
"Once I stopped smoking, the semen analysis became normal. That was really proof positive to me how impactful smoking could be." - Dr. Werthman
02
Cannabis via inhalation
THC affects sperm shape and motility. The combustion piece is also a problem, smoking organic material, no matter the source, delivers oxidative damage. Alternate-form use is less damaging than inhalation, but the cleanest move is to pause during a conception window.
"If you're gonna use that, don't use it via inhalation." - Dr. Werthman
03
Heat (jacuzzis, saunas, hot yoga)
Testicles are positioned outside the body because sperm production requires a temperature lower than core body temperature. Even regular jacuzzi use can measurably impact sperm parameters. Hot showers are fine — the water moving off the body is cooling. Immersion is the problem.
"Even sitting in a jacuzzi a couple of times a week can be enough to significantly impact someone's sperm parameters." - Dr. Werthman
04
Extreme endurance training
Marathon and Ironman-scale training puts the body into a catabolic state. Sperm quality measurably declines during those cycles. For endurance athletes trying to conceive, the move is to time training so the biggest efforts sit outside the conception window, not to abandon the sport.
"Your body's not really looking to reproduce when you're running 26 miles or more." - Dr. Werthman
05
Chronic stress and cortisol
Chronically elevated cortisol doesn't just raise blood pressure and strain the cardiovascular system. It suppresses testosterone. It's not a formula for conception. The catch is that telling a stressed person to be less stressed adds stress. What helps is structural, sleep, real recovery, boundaries, professional support where appropriate.
"Cortisol does not help people get pregnant. I think that is a very clear statement." - Dr. Werthman
06
Environmental toxins
The research on endocrine-disrupting chemicals, phthalates, bisphenols, parabens, organochlorines, is consistent. A 2016 meta-analysis found classic EDCs associated with 1.67 times the odds of abnormal sperm quality. These chemicals are in personal care products, plastics, cleaning supplies, and food packaging. This is where Hugh & Grace lives as a brand.
"It really is the buildup of toxins that ultimately causes the damage to the sperm." - Dr. Werthman
WHAT HELPS
Small changes, compounded over 90 days.
None of what follows is revolutionary. Most of it is the daily-rhythm work every wellness conversation eventually returns to. The difference for male fertility is timing. Inside the 60-to-90-day window before trying to conceive, these small levers have disproportionate leverage over what shows up in a semen analysis.
01
Antioxidant support
Antioxidants neutralize the free radicals that damage sperm DNA and membranes. Dr. Werthman calls supplementation here cheap, easy, and free of meaningful side effects. Evidence on specific outcomes is mixed study by study, but in his clinical experience he's seen men with documented sperm DNA damage return to normal parameters inside of three months.
Our entry: Hydrate+Detox - built around L-glutathione, which the body uses as part of its own antioxidant and detoxification system, alongside a patented probiotic for gut health.
"I've seen people where they've had high levels of DNA damage in their sperm, and in three months it goes to normal." - Dr. Werthman
02
Sleep
Sleep is the foundational hormone-regulating behavior. Testosterone is produced primarily during sleep. Chronically short or fragmented sleep degrades every marker that matters here. Seven to nine hours is the range.
Our entry: Our Night Supplement was built to support restorative sleep and overnight recovery as part of a daily routine.
03
Healthy weight range
Body mass index is linked, and, in Dr. Werthman's language, "pretty much causative", for both male and female fertility at the extremes. For men carrying significant excess weight, the metabolic tools that have emerged in recent years (including GLP-1 medications) are now making previously unreachable changes accessible.
"Body mass index has always been an issue that has been linked, and pretty much causative, for both male and female fertility." - Dr. Werthman
04
A cleaner home environment
Reducing exposure to endocrine-disrupting chemicals is one of the most direct levers available. The categories that matter most: personal care products, household cleaners, fragrance, plastics in food contact, and water filtration. Changes here compound daily.
Our entry: The entire Hugh & Grace product suite, wellness, skin care, hair care, and home care, is formulated without the endocrine-disrupting chemicals described above. This is the lever the company was built around.
05
Stress down-regulation
Not "be less stressed." Structural interventions, consistent sleep schedule, real recovery windows, movement that isn't catabolic, professional mental health support where needed, and protected time with a partner, move cortisol downward. Fertility responds.
06
Patience with the cycle
The 72-to-90-day cadence is the single most useful timeline in this conversation. Changes made today are reflected in a sample roughly three months from today. That's longer than most men expect, and shorter than most women's fertility interventions. Work the window.
THE ENVIRONMENT QUESTION
A story Dr. Werthman tells patients.
During our conversation, Dr. Werthman told us about a patient, a friend of his, who owned an automotive garage. Tire shop, brake shop. Heavy fumes. Poor ventilation. The friend already had one child but came in for testing when he and his wife wanted a second. The analysis came back with no sperm. Surprising enough on its own. But the story got more specific.
"When he had his kid, he didn't own the shop. And not only that, but he has several other brothers. The brothers who worked in the shop, no kids. The brother that didn't work in the shop, kids."
Dr. Philip Werthman, MD
The shop eventually called in OSHA. Ventilation was fixed. Chemical handling was cleaned up. Six months to a year later, sperm were back. A new sample came in with plenty. It's one anecdote and Dr. Werthman is careful with how he uses it. But it illustrates something the peer-reviewed literature backs up, a 2016 meta-analysis found classic endocrine-disrupting chemicals (phthalate esters and organochlorines) associated with 1.67 times the odds of abnormal sperm quality. The mechanism, as with almost everything else here, is oxidative stress.
"Some of the most toxic chemicals around are under your kitchen sink."
Ben Jensen, Co-Founder, Hugh & Grace
That sentence is, in many ways, the origin thesis of Hugh & Grace. When Ben and Sara began their own 14-year fertility journey, the dots connected in their family was that the products they used every day, skincare, haircare, cleaning supplies, the things inside the house, carried chemicals capable of disrupting hormonal function. That realization is what the company was built around. A cleaner home environment is one of the few levers available to men and women on this journey that doesn't require a specialist to start.
WHY THIS CONVERSATION EXISTS
A note from Ben.
Sara and I tried to have a baby for 14 years. In the early stretch of that, when it wasn't working, I told her to go figure it out. I got tested, I had to, but I stayed on the outside of it. I had convinced myself, somewhere inside, that needing help to have children made me less of a man. So I checked out emotionally.
It took watching Sara break down, a few rounds of IVF in, for me to finally get it. She is a tough woman. Seeing her lose it was the thing that woke me up. This wasn't her problem. It was ours. I needed to step up.
We never got pregnant naturally. We have our children because family members volunteered to carry for us through surrogacy. That's the short version of a long story, and it's a piece of why Hugh & Grace exists. The other piece is what our fertility physician explained during Sara's sixth round of IVF, that the chemicals in the products we used every day could be disrupting the very hormonal function we were trying so hard to restore.
This page is a small part of a larger commitment to make sure the male side of the fertility conversation doesn't keep showing up last. If one man reads this and decides to get tested earlier, to make a few changes during his next 90 days, to show up for his partner in a way I didn't show up for mine, it was worth building.
— Ben Jensen, Co-Founder
HUGH & GRACE MEDICAL ADVISOR
About Dr. Philip Werthman.
Philip Werthman, MD, MMH, FACS
Medical Advisor · Hugh & Grace
Board-certified urologist, andrologist, and microsurgeon. Director of the Center for Male Reproductive Medicine & Vasectomy Reversal in Los Angeles, with surgical facilities in Beverly Hills. Widely recognized as one of the leading male fertility specialists in the world. More than 20,000 procedures. Author of the chapter on male reproductive surgery in the leading urological textbook. Featured clinical authority on ABC, CBS, NBC, ESPN, CNN, FOX News, Men's Health, WebMD, and The Doctors.
Hahnemann University School of Medicine — class valedictorian · UCLA urology residency and fellowship · Visiting fellowship in male infertility and microsurgery, Baylor College of Medicine · Past President, Los Angeles Urologic Society · Recipient, American Fertility Association Illuminations Award
WHERE DO YOU START
The simplest first step is a daily routine.
The most common question we hear from couples early in a fertility journey, or from anyone beginning a hormone-health reset, is where to start. The honest answer is the daily stuff. The levers that matter most compound quietly over weeks. Sleep. Antioxidant support. A cleaner home. Stress down-regulation. None of it requires a specialist or a prescription to begin.
Hugh & Grace built The Routine+ as the foundational daily system for exactly this reason, three products designed to work together, morning and night, supporting the body's hormone-regulating pathways as a daily practice. For people who want a simpler starting point, The Routine is the same philosophy in a two-product form.
Neither of these is a fertility treatment. They are daily wellness systems. But they were built by a couple who spent 14 years on a fertility journey, and the formulations reflect every lesson from that time.
FREQUENTLY ASKED QUESTIONS
What people ask about male fertility.
Yes. Across multiple peer-reviewed sources, the Lancet, RESOLVE, the American Society for Reproductive Medicine, NCBI StatPearls, the consensus estimate is that a male factor is the sole cause in roughly 20–30% of cases, and a contributing cause in another 30–40%. That puts male factor involvement at approximately 50% of all infertility cases. Dr. Werthman's own clinical breakdown is consistent with that range.
A full sperm production cycle is roughly 72 to 90 days. Changes in diet, sleep, stress, environmental exposure, smoking, and alcohol use can show up meaningfully in a semen analysis inside that window. Dr. Werthman has seen men with documented high levels of sperm DNA damage return to normal parameters in three months after targeted lifestyle and supplementation changes. Individual results vary and structural issues may require clinical intervention, but for most men, the first 90 days are where the most accessible changes live.
If someone smokes, stopping smoking is the single largest lever, Dr. Werthman shared his own story of doing exactly that and watching his semen analysis return to normal. For men who don't smoke, the honest answer is that several changes tend to move together: reducing heat exposure (jacuzzis, saunas), managing stress, improving sleep, reducing alcohol, and reducing environmental chemical exposure. None of them alone is a silver bullet. Compounded across a 90-day window, they add up.
Hugh & Grace was founded out of Ben and Sara Jensen's 14-year fertility journey. The founding realization was that the products they used every day, skincare, haircare, cleaning supplies, anything that goes on skin or surfaces at home, carried chemicals capable of disrupting hormonal function. The male fertility conversation is an extension of that same thesis: endocrine-disrupting chemicals are associated with impaired sperm quality, and reducing exposure is one of the few daily levers available without specialist intervention.
Primary sources are listed below. The two most important are the Levine et al. meta-analyses on global sperm count decline (2017 and the 2022 update in Human Reproduction Update) and the WHO 2023 Infertility Prevalence Estimates report. For the chemicals-and-sperm mechanism, Wang et al. 2016 in Scientific Reports and Virant-Klun et al. 2022 in Antioxidants are both openly accessible.
SOURCES & CITATIONS
Levine, H., Jørgensen, N., Martino-Andrade, A., Mendiola, J., Weksler-Derri, D., Jolles, M., Pinotti, R., & Swan, S.H. (2023). Temporal trends in sperm count: a systematic review and meta-regression analysis of samples collected globally in the 20th and 21st centuries.Human Reproduction Update, 29(2), 157–176.doi:10.1093/humupd/dmac035
Levine, H., Jørgensen, N., Martino-Andrade, A., Mendiola, J., Weksler-Derri, D., Mindlis, I., Pinotti, R., & Swan, S.H. (2017). Temporal trends in sperm count: a systematic review and meta-regression analysis.Human Reproduction Update, 23(6), 646–659.doi:10.1093/humupd/dmx022
World Health Organization (2023).Infertility Prevalence Estimates, 1990–2021. Geneva: WHO.who.int
Wang, C., Yang, L., Wang, S., Zhang, Z., Yu, Y., Wang, M., Cromie, M., Gao, W., & Wang, S. (2016). The classic EDCs, phthalate esters and organochlorines, in relation to abnormal sperm quality: a systematic review with meta-analysis.Scientific Reports, 6, 19982.doi:10.1038/srep19982
Virant-Klun, I., Imamovic-Kumalic, S., & Pinter, B. (2022). From oxidative stress to male infertility: Review of the associations of endocrine-disrupting chemicals (bisphenols, phthalates, and parabens) with human semen quality.Antioxidants, 11(8), 1617.doi:10.3390/antiox11081617
Leslie, S.W., Siref, L.E., Soon-Sutton, T.L., & Khan, M.A.B. (2024). Male Infertility.StatPearls. Treasure Island, FL: StatPearls Publishing.ncbi.nlm.nih.gov · RESOLVE: The National Infertility Association — Male Factor.resolve.org