Introducing The BALLS Method

It takes two to tango. The same is also true when it comes to baby-making.

Whether you are trying to get pregnant at home or with IVF, the BALLS method is for you.

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As you may have guessed from the name, this approach has everything to do with the dude part of the baby-making equation.

I’ve come to find in my experience of helping thousands of patients get pregnant that too often men are left out of the fertility planning. Yet, sperm is an equally important part of having a healthy pregnancy outcome.

To be clear, I’m not suggesting we point fingers or play the blame game when it comes to fertility struggles. That’s so 1990. We’re in the age of problem-solving and even better, problem prevention. Whatever the case may be, egg and sperm must meet to create a healthy embryo. That’s what I’m focused on.

Let’s invite men to the fertility party

I want to make it incredibly easy and socially acceptable to talk about sperm. If you’ve been watching my show, you know that I am a firm believer in doing simple and affordable diagnostic testing to understand your fertility diagnosis BEFORE any treatment. My pneumonic for this is TUSHY. (Tubes, Uterus, Sperm, Hormones, Your Genetic Profile). You can learn more at

If after a TUSHY check you learn that sperm quality is low then you’ll want to understand why. This is why I created the BALLS Method. To help men, and their partners, understand and remember the simple steps to understanding their fertility health.

The BALLS Method helps men understand their fertility

The BALLS Method is an easy guide or checklist for sperm health to review at the start of a fertility journey. It’s focused on understanding and improving sperm health for the best chance at a healthy pregnancy.

Before diving into the BALLS method, I ask every patient to start with a very simple, yet informative, semen analysis. Do you want to know the best part of this? You no longer need a doctor’s order to do this test! is a helpful DIY sperm test anyone can do as long as they have a cell phone.

I typically order a semen analysis from the andrology lab and ask that the test be done at the fertility center. However, if a patient doesn't live near a lab or fertility center or has anxiety about getting a semen analysis done then I recommend doing it at home through

Let’s talk BALLS

Here are the 5 parts of the BALLS Method:

Background genetics: The answer to why you’re having sperm issues could be in your DNA. If the sperm count and motility are low then talk to your doctor about additional testing. I’d ask about a chromosome analysis, y chromosome microdeletion, phosphorus gene test, carrier screen, and a sperm DNA fragmentation test.

Anatomy: A varicocele is a common finding seen in 10–15% of men and it could be a reason for low sperm count, motility, morphology and testosterone levels in men. The way to get this properly diagnosed is through an exam by a urologist (male fertility specialist). Other anatomic causes of low sperm counts can be if a guy has a history of prematurity which is associated with undescended testicles.

Lifestyle: there’s more and more evidence to suggest that lifestyle affects sperm count. Do what you can through healthy eating to maintain a normal BMI. Try and sleep well (8 hours per night). Work on decreasing stress in your life and avoid exposure to heat (hot tubs, saunas, and steam rooms). Alcohol should always be in moderation and avoid tobacco and marijuana to improve sperm health. Talk to your doctor about the medications you’re taking (calcium channel blockers and testosterone) as some could act almost like birth control for men. Men can also take vitamins to help with sperm quality.

Labs: There are lab tests your doctor can order for you that may help you with a diagnosis. Low testosterone, high prolactin, thyroid issues, diabetes, high cholesterol, and low vitamin D are all issues that when fixed can improve sperm quality. Simple blood tests can be done at a lab to determine Testosterone, FSH, LH, estradiol, Prolactin, TSH, vitamin D, and Hgba1c levels.

Your doctor can interpret the results and then they can see what kind of treatment would be good for you. Medications like Clomid and anastrozole may improve testosterone and sperm counts. Treatment for high prolactin and a thyroid problem can also help. Low vitamin D is easily fixed with the right dose of vitamin D replacement. Pre-diabetes or diabetes and high cholesterol can be treated with lifestyle changes and medications like metformin and lipitor.

Sex: The relationship between sexual dysfunction and infertility is well known. Fertility doctors are used to asking “How is your sex life?” If your doctor isn’t asking you about any issues with erections, ejaculation or sexual desire, be sure to bring this up during your next visit. If you’re not comfortable sharing this with your current doctor I’d encourage you to see a urologist or sex therapist. I recommend Viagra and Cialis to patients with sexual dysfunction. Overall my hope is that by talking about this more it will become less taboo for patients to discuss these sorts of things with their doctors.


I always tell my patients that if possible, I want them to get pregnant without my help. I want everyone to do all they can that’s in their control to improve outcomes before seeking more involved treatment.

My hope is that the BALLS method is a helpful tool that can be used on your fertility journey.

As always, please comment below or send me a note if you have any questions about the BALLS method.

You can also catch more of me and fertility topics like this through The Egg Whisperer Show. The episodes are live-streamed on YouTube, Facebook, and Twitter and on Wednesdays at 7 PM PST. Subscribe to the podcast too!

Fertility Doctor, Reproductive Endocrinologist, Egg Whisperer:

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