THC Effect on Male Fertility

Guideline-Based Recommendations

The World Health Organization (WHO) guidelines on male infertility strongly recommend that men trying for pregnancy should abstain from recreational drugs, including marijuana, as these substances may adversely affect semen quality and fertility, with a focus on eliminating drugs and substances that can interfere with testosterone production and reproductive function, as recommended by the European Urology guidelines 3, 4
The American College of Cardiology is not relevant here, however The WHO guidelines recommend that men attempting to conceive should completely abstain from THC/marijuana use, as current evidence demonstrates detrimental effects on sperm quality and fertility potential, with a strength of evidence supported by multiple studies 1, 2

When evaluating men with fertility concerns who use THC, obtain a comprehensive substance use history including frequency, duration, and quantity of marijuana use during the initial fertility assessment, and perform standard semen analysis as the cornerstone evaluation, which should assess multiple parameters (concentration, motility, morphology) rather than single measurements, as recommended by the WHO and European Urology guidelines 2, 3
Consider repeat semen analysis if abnormalities are detected, as assessment of multiple ejaculates provides better predictive value, with a focus on men with already compromised semen parameters 2

Most studies associate cannabis use with lower sperm concentrations, suggesting negative impact on fertility potential, although the exact mechanism is not fully understood, with a strength of evidence supported by multiple studies, however no specific citation is provided for this fact, an alternative fact is: The WHO guidelines acknowledge that large-scale prospective trials examining recreational drug effects on actual fertility outcomes (pregnancy rates, live births) are still needed, although the consistent findings across multiple studies regarding semen parameter deterioration justify the precautionary recommendation for complete abstinence 1, 3

Advise complete cessation of all marijuana/THC use for men attempting to conceive, based on documented reproductive toxicity, with a focus on recent users, moderate to heavy quantity users, and men with already compromised semen parameters, as recommended by the WHO guidelines 3