Everything You Need To Know About Male Fertility

It Takes Two

Over the past few years, we have seen more and more men with sperm issues. It's known that around 50% of fertility is down to male factors and yet this figure surprises many because for generations we've been led to believe fertility is all about women. The male partner has an equally crucial role to play at conception in providing the healthiest sperm he can for the future health of the child.

Age Matters

Although there are lots of reports of older men fathering children, sperm counts naturally decrease and sperm becomes less mobile with age. A recent study showed that over a 12-month period men aged 35 or older are 50% less likely to achieve conception with a fertile partner than men under 35.
 

Sperm Quality Is On The Decline

Evidence suggests men’s sperm counts around the world are declining. Alongside low sperm counts, there can be low motility (the sperm can’t swim properly) and higher rates of malformed sperm (poor morphology). In some men, their sperm analysis is normal, but additional tests show there is DNA fragmentation, which means the sperm can’t fertilise the egg properly. Many nutrition and lifestyle factors could be playing a role in male fertility problems and there’s evidence to show particular nutritional supplements can help. 

Your GP Can Help

Although there are a number of ‘at home’ sperm tests available, go and see your GP first. It's a good idea for both you and your partner to get advice, as fertility problems can affect men and women, and often it's a combination of both. It's important to understand the exact issue before deciding on next steps. One of the tests a GP can arrange is a semen analysis, which will check the quality and quantity of the sperm. The results are usually available within a week. If the results are not normal, the test should be repeated to ensure it was accurate. This will normally be performed after three months. Your GP can refer you to a specialist in male infertility at your local hospital or fertility clinic if any problems are found. If you want to delve deeper, it’s worth knowing the test your GP offers is quite basic, and results are often given without much explanation. A test done via a private clinic will go into more detail about the quality of your semen, as it’s not just sperm count, motility and morphology that matters.

It Takes Time

It’s hard when you are trying month after month for a baby, and it isn’t happening. In fact, it takes an average of eight to 12 months to conceive and for most people there is more an impatience than an inability to conceive. If, however, you have not managed to conceive after one year of trying for a baby, speak to your GP. There are so many myths around sex when trying for a baby, and the most common questions I’m asked are about how often to have it and whether it’s better to save the sperm up. Firstly, you should be having sex as much as possible, at least three times a week. The idea of saving sperm is a myth as it will die after a few days and research shows that the more fresh sperm there is, the better the quality.

There Could Be An Underlying Condition

There are a number of potential causes for male infertility, but the most common ones may include:

• Abnormal sperm production or function due to undescended testicles, genetic defects, health problems such as diabetes, or infections such as chlamydia, gonorrhoea, mumps or HIV. Enlarged veins in the testes also can affect the quality of sperm. 
• Problems with the delivery of sperm due to sexual problems, such as premature ejaculation; certain genetic diseases, e.g. cystic fibrosis; structural problems, e.g. a blockage in the testicle; or damage or injury to the reproductive organs.
• Overexposure to certain environmental factors such as pesticides, other chemicals and radiation. Cigarette smoking, alcohol, marijuana, anabolic steroids, and taking medications to treat bacterial infections, high blood pressure and depression can affect fertility. Frequent exposure to heat, such as in saunas or hot tubs, can raise body temperature and may affect sperm production. 
• Damage related to cancer and its treatment including radiation or chemotherapy. Treatment for cancer can impair sperm production, sometimes severely.

Know How To Deal With The Emotions

Sperm tests in themselves are scary territory for men. Many men are initially unclear about who to consult when it comes to their fertility. Women know to go and see a gynaecologist, but men are not so sure who to approach as the subject of fertility is still taboo. This makes receiving bad test results from a sperm test all the more devastating. Men feel disheartened and at a loss as to how to proceed. I often see men bottling up these emotions, thinking they should be the ones to remain strong and supportive. Other times, I see men feeling like they’ve failed their partners altogether, sometimes even breaking up as a result of feelings about their own state of inadequacy. It’s important to speak up. Bottling up emotions will not only harm your mental state but can also create a rift between you and your partner. Couples often feel they should give up at this stage because there’s no point having sex if it won’t ‘work’. It might seem hopeless but, even in the face of upsetting results, couples do go on to conceive. 

Investigate Fully

Bleak test results do not mean a bleak future for you and your partner. Don’t be passive and just settle at an analysis. Be proactive and insist all underlying factors are assessed. Consider lifestyle changes and also supplements. Studies have shown how antioxidants can improve sperm parameters. Sperm is particularly vulnerable to what is known as oxidative stress or free radical damage. Free radicals are unstable molecules that are linked with cellular destruction; high levels of them endanger sperm function and viability. Causes of raised levels include poor nutrition, pollutants such as smoking and poor detoxification processes in the body, and burnt, fried and barbecued foods.
 

Remember All Is Not Lost

Even if you have a low sperm count, it only takes one sperm to conceive. All is not lost because of a poor sperm analysis result. Treatments such as IVF and ICSI (intracytoplasmic sperm injection) can help as well. In rare instances, sperm donation may be a solution too – and this should not be seen as failure. Although they may not have been the first choice, avenues like sperm donation still lead to couples forming the families they always wanted.

“I was 15 when I was diagnosed with Hodgkin's lymphoma. After a year of treatment, I tried to get my teenage life back to normality but, when I was 17, I started having unremitting back pain. The lymphoma had returned and spread to my abdomen, meaning I needed to have chemotherapy. A week after my diagnosis, I remember so clearly being sat in an appointment talking to a fertility doctor. I had no idea what was going on, and everything was happening so quickly. I was told I had three days before starting treatment to decide whether I wanted to give sperm samples if I ever wanted to have children. I was just a child myself then; I had no idea what the implications actually meant. I ended up putting three vials into storage before starting treatment. Because storage was funded by the NHS, that was the last I thought about it.
 
“I met my wife during my time at medical school and it was only at this point that the pieces of the puzzle finally slotted together. Before this point, I’d never thought about fertility, children or marriage. My wife knew my history and her being in the medical world herself made our fertility journey so much more bearable. I don’t know what I would have done if I’d had to go through it all with someone who may not have understood so well.
 
“When we decided to try IVF, we made an appointment via the GP with a local clinic. The first round is available on the NHS, but every clinic is different. We had to do a lot of research to see which clinic had the best outcomes, but were limited geographically due to work. We were aware of the gruelling regimen of IVF courses so could not realistically be too far from the clinic. We were also acutely aware of only having three chances.
 
“Throughout the process, I felt a little guilty as I was so uninvolved physically. It was my wife who had to undergo all the treatment, needles and hormones. My sperm was already frozen and waiting to be thawed. My wife was working night shifts at the time, so it was hard on her having to inject at night discreetly as we didn’t tell anyone we were having IVF, just in case it didn't work. Sadly, we miscarried the first few times, and decided to move to another clinic.
 
“We now have three healthy children, the first one born in 2017. We started IVF when I was 32 and my wife was 31 and, in total, we had two failed rounds and two consecutive successful rounds. The failure was hard to deal with, but we said we would keep going until we ran out of vials. Maybe it was easier for us as we had an endpoint we couldn't change.
 
“Medical advances have now made it possible to overcome most fertility issues. It’s often our ego that gets in the way. If we want a child and are mature enough to take on the responsibility of being a parent, we have to let go of our ego and accept the cards we are dealt. Sadly, fertility issues can destroy relationships, more often because of the emotional damage of unsuccessful IVF rounds. But be open and honest with your partner and seek help. I only had three vials (three attempts) and I am so lucky to now have three beautiful children.”