Let's talk male infertility

It’s widely known that male infertility is on the rise but men often respond to the news with shock, anger and sorrow, says Áilín Quinlan.        

THE headlines are shocking — the sperm counts of western men are in a downward spiral that poses a threat to fertility in industrialised countries.

But behind the stories warning of an almost 60% drop in the average amount of sperm produced by men in industrialised countries between the early 1970s and 2011 is a series of real-life stories of shock, rage, distress, and sorrow.

On average, about one in 15 men have fertility issues, according to Dr Minna Geisler, consultant in reproductive medicine, adding that these range from mild to significant, and may not impact on a couple’s ability to conceive.

Male fertility issues currently account for 30% of the problems experienced by couples who attend fertility clinics, she says, while another 30% of couples will find their problems lie in a combination of male and female fertility issues.

“We have seen a decline of sperm parameters over the last few decades. Sperm counts are falling and potentially, in the future, we may see a rise in infertility,” says Geisler, who is based at Waterstone Clinic in Cork.

What’s the cause? The environment may have something to do with it, says Dr Hans Arce, fertility consultant with the SIMS IVF Clinic in Cork.

“Semen quality has dropped in the last 40 years or so, and we don’t know exactly why it is happening but there is a belief that it has to do with contaminants in everything from pesticides to the burning of plastics,” he says.

“There is a theory that the pollution ingested by men acts as a false oestrogen, which affects the male hormones, reducing the quality of sperm in the testicles — we have seen that men in industrialised areas tend to have poorer sperm counts than men in less industrialised areas.”

Despite the fact that we are in 2017, it seems that a man’s fertility is often closely associated with his masculinity.

Some men take a diagnosis of subfertility or infertility very personally, says Arce. “A lot of men are surprised when they hear it. There’s a macho stigma there.”

While the majority of men react “quite well”, he has experienced would-be fathers becoming angry or upset, while some cannot bring themselves to believe it.

“They take it as an insult. Others make jokes about it. They can be rattled by it. Society pushes men to be obsessed about their genital organs and if you tell them that something is not quite right, they may feel compromised,” he says.

However, many couples wait too long before trying for a baby.

Although increased age does not have nearly the same impact on men’s fertility as it does on that of women, one of the major causes for couples experiencing difficulty in conceiving is that they’ve waiting too long, says Arce.

“In the underdeveloped world, people are having children much younger than in the first world, and they’re not having problems with fertility.

“We were originallycreated by nature to have a lifespan of between 30 and 35 years, and now we are having children at the age we should be dead — at 38 and 39.

“There are other issues to do with sperm quality but, without a doubt, the main contributor is age.”

There is a lack of awareness in society about the prevalence of male subfertility, says Geisler. She has found that couples are so often prepared to hear that the problem in conceiving relates to the woman that they’re shocked when tests highlight a male fertility issue. Some are so stunned that they are rendered speechless, she says.

“Initially men can be reluctant to discuss it,” she says, but the clinic feels it is crucial to engage with them and discuss options and causes. “A diagnosis of infertility can have a significant impact on a couple — there may be an element of feeling responsible or of placing blame.

“I always encourage patients to attend our free fertility counselling to discuss their feelings about this because they are not prepared for it.”

Recent research has pointed to a link between male fertility and diet. “There is a belief that a high intake of fatty foods, snacks, sugar, and red meat, along with lower intake of fruit and vegetables, may be having an impact on male fertility, as well as alcohol, increased levels of smoking,” she says.

The take-home message for men who are hoping to become fathers, says fertility expert Dr John Waterstone is that they should optimise lifestyle factors in order to maximise their fertility. “Sedentary lifestyle, obesity, smoking, stress, and poor nutrition may potentially have adverse effects on sperm count and quality.

“Often, it could be just simple lifestyle changes needed, while in other cases, if natural conception is impossible, assisted reproduction techniques can overcome this problem and techniques such as intracytoplasmic sperm injection treatment can be used.”

This laboratory technique is used where a man has a low sperm count and involves selecting his best quality sperms and injecting one into each mature egg produced by the female partner.

The Waterstone Clinic carries out in-house testicular biopsy — known as TESE — for men with azoospermia (no sperm in their ejaculate). Some months ago it became the first clinic in Ireland to achieve a live birth following microsurgical testicular sperm extraction (micro-TESE), a more advanced, surgical method of sperm acquisition for men with no sperm in their semen.

While there is well-justified concern about the potential impact of falling sperm counts in the western world, thanks to increasingly sophisticated technology, there is hope for those affected.


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