Fertile ground: Dr Phil Kieran on getting his semen quality analysed

Fertility advice is something we rarely hear men enquiring about. But it is important to know what lifestyle habits might be affecting your sperm count, writes Dr Phil Kieran

CLOSE ENCOUNTER: In most cases, male infertility has no symptoms and is only identified when a sperm sample is analysed under a microscope.

ABOUT two years ago, as part of an experiment for a TV show I was working on, I had to provide a semen sample for analysis. Despite having two kids, I was gripped by a completely irrational fear on the day I was due to get the results. Even now I can’t fully explain why I felt so nervous. I knew I was fertile. Did it matter if my count was at the higher end or lower end? It wouldn’t have changed anything about who I was so why should I care? But I did…

I’m probably not alone. A lot of men hang a bizarre sense of value on their fertility as some marker of manliness.

Fertility advice is something I rarely hear men enquiring about. I’m not sure why this is but it seems that most of the burden in investigating difficulty conceiving falls on women — in fact, I have probably spoken to more men who are partners of my patients about this issue than to my own male patients. The truth of the matter is that the causes of difficulty getting pregnant are just as likely to be on the male side as the female side. About 40% of fertility issues are female, 40% male, and the other 20% are either combined difficulties or cases where no clear cause is found.

What I’m saying is, if you are having difficulty conceiving and decide that further tests are needed, it’s both parties who need to take responsibility.

So, what do I need to know?

As a man there are three basic components to fertility and they are fairly intuitive really. First you need to make sperm and enough of it (sperm count), second you need to be able to get it to the egg (normal sexual function and sperm motility), and third that sperm has to be healthy enough to fertilise the egg and produce a baby.

Problems can arise at any one of these points and, unlike in women where very regular periods can be a reassuring sign that the system is in good working order, male infertility often has no symptoms and is only identified when sperm sample is looked at under a microscope.

Sperm is made in the testicles and under normal conditions this process continues from the time we hit puberty until our death. This is a process which takes between 74 and 120 days start to finish. You can think of this as a production line for sperm with new sperm cells starting production every day as complete functional sperm roll off the end of the line ready to go.

Sperm mature in tubes, which are attached to the top of the testicle known as the epididymis, and then during ejaculation a large number (normally 15m to 200m per ml) are delivered to the penis via the seminal vesicles and the prostate gland and is mixed with fluid. The fluid makes up about 99% of ejaculate with sperm accounting for only 1% this is why after vasectomy, there is no difference in ejaculate except under a microscope.

The whole process

I have described above

is influenced by a number of factors, some within our control. On the odd occasion, when I do have a man in my surgery asking what he can do to try and improve his fertility, there are quite a number of things I can recommend.

What can I do to fix the problem?

To begin, let’s talk about smoking and alcohol. These have quite profound effects on sperm production with smoking causing decreases in the number of sperm produced and, perhaps more importantly, causes a significant number of the sperm produced to be abnormal or ineffective.

Alcohol can do the same, particularly binge drinking. Unfortunately any of these changes can be slow to improve the situation due to the length of time sperm production takes. It may take up to three months for problems to reverse.

Also, it’s important to point out that c

Cannabis use will also decrease fertility and can have longer lasting effects than normal tobacco use.

Obesity reduces sperm count and again reduces sperm quality although not as much as alcohol and smoking. This is because carrying extra weight, particularly around your belly, is associated with a number of hormonal changes, which aren’t good for you. Improving your diet, reducing alcohol intake, and stopping smoking can help with most male fertility problems.

A lot of this is old news to some patients but there is another factor which surprises most people and it relates to why our testicles hang outside our body.

Anyone who has been kicked in the testicles will confirm that having something so sensitive hanging on the outside of the body is a terrible design flaw. Why are they there? The answer is temperature. Sperm production works best at a temperature of 35C-36C, up to two degrees colder than your core body temperature.

This is something a lot of us interfere with without even noticing, and it can have a surprisingly negative effect. Wearing tight underwear, sitting on heated seats in your car, or enjoying regular hot baths or Jacuzzis can decrease sperm count as much as smoking (although smoking has effects other than just reduced numbers).

…and if that doesn’t work?

For some men, even with all the best lifestyle habits in the world, there just isn’t enough sperm being produced. . Up to a few years ago, if this was the case, there was little that could be done. Now, however, with assisted fertility there are procedures which can locate sperm in the testicle itself and transfer it directly into an egg, giving even people with almost no sperm in their semen samples some hope of conception.

If you are planning on starting a family my advice is try and give the unhealthy habits a rest, get a reasonable amount of exercise — nothing excessive though — and keep cool.


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