- 21. 8. 2018
- Reproductive health
FOR 40 PERCENT OF COUPLES WHO CAN NOT CONCEIVE, THE PROBLEM LIES WITH THE MAN. SO WHY IS MALE INFERTILITY RARELY SPOKEN ABOUT?
Female fertility is a “hot” topic. Women are constantly reminded of their biological clocks and warned about the risks to fertility of diet, alcohol and stress, but there is a gradual dawning that men, too, should plan their families sooner rather than later. It is devastating for any couple to learn they may never have biological children, but when the problem is found to lie with the man it can be even more difficult to deal with, as it is harder for men to access support and find the right treatment.
Women are all too aware of the pressure to start their families young, or freeze their eggs for future use, where as male infertility is rarely discussed. When there is a man with infertility diagnosis, for example of azoospermia (which means absence of motile sperm in semen) the whole fertility world is geared towards women.
There is a gradual dawning that men, too, should plan their families sooner rather than later. Not only is there concern that sperm quality and quantity are decreasing throughout the developed world, there is also mounting evidence that late fatherhood (from 45 onwards) has risks attached for the health of the child. Sheena Lewis, emeritus professor at Queens University Belfast, has been working in the male infertility field for 30 years and believes we are in a male fertility war zone. A massive 40 percent of fertility problems involve men, yet fertility has always been seen as the woman´s department.
The stream of male celebrities who have started families in later life has lulled men into a false sense of security. Paul McCartney and David Jason both had children at 61, Rod Stewart and Clint Eastwood at 66. These superstar dads make people think fatherhood is as easy and natural at 60 as it is at 20. Well, it really isn´t. In truth, a man in his 40s is half as fertile as he was in his 20s (this is why sperm donors have to be under 40). If an older man with fertility issues is with a much younger woman, then her eggs have a good chance of overcoming the problems. This explains those superstar dads. But most men partner women within five years of their own age. When you have a man in his 40s and a woman in her late 30s, there are more likely to be problems on both sides.
The question of sperm quality is even more important. People tend to believe all sperm are of equivalent quality though we are all aware that egg quality declines for women. Now we are beginning to acknowledge that paternal age raises the risk of DNA mutations and chromosomal abnormalities. Studies have shown that the children of older fathers are more likely to suffer mental disorders as well as a greater rate of childhood cancer.
Age aside, there is also concern that sperm quality and quantity is decreasing across the board. Recent research from the University of Copenhagen suggests that unhealthy lifestyles are written into sperm, so, for example, obese men could pass on obesity to their children. And last year, the annual meeting of the European Society of Human Reproduction and Embryology heard that just 25 per cent of young men have optimal semen quality, while 20 to 30 per cent have reduced numbers and quality of sperm. A further 10 to 15 percent have sperm counts low enough to require fertility treatment should they wish to become fathers.
One possible explanation is the volume of manmade chemicals in the environment that mimic female hormones. (Exposure in rivers has been shown to feminise male fish.) Modern life may also be to blame. Hot baths, tight-fitting nylon underwear, laptops, prolonged sitting down, smoking, obesity. Then there is a stress. Studies suggest it can affect sperm concentration, appearance and ability to fertilise an egg.
Obesity might have an impact on male fertility as well. If you work on your healthy diet and lifestyle, covering everything from hot baths (bad) to boxer shorts (good), smoking, over-the-counter medication such as antihistamines, weight loss and the benefits of a high-antioxidant diet you are helping to your fertility. If diet and lifestyle changes make no difference, what follows is a kind of grieving and then a coming-to-terms process.
There is more stigma for men. Women cry it all out; men have to be dragged to deal with the facts. There is this male-locker-room idea that poor sperm quality means you are not a real man. Men struggle hard with infertility issues.
And – the imbalance is a problem. There are no great treatments for men we stumble across them left-field. The only breakthrough on the horizon is the possibility of growing sperm in a lab for men who don´t have any. (A French team claimed to have done so last year, though this is yet to be verified.) Also, for men wanting a test that goes beyond fertility to check sperm quality and DNA damage, has been developed the SpermComet test.
Men have been marginalised. It is as if all they need to do is produce one sperm and that is it, job done. No one has questioned quality, no one has told men that, when they are in their 20s, they do need to think about when they are going to start a family just as women do.
Lets hope that is finally beginning to change.