1 in 6 couples in the UK have difficulty conceiving a baby. Modern medicine has tended to regard this as a female problem. Most research money has been spent on female factors and treatment is mainly provided by gynaecologists. In fact both male and female factors contribute equally to infertility. Male fertility has declined 60% in the last 40 years meaning that young men today have less than half the healthy sperm of their grandfathers. In fact some scientists predict that the human race could be infertile in 50 years! When a man has a poor sperm analysis no treatment is usually offered to him. His wife will be offered ICSI, an artificial reproductive technique where scientists choose one healthy sperm and inject it into the egg to fertilise it, or even for IVF using donor sperm. ICSI allows the man to have his own genetic child but can leave him feeling confused about his poor sperm analysis, and he may struggle to find information. There is also reason to believe that babies born from ICSI may have fertility problems themselves in adulthood.
In fact there is quite a lot that can be done for male factor fertility. Unlike girls, who are born with their lifetime supply of eggs already present in their ovaries, boys start producing sperm at puberty and go on producing it all their lives. It takes about 74 days to produce a healthy sperm and the quality of this sperm is related to his lifestyle and behaviour over that time period. Fortunately changing lifestyle and behaviour can significantly increase sperm quality.
A sperm analysis is not only a sperm count but also looks at the volume of the ejaculate, how well the sperm swim, and whether they are normal in shape. Each of these factors can affect fertility.
What causes a poor sperm analysis result?
There are 2 types of infertility, obstructive and non-obstructive. In obstructive infertility we can imagine that the factory is working but the road is blocked so sperm cannot get through. In non-obstructive infertility the factory itself is not working as it should, even though the road is clear.
There are several causes, of non-obstructive infertility. Overheating is a factor. The testes are positioned outside the body because they need to be about 2 degrees cooler than the body to work properly. Several factors can increase the temperature of the testes. A sedentary lifestyle, sitting all day with the testes between the thighs, sports, especially cycling, wearing tight underpants, keeping your mobile phone in your pocket, using a laptop on your lap, obesity increases heat from the fatter thighs, and varicose veins in the scrotum, known as varicocoele, also increases the temperature of the testes.
Poor general health due to smoking, drinking alcohol, taking non-prescription drugs including anabolic steroids and narcotics, obesity, which as well as causing overheating also causes some hormone abnormalities, workplace stress, and high blood pressure, as some high BP drugs cause infertility.
These factors can cause sperm oxidative stress. Our bodies use the oxygen we breathe to produce energy, but this process produces byproducts called free radicals which can damage cells and DNA. In small amounts they are useful because they stimulate repair, but if their numbers overwhelm repair processes it is called oxidative stress and it damages sperm DNA, which can cause infertility and also miscarriages.
Many different hormonal problems can also interfere with sperm production.
Some hereditary diseases can cause infertility, including Klinefelter syndrome, Y chromosome microdeletion syndrome, and Kallman syndrome.
Obstructive causes are where the factory is working but the road is blocked, such as where a man has previously had a vasectomy. The blockage can be high up or further down the sperm tubes or ducts. Some men are born without the sperm ducts. Cystic Fibrosis a common genetic condition which causes the small sperm ducts to become blocked. Men who have had an inguinal hernia repair using mesh can sometimes have a blocked duct. Infections can also cause the ducts to get gummed up.
Having trouble conceiving is itself stressful and may cause relationship problems which may effect sex drive and result in less frequent sex which compounds the problem.
Almost all of these causes are treatable. A physical examination by a urologist and blood and sperm tests will identify the cause and treatment can be prescribed.
What can you do to help yourself?
Refrain from smoking, recreational drugs and excessive alcohol consumption. Refrain from excessive exercises such as marathon running and cycling, but take regular moderate exercise. Eat a nutritious diet of vegetables, fruit, wholegrains, lean meat, and eggs. Eat good fats such as butter, cheese, olive oil, avocados and nuts as fats are required for sperm production. Maintain a healthy weight. Avoid exposure to synthetic chemicals and environmental pollutants including keeping electronic devices at a good distance from your body. Do not take hot baths, and wear underwear that allows air circulation around the testes. Take a supplement of antioxidants. Make these changes about three months before attempting to conceive, especially before having Artificial Reproductive Techniques such as IVF or ICSI. Finding out if you have sperm DNA damage early can save you time and the financial and emotional costs of failed IVF. This test is not normally offered by your doctor and will not show up on a normal sperm analysis. Get advice from a natural fertility specialist who can help you liase with your GP to get the right tests done, refer you for further tests if required, or to an andrologist if abnormalities are found, and to a Fertility Clinic only if necessary.