Male fertility

One in eight Australian couples are described as infertile. Infertility is defined as the inability of a couple to fall pregnant after one year of unprotected intercourse. In most cases, the diagnosis of ‘infertility’ definitely does not mean that you will never be able to have children, though it’s such a loaded term, it ‘feels’ like that’s what it means.

Around 40 percent of couples who use IVF or other assisted reproductive technologies (ART) do so because of male fertility problems. Around 5 percent of the Australian male population of reproductive age is thought to have fertility problems – with low sperm counts or poor sperm quality.

Common reactions to a diagnosis of male fertility problems

Most men who are told that they have a fertility problem are shocked and upset by the news. Even though male fertility issues are extremely common, they are not openly discussed.

Because there is a widespread (and incorrect) assumption that most infertility issues are related to a female partner, couples who experience fertility issues often have an expectation that a problem will be found.

There’s a cultural link (but NOT a medical or physical one) that assumes that a virile and masculine male will be very fertile and have a high sperm count; so for many men diagnosed with a fertility problem, the psychological association with male weakness is pretty devastating, even though it’s not an accurate one.

Men often feel humiliated and angry and do not want the information to be discussed publicly. Denial, depression, resentment, and loss of self-esteem are very common reactions. Sexual problems (such as a loss of interest in sex and temporary impotence) are also common responses.

Most fertility clinics have counsellors who specialise in these issues and there is strong support available from others in the same situation through support groups such as Access Australia.

A common and understandable male reaction is to want as much information as possible about the cause of their infertility. With around 40 percent of male fertility problems having no clear cause, this can be met with very frustrating responses from medical professionals.

The basics of male fertility

The most common causes of male fertility problems are due to an issue with the production of sperm in the testes or a blockage in one of the reproductive tubes.

Sperm take around three months to go from their earliest stage to ejaculation – which is why male fertility treatment that involves changes in diet or environment sometimes recommends that couples wait for three months before trying to get pregnant again.

After developing for about seventy days, almost-mature sperm then leave the testes and take another fourteen days or so to pass from the testicles through several tubes before combining with fluid from the seminal vesicles, prostate gland and the bulbourethral and urethral glands just before ejaculation. (No wonder you’re so tired afterwards!)

In a healthy young male, around 100 million sperm are produced within the testes daily. This number declines with age and with other stressors such as poor health and exposure to heat, chemicals or radiation which all affect male fertility.

About 60 percent of semen comes from the seminal vesicles and around 30 percent comes from the prostate gland. The average volume of semen is between two and five ml and the average sperm concentration is around 85 million per ml.

There are usually quite a lot of dead or abnormal sperm in a ‘normal’ sperm sample. The World Health Organisation definition of a ‘normal’ sperm sample is:

• sperm concentration of at least 20 million per ml
• total sperm count of at least 40 million
• total semen volume of at least 2ml
• at least 75 per cent of sperm still alive
• at least 30 per cent of sperm “of normal shape and form” (structure)
• at least 25 per cent of sperm swimming with rapid forward movement
• at least 50 per cent of sperm swimming forward, at any pace (motility)

Testing for male fertility

When a couple are investigated for fertility problems, the male partner will usually give his medical history, undergo a clinical examination and provide several semen samples over a few days (because results often vary a lot over time).

Semen analysis is the most useful test for male fertility and laboratory testing of the presence and nature of sperm in the semen is often all that is needed.

If further investigations are ordered, male fertility may be checked with blood tests that investigate levels of sperm antibodies, hormone levels and for the presence of various genetic disorders.

Male fertility investigation can also involve an ultrasound of the testicles and prostate gland, a biopsy of the testes and occasionally a surgical investigation to look for tube blockages.

Male fertility causes and treatment

An estimated 12 percent of men have untreatable sterility, around 13 percent have treatable conditions, and a further 75 percent of male fertility is related to problems with the production or function of sperm, where treatment is not clearly defined and may vary for each case.

Short-term causes of male fertility problems can include recent infection or illness, heavy consumption of alcohol or street drugs, consumption of anabolic steroids, and even regular use of spas or saunas. In these cases, lifestyle changes can improve male fertility in about three months.

Other causes thought to contribute to a short-term reduction in male fertility include smoking, poor diet, levels of exercise that are either too low or too high, stress and anxiety, exposure to toxins such as chemicals, heavy metals and radiation, use of vaginal lubricants and even wearing too-tight underwear.

In cases of untreatable male sterility, where no sperm is produced, adoption or donor insemination are the remaining options for those who wish to have children.

Low sperm production is sometimes treated with testosterone, or with injections of other gonadotrophins such as luteinizing hormone (LH) and follicle stimulating hormone (FSH), if hormone deficiencies are the cause. This can take a number of months to work.

Male fertility issues caused by genital tract blockages can sometimes be treated with bypass surgery, or sperm can be extracted by a needle or testicular biopsy for use in IVF or other fertility treatments.

Another cause of male fertility problems is the presence of sperm antibodies which reduce sperm count and motility. Treatment may involve steroid drugs for the male partner followed by natural conception or artificial insemination.

Male fertility is also affected by impotence, failure to ejaculate, or ‘retrograde ejaculation,’ with treatment including masturbation, vibroejaculation or electroejaculation combined with artificial insemination.

Male fertility diet

A number of foods are thought to be “sperm-friendly” and to encourage the production of good quality sperm. Vitamin supplements that include zinc, selenium and B-group vitamins are also thought to be helpful.

Male fertility is affected smoking, by eating foods high in trans-fats (basically all junk food) and also by consumption of tea and coffee.

A general healthy diet that is rich in unprocessed foods such as fruit and vegetables (organic where possible), whole grains, legumes and nuts and seeds.

Good quantities of grains such as oats, rye, wheat and buckwheat are recommended. Egg yolks and most seafood (particularly oysters and deep-sea fish) are also a good source of sperm-friendly nutrients.

By Fran Molloy, journalist and mum of four