Expert / 30 October, 2019 / Dr Larisa Corda

Male Infertility: The Stigma, Causes, Treatments & Emotional Impact on Wellbeing

Male infertility: Men are often the neglected and forgotten part of infertility. Whether it be a medical issue affecting their ability to conceive, or whether it’s the burden of anger and frustration they have to bear seeing their partner struggle to conceive, the emotions engendered are many and complex, yet often endured in silence.

The stigma around male infertility

There still continues to be a stigma around male infertility, which is nowhere near as widely discussed as the female problem, and this stigma is even seen in the medical profession where the term “andrological ignorance” has been coined to describe the paucity of male fertility treatments and male contraception, compared to the female, where there are more options.

What is the emotional impact of male infertility?

A survey done in 2017, 93% of men said that infertility had a negative impact on their lives, their wellbeing and self esteem. Men claimed to feel depressed, anxious, lonely and even suicidal. The incidence of male mental health problems is increasing, yet we continue to treat male infertility as a taboo subject and creating even more of a barrier for men to talk. Men are being left in the dark about the importance of sperm health to pregnancy and the health of the future child, which means a delay in recognising abnormalities and presenting to the doctor.

I believe that a good deal of the problem lies in the fact that there is very little education about the incidence of male infertility. Male infertility can account for problems in 30-40% of cases. yet this is rarely discussed.

Male fertility is declining at an alarming rate

In fact, despite growing evidence that male fertility is declining much faster than anyone had anticipated, leading some to question whether this is part of a wider testicular dysgenesis syndrome that involves declining sperm quality, and an increasing incidence of testicular cancer as well as undescended testicles in male children.

A comprehensive study published last year by the Hebrew University of Jerusalem suggests that sperm count among Western men has more than halved over the past 40 years. There have been several other studies that have reached similar conclusions, but this was by far the largest. According to experts in the field, as many as one in five young men have low sperm counts, and about one in two are below the optimum.

What is responsible for this phenomenon we’re seeing and why are we not doing something to reverse it?

Part of the issue is that male infertility is under reported, because of the barriers to going to see the doctor in the first place, and therefore not investigated as much as it should be. Even when it is investigated, we have very limited means of doing this, including a semen analysis, that fails to inform a man about how well the sperm are actually functioning. In other words, just because a man’s semen analysis is normal, does not mean that the sperm are normal.

We have recently seen headlines being made by the fact Klinefelter’s syndrome, where a man carries an extra copy of the female X chromosome, is far more common than we think, affecting 1 in 600 men and their ability to produce sperm. Diagnosis can take up to two years because of the barriers to male infertility testing.

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Lack of education around lifestyle

The other part of the problem is a lack of education around the impact of lifestyle, including diet, exercise, smoking and alcohol on sperm quality. Also, how epigenetically speaking, these same lifestyle factors can affect sperm production in a male baby because of the genes the baby inherits via the sperm used to conceive them. Recent science is showing us that lifestyle has a large and significant role in influencing gene expression and DNA that is passed on to future children.

We can’t have a conversation about infertility without involving the men too. Their contribution to the process of conception is just as important as a woman’s and it’s time we start discussing it on equal terms as well, providing men with an arena to discuss their problems in, but also with good education on practical changes they can make and start to help optimise their chance of success when it comes to having a baby later down the line.

In an age where women and men are getting older before they look to start a family, we often hear about the reproductive decline on the female side, yet there remains this false notion that men will be able to continue to father children even into their 90’s! The media runs headlines of men in their 70’s and 80’s who supposedly had no problem at all making their partner pregnant. This is despite the fact sperm counts are declining all over the world, such that over 15% of young men now have poor semen quality. There doesn’t seem to be the same push to raise fertility awareness in men and enable them to be more proactive, so that they can detect any problems sooner rather than later and still have time to optimise their sperm production.

Men are able to produce new sperm every 3 months, which essentially means that lifestyle changes have the ability to positively influence male fertility on a massive scale even if before then a man might have led an unhealthy lifestyle. Because sperm are particularly sensitive to environmental triggers, such as plastics and certain pollutants, it’s especially important to consider how to minimise the risk of exposure to anything that could be a toxin. This is why I always recommend The Conception Plan to any man who is looking to optimise his reproductive health, even if he hasn’t already actively started trying with his partner, or if he is undergoing treatment. The principles are essentially the same as for women, with all pillars complementing each other and improving sperm health in a very real and significant way that can be noticed after just 3 months of commitment. The main principles are summarised here.

Remember not to neglect your own emotional needs as a man. Whether it’s dealing with your own infertility, or helping to support your partner, it’s important to seek help and talk to a counsellor or a support group that can help, and where you’ll be able to gain strategies in how to deal with the stress this burden brings, as well as realising you are not alone.

By Dr Larisa Corda

For support with IVF/TTC join The Jellie Diary support group IVF/TTC A Place to Talk. There’s also a new men’s only support group, The Men’s Room.

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