Causes of male infertility
22nd November 2018
So, who is an avid fan of Handmaid’s tale? Definitely me! It always sparks curiosity about the causes of male infertility. As a mirror to our society the show seems to mainly highlight women. However, the background story is also about male subfertility, though the show doesn’t explore much about the actual causes of male’s inability to cause pregnancy in a fertile female.
Fellow fans will have noticed when ‘Commander Waterford and Mrs Waterford’ visited Canada in the last episode. An American official – in protest of the regime in Gilead – said “Gilead blames the fertility crisis on women, on their sinfulness, we see the problem more often originating with the men. Some of the best scientists in America have been working on fertility for years.”
**End of spoiler**
What causes male infertility?
So what is the role of male fertility? Men don’t have an equivalent to the menopause right? So they don’t have this ticking biological clock? In this blog we explore what the most recent scientific research says.
While women do have a biological cut-off point for fertility – the menopause – it is true that no such point has been defined for men. This has meant, however, that the study of age and male fertility has lagged behind that of female fertility – this includes the public perception of the issue.
It’s fair to say our current healthcare system doesn’t reflect this. As pointed out by Dr Sarah Martins da Silva, female fertility is closely scrutinised for fertility treatments. But the influence of paternal age is often ignored.
Top causes of male subfertility
There are several issues that can be a cause of male infertility. I’m not going to try to give a definitive “Top 10 causes of male infertility” here as this is still very much an area of research and can be quite specific to a man’s situation.
- Very low or no sperm count (called oligozoospermia, yes, that’s for real!)
- Weak sperms that aren’t able to reach the egg (known as sperm motility)
- Abnormal sperm shape (known as morphology), which makes it difficult for them to reach and fertilize the egg
- Damage to testicles which affects the quality of semen (typically varicocele, the enlargement of veins)
- Ejaculation disorder, whether premature, delayed or retrograde.
- Hypogonadism, when the body doesn’t produce enough testosterone
- Genetic causes of male fertility also do exist but this is quite rare though as noted above this is a very interesting area of new research
- Hormonal causes of male infertility can actually be a bit misleading. Typically this is not so much about how hormones impact the quality or volume of sperm but rather sex drive, mostly through the hormone testosterone
The science is starting to catch up
But science is starting to catch up on understanding the causes of male infertility. Recent research shows that age does have an impact on male fertility. One study found men over 40 years old were half as fertile as men under 25. Another study found it takes five times longer to conceive when the father is over 45. Studies also associate paternal age with increased risk of pregnancy complications and loss.
Whatever the cause of fertility problems, it’s obviously crucial for no blame to be assigned – the dystopian version of that reality can be found in the Handmaid’s Tale. Instead we must have an open and honest conversation, empowering people to understand the facts and make more informed choices.
We often focus on women’s fertility when trying to get pregnant. Have you ever wondered about the male side of the equation –and how important sperm count is? It is often considered a taboo to discuss this issue among men and if you have a male partner, it can certainly be tricky to talk about. As a result it is often ignored.
What is Movember?
November, also known as Movember, is the month where you will see lots of moustaches around town. Movember is a big campaign to raise awareness about men’s health. It’s all about starting a conversation about infertility taboo topics and encouraging men to take action about their health. One of their big campaigns is around mental health – three quarters of suicides are men and poor mental health leads to half a million men taking their own life every year – yet men’s mental health remains shrouded in silence.
As you might guess there is a lot of taboo surrounding male infertility and reproductive health in general. There are some great organisations around the world setup to support Movember and raise awareness including this one in the UK.
Influence of male factors on infertility
If you’re planning on trying to conceive in the near future it’s important for you to understand the causes of infertility and remember the crucial role that sperm health plays. It’s not just women who are responsible for fertility health. In fact, you might be quite surprised to know that female factors just account for the 40% of the problems in conceiving which means men’s factors account for more than 50%!
Everyone seems fixated on the age of 35 that women’s fertility starts to decline. Yet little attention is given to sperm health and it is a widespread historical misconception that male fertility doesn’t decline with age. While it’s true that men don’t experience the menopause – a biological cut-off point for fertility -research does show that ageing has an impact on male fertility.
Research finds that men above the age of 40 have less than half the fertility than males under the age of 25. Research also finds that older parents also experience more pregnancy and fertility complications.
Can a man go from infertile to fertile?
While there are a wide range of causes of male infertility. The good news is most conditions that may limit male fertility most can be addressed and managed to improve fertility. For men there is (obviously) quite a different “situation” let’s say than for women. For women fertility in terms of ovarian reserve (or the number of eggs a woman has) starts declining from birth! There is really nothing women can do about that decline over time and often the rate of decline increases in the late 30s. However that is not the end of the fertility story as the other elements of female infertility such as the ability to recruit an egg or the quality of the egg can really make a different in someone’s ability to get pregnant. That’s why understanding other hormones such as anti mullerian hormone (AMH) through a comprehensive fertility test like the one Adia offers and fertile signs is so important.
Men have it a bit easier let’s say as their supply of sperm does not decline from birth in the same way. Men actually replenish their entire sperm count about every 72 days. Yes, I’m not making that up – it really is about 72 days. Over time that count can go down but more importantly the quality of sperm can decline. However, men can make fairly dramatic improvements in that sperm quality through mostly dietary changes. Specifically, improve the in-take of anti-oxidants, which can be easily consumed through supplements or, interestingly, nuts! Yes, nuts are a great source of anti-oxidants and a range of other health benefits.
Can a man prevent infertility?
The answer is yes and no. Sorry, I know that doesn’t seem very helpful. Here is the thing, male sperm count and quality does tend to naturally decline with age. And here is the scary part, over the past couple of decades it has begun to decline dramatically. As explained in this recent GQ article “Sperm Count Zero” a study led by Hebrew University and Mt Sinai medical school found that “sperm counts in the U.S., Europe, Australia, and New Zealand have fallen by more than 50 percent over the past four decades.” That means we are producing half the sperm our grandfathers did. Specifically the study found that “Sperm counts went from 99 million sperm per milliliter of semen in 1973 to 47 million per millimeter in 2011, and the decline has been accelerating.”
Now you might ask well why hasn’t that decline led to a massive decline in male fertility. The reason is men don’t need 99 million sperm to reproduce, they just need one to conceive. So the changes in fertility rates are really being masked by sociological changes like couples in developed countries choosing to .have fewer children. However, the rate of change is nonetheless alarming as a mix of a range of factors that just make it harder and harder to conceive.
That may all seem pretty depressing. But as I noted a male doesn’t need hundreds of millions of sperm to conceive and a true condition of male infertility is far from that average in the study above. Men can do a lot to prevent fertility decline and avoid infertility by avoiding the following key risk factors:
- high alcohol consumption
- certain illicit drugs
- severe depression
- past or present infections
- exposure to toxins
- overheating of testicles
Most importantly, it’s best to get a male fertility test and then talk to a fertility specialist, like our experts on Adia, if results are low. There are also many medical conditions that can a cause of male infertility so its worth speaking to a doctor if the test results indicate something’s not right.
How to take action
I hope this has all been informative in understanding the causes of male infertility. My aim of this post though is really to empower you to take action and understand both your fertility health and how to improve it. So here are a few key ways to take action:
- Get those sperm tested: If you have been trying to conceive for quite some time, but haven’t had any success, then undertake a semen test or sperm test to know whether you have a normal sperm count or not and whether your sperms are healthy and moving properly or not.
- Boost your sperm health:There are steps you can take to boost sperm health. Some of the steps are well known (although easy to say and harder to do in practice!) – like stopping smoking, reducing alcohol intake, and maintaining a healthy weight. Others like keeping your testicles cool and managing stress less so! More information here.
- Take supplements: Oxidative stress (sperm cell damage) is a leading cause of male subfertility. Recent studies have also shown that antioxidants can reduce oxidative damage. Proxeed is a supplement that has been validated in clinical trials to support sperm health, and contains antioxidants.
- Focus on your relationships: Trying to conceive can place pressure on your relationships – whether that’s with a partner, family or friends. Having open conversations, including about any issues, can provide much needed support. If you’re in a relationship, take time for your partner – remember to have date nights, practice gratitude, and have fun together. If you’d like to find out more relationship tips, check out our blog “what makes a good relationship?
- Get support: Don’t go it alone – speak to fertility experts, speak to your friends/ family or connect with others going through a similar experience – once you start the conversation you’ll be surprised how many people experience complications on this journey. Your Adia Coach and Experts can help guide you too.
This post is a summary of a longer module in Adia’s FREE 12-week fertility health programme. To see the whole programme just sign up!