Michal Schonbrun, MPH,
September 2024
Share this article with someone you know who is going through the process and with your physician.
In the ways medical professionals “manage” infertility, you might never know that nearly half of all known infertility problems are among men. And contrary to what we might think, in the majority of cases, male infertility (and subfertility) is not typically caused by low numbers of sperm (even though this number has significantly declined in past 50 years); rather it is caused by low-quality sperm, particularly motility (how fast and straight the sperm swim and move forward) and morphology (sperm forms or shapes).
While a woman’s body carries a pregnancy, it is not biologically inevitable that she must undergo infertility treatments. So why do women carry the burden and stigma of infertility if the problem lies 50% of the time with men?
“Modern medicine” does not have tools for “fixing” poor-quality sperm. So doctors piggy-back on the problem by performing IVF on women, with carefully-selected sperm cells.
The majority of IVF treatments today are done with Intracytoplasmic sperm injection ICSI– a procedure in which a single sperm is injected into an egg cell (in a petri dish, in the lab). After a number of days, the now fertilized egg is inserted up into the uterus (via catheter) where it will hopefully grow into a healthy pregnancy. ICSI is done for two reasons: one, it apparently leads to higher fertilization rates (but there is some controversy about this) and two, because male infertility is the elephant in the room. Why has this become the default treatment? Because poor sperm quality has become the norm and poor sperm reduce the likelihood of a healthy pregnancy and live birth.
Too many women’s bodies go “under the knife,” enduring a slew of invasive treatments, complete with side effects and short and long-term health risks. As health consumers and patients, we put our unwavering faith and trust in medical science without any critical thinking or analysis. We view ART and IVF as miracle methods when natural reproduction fails while forgetting that IVF is still experimental medicine and we women are its guinea pigs. Even after forty-plus years of IVF – the live birth (success) rate is still low, only 25-30%, which of course decreases with advanced maternal age. Yet the IVF industry (unregulated) is valued at more than $35 billion!
While we are grateful and blessed that such technology enables thousands of women and couples to bring life into the world, it behooves us to be mindful about the reality. One of the major reasons why IVF success rates (defined as having a healthy baby born at the end of a pregnancy) are still low is that too many artificial “fertilizations” result in chromosomal abnormalities and DNA damage- caused by abnormal sperm. Because current sperm analysis (SA) testing does not look at the genetic and epigenetic factors of male subfertility, the result is often recurrent pregnancy loss (miscarriage) and infertility – something that is mostly attributed to women! Some scientists are beginning to sound the alarm that a current sperm analysis can render sperm “normal” from the outside, but a genetic analysis from the inside can render these sperm as dysfunctional.
Not only is the way sperm are analyzed not changed in decades, it turns out that traditional semen analysis is limited because it does not actually predict a man’s fertility potential or the sperm’s ability to travel and reach the oocyte (egg). An estimated 15-30% of men with infertility actually have normal sperm profiles! There is a slow but growing medical awareness that new tools need to be developed and tested for diagnosing and treating abnormal sperm and male subfertility.
Believe it or not, we don’t have doctors who specialize in male infertility related to poor sperm quality. We have andrologists for a minority of men whose infertility is related to hormone imbalance, among other issues. We have urologists who can diagnose and treat the 15% of men with varicocele- veins that are blocked in the scrotum which prevent semen from being ejaculated (but urologists are mainly focused on treating kidney, bladder and prostate problems). And we have gynecologists who are the de facto “managers” for helping women to conceive.
Until the science leads us to better diagnostics and treatment options for men, this is how we can become more proactive about the gender gap around infertility and who gets treated.
As health consumers, we need to wake up and recognize the reality- men’s reproductive ill-health is contributing to the infertility crisis. It deserves more attention; male infertility needs to come out of the closet. When practitioners and scientists keep their heads in the sand, they are reinforcing the cultural perception that infertility is still (mostly) a woman’s problem. This means we are lagging behind and ignoring the urgent need to step-up research and create new tools for diagnosing and treating genetic aspects of poor sperm.
Take responsibility: Men are partners and co-creators in their fertility journeys. Don’t take your fertility for granted. Join the conversation. Men and the doctors (gynecologists) who communicate with couples about their infertility need to swallow their pride, put their psychological discomfort aside and become more fertility-aware about the prevalence of male infertility and its impact on overall health. Fertility Awareness is not just a woman’s issue. Creating a healthy pregnancy is a responsibility that belongs to both partners equally.
Ask questions: After you do a sperm analysis- ask the gynecologist to precisely explain your test results because they often do not! Many doctors will downplay or avoid the unpleasantness of informing a man about his poor sperm quality as this can cause a male to doubt his sense of masculinity and self-worth (while there is never a problem informing a woman about her problems). The doctor’s calculation is this: In the end- the woman will be treated, so we can spare the male partner the “bad news” that something is wrong with him. Technology enables the selection of a single, high-quality sperm, injecting it into the egg, and returning it to the uterus, while a couple prays that a viable pregnancy develops.
Educate yourself: If you don’t get a satisfactory response from the doctor- go home and google “how to interpret a sperm analysis.” It’s not rocket science; you can easily access this information online. If you understand that your sperm motility and morphology are low/borderline low- consider the many ways in which you can improve your fertility. Lose weight if necessary, switch to a healthier, balanced diet and learn about vitamins and nutritional supplements. Get regular sleep, engage in exercise, manage and reduce the stress in your life. Also, don’t wait too long. Age is also a factor. In the same way that chronic annovulation in women can harm their overall health, male infertility including low-quality sperm can harm men’s health too. It’s time to connect the dots.
Avoid bad lifestyle choices: Many social and environmental factors are known to harm male fertility: high temperatures, exposure to electromagnetic radiation (this includes laptops, computers and cell phones), sexually-transmitted infections (wear condoms if you are partnered with more than one!), alcohol, tobacco and cannabis, and chemicals in processed food. Avoid risky sports which can cause injury to the testicles. Avoid steroids (fitness and muscle training) and addictive substances. If using psychiatric medications (SSRI’s), speak with your health care provider or fertility specialist as these treatments can have a negative effect on male (and female) fertility.
Get healthy- the earlier the better. Do everything possible to avoid chronic illnesses, as most illnesses (and the meds they require for treatment) will impact your fertility. Poor nutrition can lead to gastrointestinal diseases, obesity, insulin-resistance and Type 2 Diabetes, heart disease and more. Take care of sexual dysfunction.
Now that we have more information and awareness, we can agree that women should be spared the burden of invasive treatments and that joint responsibility for healthy pregnancies should be a shared value among couples trying to conceive. The status quo is outrageous and unjust. If we choose to stay silent because we fear or respect the power of others, we pay a price. If we stay silent because we do not believe we have the power to be heard or to make a difference, we pay a bigger price. Is it not time to lift the veil over our eyes and speak up, acknowledge, ask questions and become part of an honest conversation about the problem? We owe it to ourselves, our children, families and friends to find the courage to speak truth to power. If I am not for myself, who will be for me? If I am only for myself, what am I? And if not now, when?
References:
How Male fertility changes with age, 2023
Frequency, morbidity and equity — the case for increased research on male fertility, 2023
Male fertility as a marker for health, 2022
The Gender Gap in the Diagnostic-Therapeutic Journey of the Infertile Couple, 2021
Male infertility is a women’s health problem, 2020
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