Fertility has long been considered a female problem, but with sperm counts under threat, it's time to realise that men have ticking clocks too. Chrissie Russell reports
Happy families resemble each other, and to anyone, Paul (33), his wife Kristel (32) and their 18-month-old daughter Zoe look like any other young, happy family. Looking on, you’d never know the battle that brought them to this point in their lives.
Five years ago the couple from Arklow, Co Wicklow sought medical help after trying, and failing, to conceive. They attended a fertility clinic and Kristel started taking regular injections of fertility drugs. After eight months and no success they switched to Sims fertility clinic and tried a cycle of IVF. But despite Kristel producing viable eggs, the pregnancy was arrested — failing to continue even though the embryo had initially looked healthy.
By this point the couple had spent around €20,000 and Paul had done three separate semen analysis tests, all of which had come back clear. Then it was suggested he have a €395 DNA fragmentation test which checks to see if the genetic material within the sperm is abnormal, something that may result in male subfertility and IVF failure.
When the results came back two weeks later they changed everything. “The normal reading for the DNA fragmentation index is 15; mine was 49. That obviously was really bad. It meant that the egg was trying to repair the DNA instead of fertilising,” reveals Paul.
When it comes to fertility problem, Paul says honestly that “for some reason, you always think that it’s the women.
“We would have joked about how ‘my swimmers were perfect’. You never think it’s yourself so obviously when they told me, ‘it’s you’, I remember thinking ‘well she’s taken these hundreds of injections — I’ll do whatever I have to do’.”
Paul’s admission that we ‘always think it’s the women’ isn’t uncommon when it comes to fertility discussion. The vast majority of those frequenting the online forums dedicated to couples having trouble conceiving, are female. Stories often revolve around a women’s desperation to become a mum. But men are often just as emotionally involved in the drive to be a parent, and equally as likely to encounter problems.
It is estimated that one-in-six couples in Ireland today will have difficulty conceiving. Of these, 30pc of the time it will be an issue on the female side, 30pc of the time it will be something on the male side, 25pc of cases will involve both partners and 15pc will include unexplained factors.
A growing body of evidence suggests that male infertility is on the increase. Last summer, scientists at the Hebrew University of Jerusalem found that male sperm counts have fallen by almost 60pc in 40 years. Other studies show the same thing. Research carried out in France analysing males between 1989 and 2005 found counts fell by a third. A 2007 study in a British city saw a drop of 29pc between 1981 and 2002.
Just recently Stefan Chmelik, the founder of Harley Street’s New Medicine Group, was quoted in a British newspaper saying: “At the current rates of sperm decline, the human race will be infertile in 50 years.”
Dr Alejandro Aldape at Sims IVF Cork, agrees there’s a decline but doesn’t believe the prognosis as quite that bleak. “Sperm quality is decreasing, we know that for a fact,” he says. “But it is not so easy to state that the human race will be infertile in 50 years because technology on the male side is always improving, as is our understanding of male infertility.”
According to Dr Aldape the most common cause of male fertility issues is a low sperm concentration, something that can be due to many factors including mumps and undescended testes. “Those are two of the more common causes,” he reveals. “We still don’t know for sure which are the lifestyle habits that can truly affect the quality of the sperm.”
Several hypotheses exist behind the decline in sperm quality. There’s the suggestion that increased stress levels (the constant bombardment of emails and information) could be reducing sperm counts and the fact that men are spending longer periods of time sitting — thus raising their testicular temperature — which may have an adverse affect sperm quality and quantity.
A host of household items also could be contributing: chemicals in sunscreen, non-stick frying pans, flame retardant chemicals in mattresses, triclosan in antibacterial soaps and chemicals in hard plastics such as ready meal containers and plastic waterbottles — all potentially having an adverse effect on effective swimmers.
Increasingly, scientists are becoming more aware of the male biological clock. A recent US study revealed live birth outcome is affected by the age of the male partner. It found that women aged 35-40 did significantly benefit from having a male partner under the age of 30. There was almost a 30pc relative improvement in cumulative incidence of live birth, when compared to women whose partner was aged 30-35. The research supports an earlier large population study in Britain that found that natural conception during a 12-month period was 30pc less likely for men aged over 40 than for men under 30.
“Celebrity examples like Rod Stewart or Mick Jagger give the impression that male fertility goes on forever,” says Dr Aldape. “However, advancing male age, including the man’s overall health of his sperm cells can have a significantly detrimental effect on a couple’s chances of success.”
Almost eight years ago, Clondalkin couple Thomas (36) and Karen McCluskey (35) took part in the TV3 show, How Healthy Are You?. The couple had visited a fertility clinic where a test had revealed Thomas had a sperm count of zero and the couple had been told their only chance of conceiving lay with donor sperm.
“It was devastating,” says Karen. “We got this news and were handed a price list for sperm donors and fertility treatment.”
“We weren’t told anything we could do to try and fix it,” adds Thomas. “We didn’t want to use a donor and we knew we couldn’t afford IVF but we still wanted answers.”
Through the programme they were put in touch with Declan Keane, director and senior clinical embryologist at ReproMed Ireland, and Nutritional Therapist Elsa Jones. “Declan reassured us that certain things in the body could change; that if it was a hormonal issue, there was something we could do with that,” says Thomas.
As a night-shift worker, Thomas’s diet was reliant on quick, convenient but nutritionally empty fast foods and processed foods. After working with Elsa, he cut down his alcohol intake and his smoking. Out went the pizzas and deep-fried chips and in came homecooked stir fries rich in fresh vegetables and seeds.
In three months, Thomas, who is 6ft 2.5in, went from 19.5 stone to 17 stone. When he went for a second semen analysis test, it revealed his sperm count had risen from zero to half a million. “That’s still low, but to come from nothing… I was over the moon,” he laughs. “I felt like doing cartwheels!”
The couple continued their healthy eating together, as well as trying more alternative therapies such as hypnotherapy and fertility acupuncture and, in 2014, Karen gave birth to a baby boy, Thomas Joseph (TJ).
“A man’s sperm is particularly affected by the amount of alcohol consumed, and smoking can also lower sperm quality and motility,” explains Elsa. Some estimates suggest that up to 13pc of infertility cases may be attributed to smoking. “Eating an overall balanced diet is key,” she continues.
Elsa says that certain nutrients play significant roles in male fertility. “Zinc is one of the most important minerals for healthy sperm with good sources including shellfish, eggs, oysters and pumpkin seeds.”
Eating five portions of different coloured fruit and vegetables is advised since vitamin C protects sperm health while garlic, fish and brazil nuts are good sources of the antioxidant selenium which enhances male reproductive health. Omega 3 and Vitamin B9 — also known as folic acid — have been shown to help, and Vitamin E is thought to protect the sperm membrane.
“Sperm take three months to develop, which means the most important time for men to improve their diet, quit smoking and reduce alcohol intake is in the three months leading up to conception,” says Elsa.
In cases where resolving the problem isn’t as simple as cutting out smoking or improving diet, science is constantly advancing to help.
If ejaculation is an issue, a testicular biopsy — known as testicular sperm extraction (TESE) — can be carried out to retrieve sperm from testicular tissue, or a intracytoplasmic sperm injection (ICSI), where a single moving sperm is injected into the female egg, might be an option.
In cases where the problem can’t be resolved by diet or science, a sperm donor might be the only route.
A year ago, Conor* was diagnosed with Klinefelter syndrome. The condition, which affects between one in 500 and one in 1,000 males and accounts for approximately 3pc of infertile men, is a chromosomal condition that interferes with male sexual development, reducing the levels of testosterone and preventing the testes from functioning normally.
“The doctor told me I couldn’t have kids and it was heartbreaking,” he says. “I kept thinking this was my marriage over and I remember sitting in the Dart station afterwards just crying and crying.”
Conor and his wife were referred to ReproMed where they’ve done two rounds of IVF using donor sperm. They’re now intending to try a third cycle using a donor egg. Conor reckons that, to date, they’ve spent around €23,000.
“We’re getting ready to go again in April,” he says. “It’s been stressful and draining but it’s also made us stronger. I do believe I’ll be a dad some day and I’ll still be a loving father, to whatever child we have, however we have it.
“When I got the news I felt ‘life is over. I can’t produce anything’. You just never think it’s going to be a male problem.”
And yet, until men accept that fertility is a ‘male problem’ it seems unlikely that it’s a problem that will be resolved.
“For many decades women were more investigated than men,” says clinical embryologist Declan Keane. “Once a man could perform sexually, ejaculate and sperm cells were identified in the sample, then it was assumed he was fertile.” Although it’s still difficult getting men talking openly about problems, Declan believes the taboo is lifting. “Society is beginning to accept that subfertility is not a direct reflection of sub performance in sexual activity,” he explains. “The Irish male is more willing to share responsibility, look for causal agents, and effect changes to improve fertility. But education and normalising the problem is key to combating the natural first move to hide the problem or just accepting it.”
“I know couples whose marriages have ended because the man wouldn’t think about going to the doctor,” says Karen, Thomas’s wife. “I thank God I married a man who was willing to go down the route of opening up and getting help.”
When Paul realised his diet could make a big difference in his and Kristel’s hopes of having a family, he started taking around 10 nutritional supplements, cut down caffeine, smoking and alcohol, began eating food made from scratch and changed the drugs he’d been put on post-gall bladder surgery.
Three months later he took another DNA Fragmentation test and the score came back at 19, a huge improvement. The couple booked to start IVF but decided to take a holiday first. When they returned, Karen was pregnant.
“We couldn’t believe it,” says Paul. “It was the best possible news.” His advice to all other men is to not be shy about seeking help. “It’s just another medical problem,” he says. “People talk about having cancer or a bad back, why not this? It’s often curable but it won’t happen if you don’t get help.”
* Some names have been changed