We’ve seen considerable research surrounding male factor fertility in the media recently with articles coming out of Israel and Europe, with commentary coming from North American doctors. This research associated with the decline of male fertility in Western countries, while not astonishing, is interesting as fertility is often considered the “woman’s issue.” With eye-catching headlines like “There May Be Something Wrong” and “Sperm Count of Western Men Declining”, this appears to be a new problem when in reality, male factor fertility has always been a tested issue in a couple’s ability to conceive, as it’s fifty percent of the pregnancy puzzle. So why until now were women bearing the brunt of infertility? Could male factor have been better researched and more thoroughly understood? Should clinics have routinely encouraged fertility testing for both male and female patients? Even though male factor fertility can account for up to fifty percent of a couple’s combined issues in getting pregnant, why has it has taken until 2017 for researchers to address the issue directly and for headlines to alert people – and males to their “pending” fertility?
TRIO’s medical experts tackle some of the important questions surrounding male factor fertility, providing insights, statistics and information about Reproductive Endocrinology, IVF, semen analysis and environmental factors:
On average what is the percentage of male factor contributing to a couple’s infertility?
Dr. Michael Hartman: I would say that the contribution of male factor infertility is grossly underestimated. Nearly half of couples I see will have some issue come up upon semen analysis. While most of these are fairly minor, some can have a significant impact on fertility.
Dr. Dan Nayot: Difficult to predict, but what percentage of men have “abnormal semen analysis” is generally quoted as 1/3.
Dr. Jennifer Fitzgerald, ND: Approximately 50 percent.
Dr. Kaajal Abrol: In my practice, I would say there is some degree of male factor in at least 50-60 percent of couples.
What are some of the solutions or treatment options to male factor?
Dr. Paul Chang: Vitamins, quitting smoking, regular exercises, avoiding excessive use of alcohol and avoiding tight underwear.
Dr. Dan Nayot: Depends on the cause,
Hormonal issue -> Hormonal supplements
Mechanical issue -> Surgical
Genetics -> Donor sperm
Lifestyle -> Change lifestyle
Unexplained -> Lifestyle; supplements; experimental
Dr. Sony Sierra: The biggest advancement in treatment of male factor infertility has been the advent of ICSI and its proven safety record. ICSI has allowed thousands of couples to have a child with very low sperm counts and low motility whereas before it was almost impossible with very low counts. Outside of IVF, IUI (intrauterine insemination), can also help in cases with reduced motility (helps the good swimmers get to the egg). Otherwise, treatment directed to the cause, e.g. other hormonal factors (investigating and treating thyroid problems, testosterone production, etc.)
In the case where we are concerned about environmental factors counselling helps: quit smoking (cigarettes and marijuana), incorporating a healthy diet and exercise choices (healthy BMI), min-mod alcohol consumption (glass of wine with dinner OK, but no binge drinking), ensure no excessive heat exposure, etc.
The media has been focusing on environmental factors contributing to male factor. What types of environmental factors could be contributors?
Dr. Jennifer Fitzgerald, ND: Pesticide and herbicides, heavy metals, radiation, pollution/smog, second hand smoke, plastics, etc. Occupational exposures are also a consideration as men tend to have higher exposure occupations than females i.e. construction, factories, oil workers, etc.
Dr. Ken Cadesky: Smoking, recreational drugs, increased exposure to heat, stress and exposure to toxins.
Dr. Kaajal Abrol: Environmental factors may include exposure to cigarettes, drugs or alcohol; heat exposure (e.g. through hot tubs or very tight-fitting clothing such as cycling gear); or work-related toxins.
Why do you think science and research have long tested female infertility over male factor with the percentage of male factor growing?
Dr. Paul Chang: I do not believe male factor infertility is growing as much as what the press and social media are reporting. It is certainly on the rise. As a male and a physician in this field, I am not overly concerned but more research is warranted.
Furthermore, isn’t it important to have a field where research is focused on the gender that is doing most of the pregnancy rather than focusing on men as other fields in medicine have done historically.
Dr. Michael Hartman: The short answer is chauvinism. Since the women get pregnant, it is easier to blame them if they aren’t getting pregnant. Women seem to blame themselves more for infertility, and often times it is oversimplified to assume that only one person or one factor is to blame. The truth is that it is rarely just one thing that causes infertility, and usually an interplay of many smaller things. Men are often much more reluctant to seek care and do testing.
Dr. Dan Nayot: Biologically women are a more important variable (egg is much more complex than sperm; fallopian tubes, uterus for implantation and gestation). Many sperm issues can be overcome with technology – surgery, IVF/ICSI etc.
Dr. Jennifer Fitzgerald, ND: I think assumptions are drawn since fertilization and implantation obviously occur in the female body, so it is easy to assume that it’s a female problem. We now know this is untrue, and even miscarriages are linked to male factor issues about 50% of the time. It’s also interesting that male sperm counts have been decreasing steadily for over 50 years, and that the standards for sperm parameters have been lowered several times as a result (otherwise no one would fall into normal range!).
Dr. Sony Sierra: Science and society have long believed infertility as a “woman’s” problem, I think with more advancing diagnostic techniques and a shift in perception, we are seeing a greater emphasis on male factor.