Avradeep and Emma met in 2010, when they were both in their early 30s and living in Bristol, England. Because they knew they wanted a family, they started trying to conceive just a year into their relationship. But after months of attempts: nothing.
Concerned, they went to their doctor. Both had several blood tests; Avradeep followed up with a semen analysis. A few weeks later, the results arrived while Avradeep was playing squash; Emma called to say they needed to talk. When he returned home, he learned the reason that Emma was failing to become pregnant: him.
THE EMPTY GUN
One estimate suggests that infertility affects as many as one in six heterosexual couples. In a third of cases, the cause lies with the man. And despite advances in medical science, some research suggests the problem is only getting worse: A study published last year showed that among men from North America, Europe, Australia, and New Zealand, sperm counts have declined by more than half in less than 40 years. Scientists love to disagree on how accurate sperm-count studies are. But for researchers like Sheena Lewis, Ph.D., a professor emerita at the Centre for Public Health at Queen’s University, Belfast, the statistics spell a widespread threat to male fertility and reproductive health—in terms of both sperm quantity and (perhaps more important) quality.
Unless you’re like Emma and Avradeep, a couple hoping for kids, it’s easy to think that sperm counts don’t matter all that much. But according to Lewis, the implications are grave and wide-ranging: “Numerous reports over the past few years show that sperm is the canary in our coal mine.” If sperm is decreasing in production and in quality—as she believes it is—“this is a big take-home message about societal health.
The message? Poor sperm could mean poor health. Diminished fertility is linked to issues including cardiovascular problems, lower self-ratings of mental health, and reduced life expectancy, Lewis says. In short: Men should be more concerned than ever about fertility. Why we’re not is partly because we’re used to pinning the fertility burden on women. That keeps sperm research and sperm consciousness out of the spotlight. Which may be why there are still only theories about what might be going wrong
THE SLIGHTLY SMOKING GUN
“I often liken sperm production to the assembly line in an expensive-car factory,” says Tim Child, M.D., medical director of Oxford Fertility, one of the UK’s largest in vitro fertilization (IVF) treatment centres. “It just takes one bit to go wrong and the end product won’t be as good as it should be. With sperm, if there is one enzyme missing, one protein that’s not quite right, then depending on where it is on that production line, it will affect the end result.”
According to Lewis, these assembly-line issues can be connected to our diet and lifestyle. Researchers have seen that when men in countries such as India adopt a Western lifestyle, the consequences—which include increases in obesity, smoking, inactivity, and alcohol and illicit drug use—could potentially reduce the number of sperm and damage its DNA, she says. Environmental pollutants, as well as exposure to chemicals such as pesticides, herbicides, and painting materials, may also contribute to low sperm count.
One of the leading known causes of male infertility is having a varicocele—that is, a clump of varicose veins in the testes. “This leads to an engorgement of blood that heats the testes,” says clinical embryologist Sheryl Homa, Ph.D. “If you raise the temperature of the testes too high, you can destroy sperm development.”
Homa is a believer in the potential benefits of varicocele repair, but that opinion isn’t unanimous. Dr. Child points to a lack of good-quality studies showing that the repair actually makes a difference for couples. Sperm counts may improve, he says, but “that doesn’t necessarily result in a baby being born.”
In general, there are no drugs or surgeries that can “fix” men’s fertility problems. Yet. Some scientists, such as Darius Paduch, M.D., the director of sexual health and medicine at Weill Cornell Medicine, are aiming to find solutions. He’s working on a technique that identifies and extracts healthy sperm from men who at first appear to have none.
But until any new treatments pan out, men can do a few things that might improve the calibre of their sperm. “Men produce new sperm every 70 days,” says Lewis. “So if you were to change your lifestyle for just three months, you might be able to improve your sperm quality.” These changes include the usual suspects: cutting down on alcohol (fertility is probably safe at two or fewer beers a day), and tobacco use (cigarette ingredients like cyanide are toxic to sperm). And, no surprise, maintaining a healthy weight through a good diet and exercise can help improve sperm quality and quantity. It’s also worth avoiding heat build-up caused by compression shorts, laptops, frequent cycling, or a lengthy soak in a hot bath.
Even fertility experts like Dr. Paduch who are less certain that sperm counts are dropping to dire levels say it’s still essential to think about sperm quality. Now. “We were always told that male fertility and sperm don’t change with age, but now we’re seeing changes to DNA quality around 35,” he says. “The guys who wait are the r eal concern.” Not only because it’s harder to conceive, but diminished sperm quality, he adds, “is going to affect the health
of the child.”
WINNING THE BATTLE
Should treatments come up short, as they did for Avradeep and Emma, couples can turn to alternative methods for starting a family. But many of these, like decreased male fertility itself, still leave men with a sense of inadequacy. “It’s the guilt that they cannot provide the thing their partner most wants,” says Homa. “I have had plenty of men break down during a consultation.”
In the end, Avradeep and Emma opted for donor sperm. “Once you realize that using donor sperm is simply just using donor DNA and that you are the father,” says Avradeep, “then accepting the donor sperm becomes much easier.” For some guys, Homa says, “parenthood is how you bring up and love a child, not whether it is biologically theirs.”
After three rounds of intrauterine insemination and five rounds of IVF, Emma gave birth to a healthy girl last April. But despite stories like these, the male fertility problem remains largely unsolved. Sperm studies require large numbers of people and many years, and the stigma surrounding low sperm count keeps it in the shadows. So the solution that’s available right now is to encourage men to talk about their experiences. “The more we share, the more it becomes acceptable,” says Homa. “If people understand they are not alone, then the taboo is broken and the real conversation can start.”
TEXT SARFRAZ MANZOOR; ADDITIONAL REPORTING BY JOSHUA ST.CRAIR PHOTOS VICTOR PRADO