Male Infertility: The Other Half of the Equation

06/10/2015

Male Infertility:  The Other Half of the Equation
Healthy Living - June 10, 2015
William Sturrock, MD
 
  
When you think about the subject of infertility, it is customary to focus on the challenges faced by women who may have to suffer though an expensive and physically demanding process known as          In-Vitro Fertilization.  This long road entails procedures to harvest the eggs from the ovaries, implant the embryos in the uterus and then carry a stressful pregnancy, frequently complicated by multiple gestations and the risk of miscarriage to term.
 
However, as we all know, it ‘takes two to tango’ and often there is less discussion and awareness of the male side of the equation.  Indeed, it is estimated that 40-50% of human infertility can be explained by ‘male factors’, and science is increasingly gaining insight into the requirements necessary for healthy male fertility. 
 
First, research has confirmed the common sense perspective that a healthy life-style plays a very significant role.  Obesity has been linked to ‘male hypogonadism’:  a condition where the testes are unable to produce adequate amounts of testosterone, which is necessary for the production of adequate quantity and quality of sperm.  Also, we know that heavy alcohol consumption stresses the liver metabolism such that there are higher levels of estrogen in some men, not a good thing for sperm production.

More recent studies have shown that tobacco smokers have a 30% higher chance of having poor semen quality.  The actual mechanism of this problem is a substitution of the element cadmium found in tobacco smoke for zinc which is necessary for healthy DNA production.  In addition, both prescription and recreational drugs can have a deleterious effect on male fertility.  Heavy marijuana use has long been known to decrease testosterone and sometimes results in a condition called gynecomastia where men have the beginning of breast development.  Narcotics in particular, whether it is oxycodone, methadone, suboxone, or heroin have a strong tendency to suppress normal testicular function and are increasingly found to be the culprit for hypogonadism in younger men.  All of these drugs decrease a man’s ability to perform, not just produce healthy sperm.

But there are other organic compounds that may be lurking in our environment such as pesticides, plastics, and even personal care products that can have an insidious effect on the healthy hormone status of males.  We now know that many of these compounds are partially metabolized to become weak estrogens, further suppressing normal hormone balance in both men and women.  In the 1990’s a seminal study in the British Medical Journal by Carlsen, et al observed that there had been a general decline in the quality of male semen for much of the 20th century, raising the specter that if this trend was not reversed our species might not be able to procreate adequately in the future.  Although these findings were contested by some experts, there is general agreement that one aspect of cleaning up our environment is decreasing our exposure to many of these compounds. 

Many andrologists (experts in male sexual physiology) will advise men to avoid the social pressure to use colognes, as well as to decrease frequent hot-showering and the use of multiple hair and skin preparations.  Nothing promotes absorption of questionable chemicals through the skin as does a warm temperature which dilates the skin blood vessels, combined with vigorous massage of the scalp or skin breaking down the protective oil barriers.  There may be some truth to the stereotype of the slightly unkempt ‘mountain man’ who bathes in a cold stream once a week whether he needs it or not as being a bit more masculine than his urbane and manicured city cousins.

Other common pieces of advice for men who want to maximize their fertility is to have enough vitamin C and zinc in the diet, and to ingest foods that have a high anti-oxidant value.  Such foods reputed to have these qualities include pomegranate, acai, elder and even the Maine blueberry.  There are even studies that show that men who eat more fish and less processed meat have better sperm parameters.

For men who are making all the right lifestyle choices but have sperm counts that are still too low, there are other options.  Just as the fertility drug clomiphene (Clomid) has been used by women for decades to increase egg production, there are studies that show at this medication, or better yet some of the newer enantomers, may increase sperm counts and testosterone levels in a relatively safe way for many men struggling with fertility.  Also, just like there are procedures for women to get eggs from the ovaries, male fertility experts can now extract sperm directly from the testes for in-vitro use.

The bottom line is that if you are a couple that has been trying to conceive for over a year without success, both members of this partnership should seek medical care.  The first step is to talk to your family doctor and have some basic studies,  such as ovulation testing and semen analysis done.  If the problem does seem to rest with the male, then the next step should be a visit with a consultant who has experience in this area for more in depth evaluation which may include both hormone and genetic tests. 

Children are one of life’s greatest joys (and truth be told, occasionally the source of great heart-break).  But the future of humanity depends on each generation doing its best to pass on its genes, as well as its values and culture to the next generation.  Otherwise, there may not be a tomorrow for the human species.