Why Aren’t More Men Aware of Their Fertility Status?
September 9, 2019
By Leah Campbell
Infertility affects approximately 15 percent of couples, according to the U.S. Department of Health and Human Services. That’s nearly 50 million couples who will struggle with conceiving when they want to start a family.
Historically, infertility has been thought of as a primarily female issue outside medical circles. This may be because women are more likely to discuss their fertility struggles, or more willing to dig deeper into the causes of those struggles.
But male factor fertility issues contribute to around one-third of all infertility cases and potentially more, with one-third of fertility issues being female factor and one-third being a combination of issues between partners or resulting from unknown causes.
Let’s talk about male fertility
“Male factor fertility issues are very common,” said reproductive endocrinologist Dr. Aimee Eyvazzadeh.
She advises men to get their sperm checked, explaining it’s a goal of hers “to educate men about the natural decline in sperm over time and to teach them about the simple steps they can take to prevent infertility.”
One of those steps, she says, may be to freeze sperm while younger.
“If I had a patient who had sperm frozen 5 years before I saw him, chances are I’d be using that sperm for IVF treatment,” she said.
However, not all practitioners share Eyvazzadeh’s proactive approach.
According to Resolve: The National Infertility Association, only 41 percent of OB-GYNs even consider a urological evaluation of the male partner in presentations of infertility, and 24 percent routinely refer men to a urologist before ordering a sperm sample.
Dr. Jaime Knopman, reproductive endocrinologist and director of fertility preservation for CCRM in New York, tells Healthline this is a common mistake that needs to be corrected.
Knopman explains that approximately 9 percent of men will struggle with infertility overall, and that analyzing male factor fertility issues should be a big part in determining the cause of a couple’s infertility.
Examining the causes of male infertility
Knopman explains this should begin with analyzing the sperm.
“We are looking at four parameters: volume of the ejaculate, concentration of the sperm, motility of the sperm, and shape of the sperm,” she said.
When one of those parameters is off, she says the reason is sometimes obvious. Other times, it may be more difficult to determine a cause.
“Not all poor sperm quantity/quality has a reason. Just like female infertility, genetic reasons are quite common, specifically abnormalities on the Y chromosome,” she said.
Knopman explains other causes of male infertility could include:
- undescended testicles
- previous infections (chlamydia, mumps, gonorrhea)
- enlarged veins in the testicles (varicocele)
- hormonal imbalances
- blockages in the ducts (tubes) that sperm swim through
- lifestyle factors
Yet most men aren’t considering the possibility of these issues.
CCRM recently conducted a survey of 1,000 men over the age of 18, finding almost half of the respondents declared they were either unaware of or unconcerned with their fertility health.
And while 42 percent of the respondents between the ages of 25 and 54 said they had experienced issues conceiving with their partners, 77 percent said they hadn’t yet taken a semen analysis.
Why aren’t we talking more about male infertility?
“One in 10 people need fertility help,” Eyvazzadeh explained. “About 9 percent of men and about 11 percent of women of reproductive age in the United States have experienced fertility problems.”
She added, “The older you get, the higher the chance you’ll need help.”
So, with male infertility being as common as it is, why aren’t we hearing more about it?
Eyvazzadeh thinks a lot of it comes down to gender stereotypes. “The media, family or cultural dynamics, and social pressures are some of the many reasons why people don’t talk enough about male fertility struggles,” she added.
According to CCRM’s survey, only 47 percent of men are open to talking about infertility.
However, Eyvazzadeh says she believes this statistic is improving and the word is spreading.
For example, she explains there are now podcasts dedicated specifically to the subject of male infertility.
“Men are talking openly about it more and more. There are support groups popping up everywhere, and men are finally being included [in the conversation] and are joining in,” Eyvazzadeh said.
Knopman points out one positive aspect of identifying male factor fertility issues is that they’re typically easier to treat than female factor issues.
She explains this is mostly because there are millions of sperm in the ejaculate. Even in a “bad situation,” she says there are often greater than 100,000 sperm present.
“IVF can be successful with very low numbers. We only need one sperm to fertilize an egg,” she said.
Even with sperm that can’t swim, Knopman says the sperm can be injected into the egg.
“I always say to patients, I would take poor sperm over poor eggs any day — it’s easier to be successful,” she said.
Planning for the future
For Eyvazzadeh, it’s all about thinking ahead.
“I like my patients to think about trimester zero,” she said. “We all know about the first, second, and third trimester, but not enough people focus on preconception health and testing.”
That, to her, is a mistake.
“We spend more time planning a vacation than we do pregnancy in this country. Having a child is the trip of a lifetime. You want to be well prepared for that trip,” she said.
For men who are trying to conceive, Eyvazzadeh advises her patients to do the following:
- Get rest. Studies show an abnormal circadian rhythm can lower testosterone levels and decrease sperm counts.
- Put down your e-cigarette, weed, and any products that contain nicotine.
- Eat right. “The pizza and beer diet isn’t going to be good for your sperm,” Eyvazzadeh said.
- Consider doing a deeper dive and doing a sperm DNA fragmentation test.
- Consider a scrotal ultrasound and visit with a urologist who specializes in male factor infertility.
- Get your hormones checked.
- Do genetic testing.
- Take supplements. Antioxidants may improve sperm count and quality.
- Avoid plastics and environmental toxins.
Ending the stigma surrounding male infertility
Knopman believes the most effective way to combat the stigma surrounding male infertility is to simply talk more about it.
Even though male factor issues contribute to approximately the same number of cases as female factor issues, female factor issues get more attention.
“I honestly think it is because we as women are more open about our bodies,” Knopman said. “We talk about it more. I think our openness has shed a light on the situation, particularly in the media.”
Changing how we approach male infertility starts with having a conversation.