The three foundations of men’s natural fertility provide a starting point for understanding the important role that the male partner’s fertility has on a couple’s desired outcome.
People often come to me looking for simple solutions to a fertility problem. However, in my professional experience, when a couple is having difficulty in getting pregnant, it is nearly always a combination of multiple factors.[1]
A breakdown of men’s natural fertility
While helping couples understand those factors individually is a key to our success, it is as important that they see the bigger picture from a natural fertility perspective. Through this, we can successfully address ALL the multiple key factors involved.
One of them is male fertility and the following are its 3 major foundations:
1. Men’s contribution to a couple’s fertility picture
Fertility statistics are not encouraging: 1 in 6 couples has a conception difficulty; 1 in 4 pregnancies will end in miscarriage; sperm quality has decreased by 50-60% since 1973; male fertility problems are an issue for at least 40-50% of couples seeking fertility treatment.[2-6]
The one thing we must absolutely stress right now is that lots of people think that miscarriage is a female-fertility problem. Yet, we now know that as the male contributes 50% of the genomic material to the embryo and placenta, the integrity of the sperm is as essential for the initiation and maintenance of a healthy pregnancy.[7]
“In 2010, my partner Andrew and I found out the heartbreaking news that our only option to have a child would be through IVF/ICSI. We were only 21 and couldn’t imagine having to go through something like that so early on in life. We found out the news when Andrew had a semen analysis done and, with a sperm count of less than .2 million and very poor motility and morphology, he was almost infertile.” An excerpt from Hilary and Andrew Mann’s creation story. Read more creation stories here.
If you want to support your partner, NOW is the time. It is really about making the changes that are going to give you the best possible outcome with regards to your health and fertility.[8]
This is also a very important distinction for us to make because, particularly when we talk about male infertility, what we often see and hear is that IVF/ICSI are the only options. That is all well and good, yet we work on the basis that we need to first find out what the problem is, and then address why it is taking place. We help couples see what they can be doing individually on a personal level and also as a couple to improve the chances of creating the healthiest possible baby.[9-11]
2. The necessary foundation of preconception health
Preconception healthcare is the preparation prior to a conception attempt. By 8 weeks’ gestation, the baby’s health is already pretty much set. At this point, the baby’s health becomes the lowest common denominator of both parents’ health prior to conception.[12,13]
Some studies show that a lot of the developmental problems children are experiencing today, ranging from dyslexia to ADHD and even autism, basically start very early on in the pregnancy.[14-16] We also know that children of men with poor sperm quality are at risk of developing congenital malformations.[17]
In Chinese medicine, by the time a child is born, he/she is already 1 year of age. The 3 months of preconception and 9 months of pregnancy are credited as an official year or age of the child. This traditional system has been around for over 5,000 years already. This is certainly an interesting point which brings me to the next one — the health of your egg and sperm today.
For men, your sperm is basically the result of your lifestyle over the last 120 days. Whatever is happening in your body right now is the result of your day-to-day choices over the previous 4 months.[18-21]
So let us emphasize this more: the health of your egg and sperm in 4 months from now, your health and fertility in 4 months from now, will be what you start implementing TODAY.
It is actually a powerful thing to know — that you can take responsibility and ownership for improving your sperm parameters and fertility, in general. This is also something that is not talked about very often in the medical arena or even in the media, but is something that is extremely easy to address.
For most men, on average, improving sperm parameters is quite an easy process.[22-26] Of course, there are some who have genetic problems or even traumatic problems from previous accidents or say cancer treatment that has impacted their fertility.[27]
3. Baseline semen analysis
The best and easiest way to find out where you are at, even before you start making any changes, is actually to have a semen analysis.
You will be able to have a picture at that moment of what is actually happening to you and your fertility. From there, you can make specific changes and then later repeat the tests to see if those have made a difference to your outcome.[28,29]
Remember that if those have not made a difference yet, it does not mean that the things you were doing have not worked. It just means that you may need to do things a little bit differently this time. That is where a practitioner as well as more information and education will definitely support your efforts.
So if you have not had a semen analysis yet, go have one. However, if you have not had one for more than 6 months, then repeat it. Just make sure that you will have your test in a specialist fertility laboratory. There is absolutely no point in going to a general laboratory where you normally go and have blood tests because they do not have the parameters which are stringent enough to know exactly where your fertility is at.[30]
Evaluating sperm quality
What constitutes healthy sperm? In a semen analysis, the following substantial factors determining the quality of the sperm are being studied:
1. Sperm count or concentration
This refers to the number of sperm present in 1 ml of semen. The World Health Organization (WHO) guidelines suggest that a normal count is at least 15 million sperm per ml or no fewer than 39 million sperm per sample.[31]
Having less indicates a low sperm count which, according to some research, is the cause of up to 90% of male infertility issues.[31]
2. Sperm motility
This refers to the sperm’s capacity to move efficiently. If it does not have a good motility, it does not have a good chance to fertilize an egg.[31]
3. Sperm morphology
This refers to the sperm’s size and shape. A normal sperm has a long tail and oval-shaped head.[31] A sperm with an odd size and shape will have difficulty reaching, penetrating, and fertilizing an egg.[31]
Take note that there are other minor factors apart from these three that may affect your sperm health. At the same time, a not-so-ideal sperm evaluation does not mean that someone is already permanently infertile.[32] Rather, further testing is encouraged to really know the root or exact issue. From there, some work can definitely be done to improve your chances at your desired outcome.
Final thoughts
Fertility is a team sport between partners — efforts must be efficient and equal from both sides. Male fertility is just as important in creating the healthiest baby, so it is up to you if you want to get closer to that outcome. Take responsibility for what you can control, and do it now more than ever. Find out more about exactly why we say fertility is a team sport here.
References:
[1] Deyhoul, N., et al. Infertility-Related Risk Factors: A Systematic Review. International Journal of Women’s Health and Reproductive Sciences, 2017. 5(1). doi:10.15296/ijwhr.2017.05.
[2] National Health and Medical Research Council. Ethical guidelines on the use of
assisted reproductive technology in clinical practice and research. 2017. Retrieved from http://www.nhmrc.gov.au/guidelines/publications/e79.
[3] Dugas, C., et al. Miscarriage. StatPearls, 2019. PMID: 30422585.
[4] Levine, H., et al. Temporal trends in sperm count: a systematic review and meta-regression analysis. Human Reproduction Update, 2017. 23(6). PMID: 28981654.
[5] Kumar, N., et al. Trends of male factor infertility, an important cause of infertility: A review of literature. Journal of Human Reproductive Sciences, 2015. 8(4). PMID: 26752853.
[6] Pantou, A., et al. Couples with mild male factor infertility and at least 3 failed previous IVF attempts may benefit from laparoscopic investigation regarding assisted reproduction outcome. Nature, 2020. doi: 10.1038/s41598-020-59170-5.
[7] Ibrahim, Y., et al. The male contribution to recurrent pregnancy loss. Translational Andrology and Urology, 2018. 7(Suppl 3). PMID: 30159238.
[8] Durairajanayagam, D. Lifestyle causes of male infertility. Arab Journal of Urology, 2018. 16(1). PMID: 29713532.
[9] O’Brien, A.P., et al. Men’s Preconception Health: A Primary Health-Care Viewpoint. American Journal of Men’s Health, 2018. 12(5). PMID: 29774805.
[10] Simon, L., et al. A systematic review and meta-analysis to determine the effect of sperm DNA damage on in vitro fertilization and intracytoplasmic sperm injection outcome. Asian Journal of Andrology, 2017. 19(1). PMID: 27345006.
[11] Hussein, N., et al. The effects of preconception interventions on improving reproductive health and pregnancy outcomes in primary care: A systematic review. European Journal of General Practice, 2016. 22(1). PMID: 26610260.
[12] Moore, K., et al. The Developing Human: Clinically Oriented Embryology. 9th ed. 2013. Philidelphia: Saunders.
[13] Tortora, G.J., et al. Principles of Anatomy and Physiology. 12th ed. 2014. United States of America: Wiley.
[14] Goeden, N., et al. Maternal Inflammation Disrupts Fetal Neurodevelopment via Increased Placental Output of Serotonin to the Fetal Brain. Journal of Neuroscience, 2016. 36(22). PMID: 27251625.
[15] Hornig, M., et al. Prenatal fever and autism risk. Molecular Psychiatry, 2018. 23(3). PMID: 28607458.
[16] Ylijoki, M.K., et al. Prenatal Risk Factors for Adverse Developmental Outcome in Preterm Infants-Systematic Review. Frontiers in Psychology, 2019. PMID: 30971974.
[17] Hanson, H.A., et al. Risk of childhood mortality in family members of men with poor semen quality. Human Reproduction, 2017. 32(1). PMID: 27927843.
[18] McGee, E.A., et al. Initial and cyclic recruitment of ovarian follicles. Endocrine Reviews, 2000. 21(2). PMID: 10782364.
[19] Neto, F.T., et al. Spermatogenesis in humans and its affecting factors. Seminars in Cell and Developmental Biology, 2016. 59. PMID: 27143445.
[20] Wu, H., et al. Preconception urinary phthalate concentrations and sperm DNA methylation profiles among men undergoing IVF treatment: a cross-sectional study. Human Reproduction, 2017. 32(11). PMID: 29024969.
[21] Stephenson, J., et al. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. Lancet, 2018. 391(10132). PMID: 29673873.
[22] Salas-Huetos, A., et al. The Effect of Nutrients and Dietary Supplements on Sperm Quality Parameters: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Advances in Nutrition, 2018. 9(6). PMID: 30462179.
[23] Nassan, F.L., et al. Diet and men’s fertility: does diet affect sperm quality? Fertility and Sterility, 2018. PMID: 30196939.
[24] Gaskins, A., et al. Paternal physical and sedentary activities in relation to semen quality and reproductive outcomes among couples from a fertility center. Human Reproduction, 2014. 29(11). PMID: 25164027.
[25] Levine, H., et al. Temporal trends in sperm count: a systematic review and meta-regression analysis. Human Reproduction Update, 2017. 23(6). PMID: 28981654.
[26] Ghayda, R.A., et al. Urinary bisphenol S concentrations: Potential predictors of and associations with semen quality parameters among men attending a fertility center. Environment International, 2019. PMID: 31376593.
[27] Leaver, R.B. Male infertility: an overview of causes and treatment options. British Journal of Nursing, 2016. 25(18). PMID: 27734725.
[28] Oehninger, S., et al. Sperm functional tests. Fertility and Sterility, 2014. 102(6). PMID: 25450304.
[29] Krzastek, S.C., et al. Future diagnostics in male infertility: genomics, epigenetics, metabolomics and proteomics. Translational Andrology and Urology, 2020. 9(Suppl 2). PMID: 32257860.
[30] Wang, C., et al. Limitations of Semen Analysis as a Test of Male Fertility and Anticipated Needs from Newer Tests. Fertility and Sterility, 2014. 102(6). PMID: 25458617.
