Men make up 50% of all fertility problems
Male fertility is important. That’s a fact. Men make up 50% of all fertility problems, and so it is important to know what checks to do and how to move forward in the best way. So this week on “Let’s all Talk Fertility” I spoke to Consultant Urologist and Lead Andrologist Professor Suks Minhas from Imperial College.
A lot of Suk’s work focuses on the causes and treatments for male infertility. Perfect for this webinar! Suks started by explaining just how much male fertility had declined over the last 50 years. The reason? We’re not entirely sure; “It maybe due to industrialisation, exposure to chemicals called endocrine disrupting chemicals” Professor Minhas told us.
So when do we start to worry? “If you're above the age of 35 some people would argue even after six months of trying, you should get a semen analysis” he said “but usually there are things we can do, lots of things.” And whilst the end point may still be IVF treatment, it's about a process of understanding.
As a country we are becoming more aware of how common male infertility is. It’s an issue that currently affects one in 15 couples. So what should we be looking out for?
Here’s Suks list:
Past history - “have there been any operations” Suks asks, such undescended testicles that may have been operated on as a child.
A varicocele - an enlargement of the veins within the testicles “which might cause heat damage”.
Drugs - for example, bodybuilding drugs, male contraceptive testosterone, chemotherapy or radiotherapy treatments.
Weight - “Because we know that a BMI is associated with infertility and semen” Suks advised.
Smoking and alcohol - both have been reported to impact male fertility.
Once these things have been ticked off, you may decide it’s time to go to a fertility clinic. “The semen analysis is obviously the basic test that you're going to do in a patient, and from there, you can decide whether or not there's sperm, the quality of the sperm, what it looks like.” Suks told us. It’s also important: 1) To assess testosterone, because low testosterone is associated with infertility. 2) Do an ultrasound scan, to ensure everything is normal and there are no tumor markers, plus to measure the size of any varicoceles. Then there is genetic testing…
“Certainly in men who have no sperm, you should be doing a full genetic screen, which includes looking at a chromosome test on men to make sure their genetic makeup is normal and also particularly no sperm is to look for evidence of wipeouts in the male Y chromosome”.
While DNA testing is still a ‘grey area’ in the fertility industry as a whole, when it comes to DNA quality in sperm, Suks thinks it’s an important biomarker; “So often we used to see patients which normal sperm counts failing IVF treatment or not getting pregnant naturally. And what we have shown in many studies - including our own - is that about 30% of patients with so called unexplained infertility have raised DNA damage.” Breakages in the DNA structure, when the egg is fertilised by sperm, may lead to a failure of embryo development or recurrent miscarriage. This is down to the genetic problems in the embryo.”
So how can this be fixed? “Dietary modification is important, as losing weight can improve DNA damage. And all these things we mentioned about general lifestyle and being healthy can improve DNA. The problem is identifying a sperm that is not damaged. There's no direct methods to do that.” Which is when Suks would turn to sperm selection techniques.
The good news is, there are many things you can do when it comes to male infertility, it’s just a case of working out which option is best for you. Plus it’s also important that gynaecologists and andrologists work together to find answers; “It's about trying to do joint collaborative work so that we can make an informed decision” says Suks, which of course is not only better for the patient but also more cost effective.
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