When the path to parenthood proves challenging, finding a solution as to why pregnancy is not happening is not only a women’s issue: a third of all infertility cases are due to the male factor. Leading a healthy lifestyle and staying on top of reproductive health is hence imperative for men too.
Charles from Dreaming of Baby discusses sperm production, the factors that impact it, and diagnosis and solutions for sperm production issues, with Dr. Mark Payson from CCRM Northern Virginia.
Charles: Good Morning Dr. Mark Payson, thank you for joining us today to discuss Male Fertility. If you would be so kind as to introduce yourself to our readers before we jump into the subject matter today.
Dr. Mark Payson: Good morning, thank you for inviting me. I am the director of CCRM Northern Virginia, a national leader in fertility care. I previously served as director for the military’s IVF center in Bethesda, Maryland.
Male Factor Infertility
Charles: It’s a pleasure to have you here! Thank you for your service both to our nation and in the medical field. To start us off, how common is male factor infertility?
Dr. Mark Payson: Male infertility is more common than generally thought, as the public usually focuses on female infertility. However about 1/3 of all infertile couples have difficulty conceiving due to male issues, the same rate as for women. (The final 1/3 is either difficulties with both partners, or without clear explanation).
What causes male infertility?
Charles: It is my understanding that male factory infertility is generally either productive or obstructive. I would like us to focus on productive issues, to gain a basic understanding what do we mean when we say productive?
Dr. Mark Payson: “Productive” male infertility would mean that the testes are not producing sufficient sperm. As opposed to “obstructive” a situation where sperm is produced but there is a blockage in the path that allows it to be released.
Charles: What are the most common causes of productive infertility?
Dr. Mark Payson: Productive disorders are due either to intrinsic problems with the testes themselves or due to problems in communication between the brain and the testes. The testes require signals from the brain to work, so in various settings from genetic disorders to situations of severe illness or stress, the brain does not send those signals and the testes remain inactive. On the other hand, there can be intrinsic problems with the testes, often congenital (occurring before birth), where the testes did not develop normally and cannot produce sperm.
How is a sperm issue diagnosed?
Charles: So, for the sake of this interview John & Mary step into a fertility clinic seeking answers as to why, try as they may, they have not yet conceived. What’s the first step to diagnosis for John? What can he expect?
Dr. Mark Payson: The first step will be to take a history of the couple. Has John ever fathered a child? Does he have any medical illnesses? Does he take any medications? Does he have any difficulties with intercourse or ejaculation? Once these basic facts have been obtained, the single most important test for him is going to be a semen analysis.
Charles: What can the semen analysis tell us?
Dr. Mark Payson: The semen analysis (SA) looks at a variety of sperm parameters. The most important of which are: volume, density (how many sperm per milliliter), motility (how many sperm move normally), and morphology (how many sperm have a normal shape). Commonly we refer to density as the “sperm count.” A normal result would be at least 15 million sperm per milliliter.
Medication that impacts sperm production
Charles: You mentioned medications, are there any common medications that adversely impact sperm production?
Dr. Mark Payson: While a variety of medications can have some impact, far and away the most critical ones to avoid are male hormones (androgens). Patients taking supplemental testosterone can reduce their sperm count significantly, sometimes to zero. This is commonly misunderstood, even by health care providers, who presume that giving male hormone will increase sperm counts. But the reverse happens, by giving testosterone to a man, the amount of testosterone made by the testes will decrease and then sperm production falls.
Dr. Mark Payson: “By giving testosterone to a man, the amount of testosterone made by the testes will decrease and then sperm production falls.”
Sperm Production and your Health
Charles: Interesting; how much of an impact does the overall health of someone like John have on reproductive health?
Dr. Mark Payson: While many men who are in poor health continue to be fertile, it is certainly better to be in good health! Any systemic disease, including periods of high stress, or jobs with exposure to heat and radiation can decrease sperm counts, and make fertility more difficult. It takes sperm 72 days to form and mature, so anything that happened in the previous two and a half months can affect sperm count. Classically, we think of someone who had the flu and then has a period of time several months later with decreased sperm count. And of course, being in good health is important when there is a baby in the house that needs to be cared for!
Charles: Wait, even the flu can impact fertility temporarily?
Dr. Mark Payson: Yes. The fevers associated with the flu can lead to a drop in sperm counts several months later. This will recover, and is part of an expected variation in sperm counts during our normal lives.
Charles: Wow, so if for example you already had a slightly lower sperm count due to other factors something like the flu could impact your chances of a speedy conception? Does the same apply to high stress periods and other factors that impact production?
Dr. Mark Payson: Sure. However, sperm counts fluctuate up and down from month to month in all men, probably due to all these factors we are discussing. Usually those changes are not enough to directly affect fertility, but in a man who already has a borderline sperm count, it could increase the time it takes to father a pregnancy, or lead to the need for treatment.
Does age impact fertility in men?
Charles: John has often heard that his age doesn’t impact his fertility; as a man so to speak, he has no rush to conceive. Is this common statement true?
Dr. Mark Payson: While men do not have the same fixed “clock” as women (women have a significant drop in fertility from age 35 to 42), age does affect men. While men continue to produce sperm and can father children throughout their lifespan, there is a decrease in sperm number and quality with time, and an increase in birth defects. The absolute risks for an older father are small, but real. There is an association between increased autism with advanced paternal age as well as a variety of genetic defects (although the majority of children from older man are still normal).
Dr. MArk Payson: “While men continue to produce sperm and can father children throughout their lifespan, there is a decrease in sperm number and quality with time, and an increase in birth defects.”
Treatments for male infertility
Charles: Taking our example further, John had a few things that could have been causing his infertility. He has adjusted his lifestyle and stopped taking medication that adversely impacted his production. Still, after months of trying, he has had no luck. Is it game over for John? Where do we go from here?
Dr. Mark Payson: It is not game over for John! There are always solutions. First of all, male factor infertility usually is due to low sperm counts, not zero sperm. As long as there are some sperm we have several options: if his count is just a little low, we can do IUIs (intrauterine inseminations) which will deposit more of his sperm directly into the uterus. If this does not work, or he has a very low count, we can do IVF (in vitro fertilization) with ICSI (Intracytoplasmic sperm injection). In this therapy, we insert a single sperm into a single egg, this has allowed many men who were infertile to become fathers. Finally, if he has no sperm, we will have a urologist evaluate him for obstructive or hormonal causes.
Charles: We have taken up a considerable amount of your time but we really appreciate you providing us this important information! So, for John there is hope. With male factor infertility, how often do we reach a successful pregnancy with the right treatment?
Dr. Mark Payson: IVF with ICSI (if necessary to go that far) will overcome almost all male factor infertility. Of course, there may then be factors on the female side that create a challenge. But we are very successful in our treatment of men. In the cases where there are no sperm available, there are sperm banks that allow men to choose sperm from a donor who is similar to them. Although parenthood does not always come the way we anticipated, there is always a way to become a father!
Charles: In short for us men, often the biggest hurdle is accepting that we may need some help but ultimately for most men, there is a very probable path to parenthood?
Dr. Mark Payson: Absolutely. And it is important to accept that this is not just a women’s issue. The diagnosis and testing and treatment also involve the man.
Dr. Mark Payson: “Although parenthood does not always come the way we anticipated, there is always a way to become a father!”
Charles: Is there any benefit in catching issues early for men? What I am asking is, as women often get regular checkups and have a more frequent relationship with reproductive health specialists; is there a benefit in men being equally vigilant with their reproductive health?
Dr. Mark Payson: Yes. In general, women take better care of their health than men, and visit doctors more frequently. For men, a lot of it comes down to having a healthy lifestyle and listening to our bodies. Heavy alcohol drinking, smoking and marijuana use, and obesity all will directly affect male fertility. And don’t ignore symptoms of problems without seeking help.
Charles: This interview has been very educational and informative. I would like to thank you on behalf of our readers for your time and detailed responses to questions I’m certain many men on the path to parenthood want the answers to. As a final question. Do you have a message to fathers to be that are dreaming of baby?
Dr. Mark Payson: Fatherhood is a wonderful thing, but getting there sometimes can be a challenge. The resources available today are better than they have been at any time in history. Most people can succeed in becoming a parent. Don’t give up!
Charles: Thank you, Dr. Mark Payson!