The inconceivable truth
Male infertility is a poorly discussed subject, yet around half of all fertility issues relate to men. Jai Breitnauer takes a look at what male infertility is, how it affects couples and the barriers to being more open.
It takes two to tango, as they say, and never is that more true than when making a baby. The vital ingredients are provided by both parties, with men (on average) releasing around 100 million sperm on ejaculation but just 100 contenders making it to the woman’s egg. Even when your chances of conception are good, the efficiency rate is scientifically low, compared to the animal kingdom at least. And sometimes, the chances aren’t good, for many reasons.
Women have opened up for years about the heartbreak they’ve felt when they’ve had difficulty falling pregnant. But it is a little- known fact that 30 to 50 per cent of infertility in couples is as a result of issues with the man of the house. Around seven per cent of men globally are affected by infertility, yet it is rarely spoken about. “Where fertility is an issue, there tends to be more of a focus on the woman,” explains Dr Shelley Reilly, a fertility specialist at Fertility Plus. “She is, after all, the focus of most of the procedures, and it is her body that will carry the baby. But statistics show infertility is a shared experience.”
One third of couples who seek fertility treatment are told the issues relate to both of them, rather than to one partner. Common fertility problems in men are reduced sperm counts and reduced sperm motility. If less than 20 million sperm are released on ejaculation, that is seen as a fertility issue. “Even a minor reduction in sperm count needs to be investigated,” says Dr Reilly. “We take a look at the whole picture. The sperm you see on ejaculation was produced three months ago, so what was happening then? An illness, even a minor virus, could affect sperm count and motility, and you also have to look at diet, alcohol intake and other environmental factors.”
It’s important to rule out potentially serious conditions like testicular cancer, and patients are often referred to a urologist in case there is some sort of tube obstruction. Obesity, smoking and trauma (through sports injuries, for example), are all risk factors for low sperm count and reduced motility, but there are other issues at play. “Men’s sperm counts are getting worse, it’s a global trend,” says Dr Reilly. “Studies are looking at environmental toxins and lifestyle factors to see what could be having an effect.” Genetic and epigenetic factors also play a role and it’s important, says Dr Reilly, not to focus on feelings of guilt that some men often feel. Male infertility is most often out of a patient’s control, and the focus should be on what can be done to help. “There is a process, and we go through the options one by one. Can we extract sperm straight from the testicle? Can we take a good enough sample and use Intracytoplasmic sperm injection (ICSI), where we inject viable sperm into an egg to create an embryo, to increase a couple’s chances? Male fertility problems don’t automatically equal ‘sperm donor’.”
Aimee and Andrew's story
Aimee and Andrew know all about that ‘process’. They’d been together about five years when they decided to start trying for children. They moved from London, where they’d both been working, back to Aimee’s home in New Zealand for the lifestyle and family support. They got married in March 2014 and started trying straight away. “I literally came off the pill a month before the wedding,” says Aimee. “It felt like the right time, the next logical step.”
Neither Aimee, then 33, or Andy, then 37, imagined there would be any problems. All around them, friends were getting married and starting a family – they just assumed they would do the same. “After nine months of monitoring my ovulation, and trying really hard to fall pregnant, I decided I should get checked,” says Aimee, who went to her GP with Andy. “As we were leaving, the GP handed me a slip,” says Andy. “She said, ‘You may as well get tested too.’ My fertility was an afterthought.”
But the results came back showing that Andy’s sperm count was exceptionally low. “They said there were only one or two sperm in Andy’s sample,” says Aimee. “Not one or two million – literally, just two sperm.” Andy admits the news hit him hard. The GP said the words ‘sperm donor’ early on, and I realised this was really serious,” says Andy. “It was a huge blow, and a lot to take in. I couldn’t imagine us having a child that wasn’t genetically mine. I couldn’t get my head around that at all.” Thankfully, at Fertility Plus, Aimee and Andy were able to review their options and get counselling. Andy had an unsuccessful procedure to extract sperm directly from his testes and it was decided the best option was IVF with ICSI using Andy’s sperm. “I had to go in every weekend for three months and give a sample to be frozen,” says Andy. “It was embarrassing to start with, but after a while you get over it.”
To support their health and wellness, they began a programme of paleo eating, no alcohol or caffeine, regular acupuncture and naturopathic remedies. “We spent a year living as health freaks to give our bodies the best possible chance,” says Aimee. Finally, Aimee had two weeks of hormone injections and went in to have her eggs harvested. On the same day, Andy was able to provide a live sample of ten viable sperm, which were matched to Aimee’s eight harvested eggs. “We were like, ‘Wow, 10 sperm! That’s amazing!” says Aimee. “It was the most sperm of the whole time. It felt like it all came together at the right moment.” Of the eight embryos created, only one was viable to be implanted. A few weeks later, Aimee and Andy were given the good news they were pregnant, and they are now happy parents to Griffyn, born in November 2016. “We were lucky we found out early, and knew what the problem was so we could tackle it,” says Aimee. “But it’s been a bit of a ride.”
“I did a lot of soul searching early on. I asked myself big questions like, ‘Am I less of a man?” admits Andy. “You have to rethink your entire identity. But it’s genetics, there’s nothing I could have done about it. I’ve come out stronger personally and as a couple it has made us more conscious of each other and our needs.”
Litesha and Peter's story
Litesha and Peter met four years ago, and married in 2015. After six months trying for a baby, Litesha was sure something was wrong. At 38, she knew she wouldn’t be eligible for fertility treatment through the public system over 40, she pushed her GP for tests, and Peter was unexpectedly diagnosed with Klinefelter syndrome, a rare condition that causes low testosterone and osteoporosis in men. “When I spoke to mum, she remembered I’d had some problems at birth,” says Pete. “But my dad died suddenly of a heart attack two weeks later. Things were so hard for her, and my condition was never followed up. “I don’t blame her though, things were really difficult.” Had it been followed up, Pete could have received testosterone injections during puberty, and had some sperm he produced early on frozen. Being in his late thirties though, there were no sperm left.
Pete struggled to get his head around the idea of having low testosterone. As a builder and avid rugby player, he’d always been a real ‘man’s man’ and in that sense, the diagnosis was difficult to accept. “When I think back though, I’d always struggled to build muscle, especially around my chest. I’ve never had abs. I thought it was just the beer, but obviously not!”
Pete was worried at first about telling his friends, who were stunned. People said, “You don’t look like you’ve got low testosterone. ‘It’s not about how you look though,” he says. “Ultimately, the few people we told have been really supportive.”
When Pete and Litesha were referred to Fertility Plus, they’d hoped some sperm could be recovered direct from Pete’s testes, but this wasn’t an option. Instead they found themselves considering a sperm donor. “In all honesty, I was just happy there was a chance for us to have a baby,” says Pete. “It didn’t bother me that the genetics weren’t mine.”
In New Zealand, there is no formalised sperm bank like in America or Scandanavia, and although some fertility clinics do hold small sperm donor samples, they find it hard to recruit and replenish their supplies. Embryologist Emily Wilson says this is probably because they limit one donor to five families, and because children can legally find out their paternity when they turn 18 – although the donor is not legally obligated to theminanyway. Ultimately, many couples find the donor themselves through support groups and internet chat rooms.
“We found a donor quite quickly,” says Litesha. “He’s the same height, build and ethnicity as Pete, and as he and his wife had experienced some fertility issues, we found them very easy to talk to.” The couple have been through two rounds of IVF with ICSI injections, and have been pregnant twice but sadly, both ended in miscarriage. They have three embryos left.
“We feel like our life has been on hold for the last three years,” says Litesha. “We can’t go on holiday, or buy a house, we can’t make any plans. We are in a holding pattern.” The couple have readjusted their expectations for the future, turning an identity crisis into potential plans. They want couples to understand fertility treatment is a big commitment.
“We’re a pretty positive couple,” says Litesha. “Dispute what life keeps throwing at us. It will be good to have that life back, one way or another.”Although fertility treatment needs to be well considered, it offers a well-supported route to starting a family in difficult circumstances.
Overcoming the stigma
That unnecessary feeling of shame is a common theme that runs through fertility issues – and it can be a barrier to getting help.
“There is still a lot of stigma around infertility for both sexes, but men do seem to talk about it less,” says Fiona McDonald, one of two fertility counsellors at Fertility Plus. “Getting a diagnosis usually hits men really hard, and comes completely out of the blue.” Initially, Fiona’s role is to help couples understand the options ahead of them and work through the challenges the diagnosis provides.
“They often feel their sense of identity is being challenged – men often associate sexuality with fertility,” says Fiona. “There are often feelings of guilt too, but it’s not about blame.” Fiona says understanding the prevalence of male infertility is often a huge help. Fiona also spends some time talking couples through the different coping mechanisms between men and women. “It sounds like a generalisation, but often women want to talk through stuff while men keep it bottled up. Recognising that is really important to the health of your relationship.” If using a sperm donor is the most viable option, then Fiona focuses on helping the couple with the sense of loss.
“There are real issues around grieving for the loss of the natural pregnancy experience, or for having a child that is not genetically yours or your partner’s,” says Fiona. “I ask my couples, ‘What is a parent? Is it about the biology or the care you provide?’ For some people the genetics are really important, but the majority move past that.”
If a couple decides to go ahead with a donor, Fiona advises on where to find one, and then counsels the donor before the process begins.
For support and information, contact Fertility plus counsellors on (09) 6309810 or Fertility New Zealand on 0800 333 306 or email: firstname.lastname@example.org
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