Feature
Sperm counts
by Sarah Barnett
When a couple can’t have children, the man is often to blame. So what can he do about it and why is he feeling so guilty?
For one in every six New Zealand couples, having a child will turn out to be much more difficult than chucking out the contraceptives and dimming the lights. And contrary to popular belief, male infertility will be a factor in about half of all cases. In roughly a quarter, it will be the only factor.
A British Medical Journal report last month suggested infertility rates could double in the next decade – partly because of in vitro fertilisation (IVF) itself, which can allow a genetic predisposition to infertility to be passed on to offspring – but largely due to the same lifestyle factors linked to almost every public health issue.
While female infertility tends to be complex, the most common cause of male infertility is impaired sperm production or function.
Research suggests clear links with lifestyle factors. To safeguard your sperm, keep fit, watch what you drink and don’t smoke (tobacco or marijuana). Men with a waist circumference over 100cm are prone to erectile dysfunction, and a high body mass index (BMI) has been linked to low sperm production. Smokers generally have lower sperm counts and higher levels of free radicals, causing DNA damage in sperm cells. The science isn’t quite so settled on alcohol use, though anything that impairs one’s health is likely to harm sperm quality.
Newer studies focus on more modern accoutrements: spa pools and laptops direct heat to the testes, damaging sperm; though counts will bounce back after the testes cool down, prolonged exposure isn’t recommended.
And studies of cellphone use are starting to show the same results – don’t keep your phone in your front trouser pocket.
About one in every 100 New Zealand children is born as a result of fertility treatment; it’s closer to 5% in Australia and the United States. Unlike other fertility services in New Zealand – maternity and termination – which are fully government-funded, IVF treatments are limited. To be eligible for public funding, a couple must score at least 65 points on the Clinical Priority Assessment Criteria (CPAC) test – which projects the likelihood of conception after an IVF cycle. The criteria include the woman’s body mass index (BMI), her age, whether she smokes and other medical history questions.
Despite new studies under way on the impact a man’s BMI, age and other factors have on his fertility, the University of Auckland’s Cindy Farquhar points out that in the CPAC criteria, “it doesn’t matter how fat the male partners are, whether the male partners smoke or how old the male partner is – and that’s partly because of the way the scoring system works. It’s on predictive models: how likely is it you’ll get pregnant on your own without needing any treatment, and how likely with treatment, and age is the big determinant there.”
If a woman is over 40, she’s automatically ineligible for funding. Having met the CPAC criteria, couples are eligible for funding for just two cycles of IVF – the second only if the first is unsuccessful.
By comparison, the Australian Government under former Prime Minister John Howard provoked outrage in 2005 when cuts to fertility-treatment funding were announced: now Australian couples are funded for only three cycles a year. Women over 42 get a total maximum of three cycles.
Research funding for reproductive issues is incredibly hard to come by, too, says Farquhar, a postgraduate professor of obstetrics and gynaecology. “We’re up against research funding that predominantly goes to the big things that kill people – cancer, heart disease, diabetes, obesity … Meanwhile we struggle on and find it very hard to get research funding in that particular climate.”
Colleague Andrew Shelling says he got “an informal response to one of my grants a few years ago that said, look, at the end of the day, it’s not common enough and nobody’s dying”.
Yet Shelling, an associate professor of reproductive science at the university, argues, “I think there are a number of drivers in our society at the moment where it’s got to a tipping point where we all know someone whose life’s been changed completely by the fact that they can’t have a child.”
Research into male infertility is just a tiny part of the studies undertaken, partly, the researchers say, because women are more complex and more things can go wrong.
“Not a lot new has happened in male factor infertility for a while,” Farquhar says. Thirty years ago, IVF wasn’t even offered for male-factor infertility “because the sperm wasn’t strong enough to fertilise the egg, even when you put it in the same petri dish”.
It wasn’t until the advent of IVF-ICSI (intracytoplasmic sperm injection) 15 years ago, whereby sperm is injected straight into the egg, that IVF became a way to deal with male infertility.
It’s very rare, Shelling says, for a man to have an absolute zero sperm count: “One woman from the fertility clinic says, ‘If there’s a sperm in there, I’ll find it!’ … They can do all sorts of sperm retrieval through a biopsy of the testes to see whether or not there are sperm present, even if they’re quite immature.”
And while science has moved ahead, ethics is lagging behind. Men with genetic reasons for their infertility can pass on that infertility gene to their sons, Shelling says.
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