This is the latest article in a Global News investigation into fertility in Canada, and the emotional and financial impact infertility has on Canadians struggling to conceive.
There’s a common misconception that fertility is a woman’s issue, but the fact is men are as crucial to conception as they are to the inability to conceive. According to statistics from the Government of Canada, three out of 10 cases of infertility are due to problems deriving from the man, while most fertility doctors say that up to one-third of their practice is exclusively made up of men experiencing fertility issues.
But while women can exhibit signs or be diagnosed with conditions that could indicate future fertility problems — irregular or very painful periods, or endometriosis, for example — most men aren’t aware of any issues until they try to conceive. At that point, a semen analysis is conducted to determine the shape, volume and motility of sperm, the three major factors that determine its health.
The good news is with interventions including surgical and non-surgical procedures, medications and lifestyle changes, male infertility doesn’t mean conception is out of the question.
“Most cases of male infertility can still result in a pregnancy even if nothing can be done to improve the situation,” says Dr. Victor Chow, clinical associate professor in the Department of Urologic Sciences at the University of British Columbia. “Even in severe cases of male infertility, we can usually find small numbers of sperm. Given the advances in in vitro fertilization (IVF), we only need one sperm for every female egg.”
In roughly 25 per cent of the cases, there is no identifiable reason for low sperm count. For the rest, it can be chalked up to a number of health issues, including testicular injuries, infections from childhood (like mumps), chemotherapy and radiation, and operations like hernia surgery.
“The hernia and the spermadic cord are in the same area,” explains Dr. Ken Cadesky, medical director of Trio Fertility in Toronto. “If a surgeon isn’t careful, they can accidentally tie off the area in surgery.”
Men who suffer from cystic fibrosis are also genetically prone to have a lower sperm count because part of that gene can code them for a condition that hinders/halts the development of the system responsible for transporting sperm from the testes to the urethra.
But much like any other bodily function, healthy sperm depends on healthy lifestyle choices.
“Sperm is on a three-month assembly line from its development in the testicles to when it’s mature, and any insult over that three-month period can have an impact on it,” Cadesky says.
For that reason, vices like smoking, excessive drinking and drug use are all factors that can significantly impact fertility.
“One cigarette can be as bad as 50,” he warns. “Once you stop smoking, regardless of how little or how much you smoked, it still takes three months to get full improvement.”
Prescription drugs can also wreck havoc on sperm. Steroids and hormones like testosterone can wipe out sperm temporarily. And to further vilify vanity in men looking to conceive, hair growth drugs like Propecia can also affect sperm quality.
Viagra, on the other hand, can be helpful. Aside from the obvious benefit of correcting erectile dysfunction, there are some studies that show it produces more semen, Cadesky says. It may not result in a better sperm count, but it does boost volume, which gives doctors a larger total sample to work with if a couple is undergoing IVF.
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If a couple is undergoing intrauterine insemination (IUI) or IVF, doctors might suggest sperm washing, a process in which mucus and non-motile sperm is weeded out of the semen to improve the chances of fertilization. And if the latter fertility treatment is being explored, intracytoplasmic sperm injection (ICSI), where a single sperm is injected directly into an egg and then implanted in the uterus, is suggested to improve the chances of pregnancy.
Depending on the cause of infertility, some minor procedures can help. Aspirated sperm, where it is extracted directly from the testes, can be used in cases where males don’t have the appropriate highways for transporting semen or have had a vasectomy, and can be injected into the female via IUI or IVF. In some cases, however, surgery is necessary.
Varicocele, a condition where varicose veins in the scrotum overheat the area thus affecting the ability to make sperm and testosterone, can be successfully fixed by blocking off the abnormal veins. Genetic issues can also often be circumvented by opening the testes and looking for areas of sperm production.
In terms of prescription medication, there aren’t a lot of options, although Cadesky says that anecdotally, fertility drugs like chlomid have been proven to help.
When is it too late?
While women are told that fertility starts to decrease after age 30, and significantly after 35, men don’t seem to have such a hard cutoff.
“There is a general gradual decline in the quality of sperm being produced as a man ages,” Chow says. “But it’s at a much smaller degree than fertility in women. It’s not uncommon for a man in his 50s or 60s to try to conceive and be successful.”
Unlike women who are born with all their eggs (that decline with age), men constantly produce new sperm. That’s what gives them the edge in the age game. But according to some experts, that doesn’t mean there aren’t genetic concerns with fathering children later in life.
A collaborative study conducted by Indiana University and the Karolinska Institute in Stockholm in 2014, found a link between men who had children at the age of 45 and psychiatric and academic disorders in their children. The problems ranged from autism and ADHD to schizophrenia, substance abuse problems and low IQ.
In examining a large data set — everyone born in Sweden between 1973 and 2001 — researchers found that compared to siblings born to 24-year-old fathers, children born to the same men at 45 were three-and-a-half times more likely to have autism, 13 times more likely to have ADHD, twice as likely to suffer from a psychiatric disorder, 25 times more likely to be bipolar, and two-and-a-half times more likely to have a substance abuse problem or suicidal tendencies. In many cases, researchers noted that the likelihood of disorders increased steadily with advancing paternal age.
“While the findings do not indicate that every child born to an older father will have these problems, they add to a growing body of research indicating that advancing paternal age is associated with increased risk for serious problems,” said Brian D’Onofrio, lead researcher and director of clinical training in the Department of Psychological and Brain Sciences at Indiana University.
“The quality of sperm declines after 45, which is the age when men have a higher DNA fragmentation rate,” Lo explains. “Sperm is a pack of DNA, and if there’s any damage to it the strands start to break. It’s hard to say if it’s entirely age-related or due to cumulative exposure of damaging elements, but it is a reality.”
In other words, famous older dads like Hugh Hefner, Larry King and David Letterman aren’t as common as men might hope.