When my wife and I decided we wanted to have a baby, a lot of thoughts went through my head. How long will it take? Am I going to have to change my lifestyle? So for those of you asking similar questions, I conducted an interview with Dr. Amos Grunebaum, a fertility expert whose also a medical health advisor for Fairhaven Health, regarding male infertility.
1. How common is male infertility?
Statistics show that up to 15% of all trying-to-conceive (TTC) couples suffer from sub-fertility or infertility, with infertility being defined as the failure to become pregnant after one year of unprotected, well-timed intercourse. While it is often assumed that the blame for most fertility-related issues should be placed at the feet of the female partner, many fertility experts are quick to point out that in at least 40% of infertile couples, it is actually the male partner that is the cause of the infertility.
2. How is sperm count related to male infertility?
Low sperm count, defined as fewer than 20 million sperm per ml of semen, is probably the most common cause of male infertility. This might be a difficult fact to accept, especially when you consider that the semen of men with low sperm count can contain millions of sperm. So, why is sperm count such a big factor in male fertility? It only takes one sperm to fertilize an egg, right? Here's where conception comes down to numbers: A man normally delivers 200-500 million sperm per ejaculation. However, many sperm die immediately upon ejaculation. And, for the sperm that survive ejaculation, it is a long and arduous journey through the female reproductive organs to find the newly released egg. Of the nearly 500 million sperm that are released during ejaculation, only a maximum of 200 sperm ever reach the egg to even have a shot at fertilization. So, the more sperm you have to begin with, the greater the chance you have that one sperm will find its way to the egg.
3. How can a man determine if he has low sperm count?
Once a TTC couple decides to seek the advice of a fertility specialist (usually after many months of trying to conceive naturally), the doctor, as a first step, should refer the male partner for a semen analysis. A comprehensive semen analysis, performed at a clinic or lab, will evaluate several sperm health parameters, including sperm count, sperm motility, and sperm morphology (the size and shape of the sperm), as well as determining the overall quality of the semen.
If a couple is not yet ready to see a fertility specialist, but is curious to know if the man’s sperm count is normal or below normal, he can purchase an at-home sperm count test (SpermCheck Fertility Test from Fairhaven Health). This will allow him to determine if his sperm count is within normal range, without the expense and inconvenience of having a semen analysis performed at a clinic. If the result of this test is negative (below normal sperm count), further testing is probably warranted, and the man should seek the advice of a physician.
4. What are treatments for male infertility?
If it is discovered that a man has low sperm count, he will undergo various tests to determine the reason for the low sperm count. In some cases, the actual production of sperm is normal, but there is a blockage in the epididymis or vas deferens (typically caused by inflammation due to a sexually transmitted disease) that is preventing sperm from entering the ejaculate. In these cases, surgery may be recommended to eliminate the blockage. A man undergoing this type of procedure has about a 40% chance of becoming a father.
It is also believed that a condition known as a varicocele can reduce sperm count. A varicocele is an abnormal enlargement of the veins in the scrotum, which causes blood to pool in these veins (similar to varicose veins in the legs). It is not known precisely how or why varicoceles negatively impact fertility, but one theory is that the pooled blood increases the temperature in the testicles, which ultimately decreases sperm count. If it is determined that a man has a varicocele, it might be recommended that he undergo a surgical procedure to repair the varicocele. It is important to note that not all fertility experts agree that varicocele repair improves male fertility (including sperm count) or increases pregnancy rates. And, varicocele repair can cause some side effects, including infection at the site of surgery, fluid buildup in the scrotum that requires draining, and/or injury to the arteries or nerves in the scrotum.
If the reason for low sperm count is unexplained (i.e. no blockage is identified), then it is possible for a man to increase his sperm count by making lifestyle and dietary changes, and by supplementing his diet with key nutrients (see below).
5. How can men increase their sperm count?
Sperm count is negatively impacted by a variety of lifestyle and environmental factors: smoking cigarettes, chewing tobacco, using recreational drugs, drinking large amounts of alcohol, and exercising excessively (e.g. high level training for athletic competitions, etc.) can all reduce sperm count. Quitting, or simply cutting back on, any of the activities above can help increase sperm count. Chronic exposure to certain environmental toxins can also have an adverse effect on sperm count, so men who work around agricultural or industrial chemicals may be at increased risk for suboptimal sperm health.
The reason that the factors above impact sperm health is that they increase the free radical load in the body. Free radicals are unstable oxygen molecules that are produced in the normal metabolic breakdown of chemicals. These unstable oxygen molecules move around the body seeking to participate in biochemical reactions that make them more stable, which result in damage to fats and proteins that are found in the cells of our body. While the body does employ a variety of “antioxidant” strategies to mitigate the damage caused by free radicals, when the free radical load is high (or there is a deficiency of antioxidant nutrients available), the body is unable to keep up, and free radicals wreak havoc throughout the body. And, as it turns out sperm cells have less effective antioxidant mechanisms to keep free radicals at bay, and are especially vulnerable to damage from free radicals due to the high amounts of fats contained in their cell membrane.
Men can help decrease the free radical load in the body (thereby reducing damage to sperm cells) by supplementing with antioxidant nutrients. Products like FertilAid for Men, CountBoost for Men, and MotilityBoost for Men contain the key nutrients necessary to prevent free radical damage and to promote sperm health.
6. Statistically, has sperm count increased or decreased amongst men inthe last 50 years?
A startling scientific report was published in 1992 (BMJ 1992 Sept 12:305(6854):609-13) that documented a 50% decline in average sperm count in the years between 1938 and 1990. The results of this report have been the subject of considerable controversy, with critics suggesting that there is no way to compare sperm counts from the early part of the century to sperm counts measured later on because modern methods of counting sperm differ dramatically from methods used earlier. However, as the dust continues to settle on this controversy, the weight of the evidence definitely suggests that sperm counts have declined dramatically over the past 80 years, and continue to decrease by up to 2% each year.
7. In your experience, is low sperm count one of the reasons why couples have a hard time conceiving? If so, why?
Yes, male factor infertility is a contributing factor in at least 40% of the couples suffering from infertility, and low sperm count is the most common cause of male infertility.
8. What are the myths about male infertility?
· Surgery to remove blockages and repair varicoceles is always successful: There is considerable controversy about the effectiveness of surgery to remove blockages in the male reproductive tract and to repair varicoceles. Men definitely need to carefully research this issue before deciding to have surgery.
· There is nothing a man can do to increase his sperm count: Sperm count is impacted by several lifestyle factors. A man can significantly increase his sperm count by changing certain lifestyle behaviors and by supplementing his diet with key nutrients.
· Male infertility is not very common: In fact, the male partner is the cause of infertility in at least 4 out of 10 couples with struggling to become pregnant.
9. Any words of advice for my readers that are trying to conceive?
· Take your health seriously.
It is important for a man to understand that his health status is as important as his partner’s health status in determining whether or not the couple will conceive, and also contributes to the health of the baby if conception does occur. Many lifestyle and environmental factors impact sperm count, sperm motility and sperm morphology, as well as the quality of the DNA in sperm. At least 3 months before trying to conceive, a man should discontinue use of any recreational drugs, limit alcohol consumption, exercise regularly (but not too excess) and eat a healthy diet (lots of fruits and vegetables and low in fat). This will allow his sperm to become as healthy as possible before the couple begins to attempt conception.
· Supplement your diet with a good multivitamin/mineral supplement.
Even the healthiest of men should consider supplementing their diet with a high quality multivitamin/mineral supplement like FertilAid for Men from Fairhaven Health. A growing body of research suggests that supplementing the diet with key minerals and antioxidant nutrients can
· Know your sperm count.
If a couple is just beginning to try to get pregnant, it does not hurt (and can save a lot of time and heartache in the long run) for a man to take an at home sperm count test. This will determine if the man’s sperm count is within a normal range. If the test is positive (sperm count normal), then the couple can begin their TTC journey with some level of confidence. If the test is negative (sperm count below normal), then the couple can immediately begin to research ways to increase sperm count and overall sperm health.
· Identify your fertile window.
A crucial piece to the “trying to conceive puzzle” is identifying the best days during the month to have intercourse. It often comes as a surprise to some men (and some women, too!) that it is only possible for a woman to conceive on a limited number of days. For conception to occur, sperm must be present in the Fallopian tubes at the moment the egg is released from the ovary. Because sperm can only survive for about five days in the female reproductive tract, a woman is really only "fertile" for a short window of time during each month. To maximize the chances of getting pregnant, trying to conceive couples must plan to have intercourse on the several days prior to ovulation (and perhaps on the day of ovulation). Many women have no trouble identifying their fertile window. However, for many other women, ovulation prediction is much more difficult. There are many ways to predict ovulation, with a wide range of cost, effectiveness and convenience. 
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