Fertility is a medical frontier where the gender gap is disturbingly wide and male infertility an under-researched part of the conception equation
The biology of how a sperm swims to and fertilises an egg remains, largely, unchartered scientific waters, and lags behind understanding of female fertility.
The alarming statistic is that although a healthy, successful sperm is 50 per cent of a successful fertilisation, there is only one licensed fertility clinic dedicated to men, while the legions of others focus almost solely on women.
Research into male factors is minimal, allowing myths to proliferate and an undercurrent of placing responsibility on the female side.
“The lack of research is crucial. Men have not featured as heavily in research in reproduction and socially we construct reproduction much more as a female issue,” says Dr Esmée Hanna, a researcher at the Centre for Health Promotion in the School of Health and Community Studies at Leeds Beckett University.
“I am really surprised by how little research we have about men’s infertility and their voices are lacking from the discussions. We don’t ask about how they feel if they can’t have children or about their desire to have children.
Our social constructs of masculinity and being a man are about someone who is sexually active and virile, and we can conflate fertility with virility
“There is a stigma about male infertility. Our social constructs of masculinity and being a man are about someone who is sexually active and virile, and we can conflate fertility with virility.”
This barren zone of knowledge is pushing couples towards expensive and emotionally draining IVF cycles or intracytoplasmic sperm injections, which involves the direct injection of sperm into eggs obtained by IVF.
Allan Pacey, professor of andrology at Sheffield University, is among many academics and experts who confirm that levels of scientific evidence on sperm cell function fall way behind other branches of medicine.
Dr Sheryl Homa, who runs Andrology Solutions, a male fertility clinic licensed by the Human Fertilisation and Embryology Authority, believes couples are directed too readily towards IVF based on a rudimentary sperm analysis without full consideration of health issues that might be impinging on male fertility.
“It is a gold-standard test, but it is not the only test,” says Dr Homa, a clinical embryologist and honorary senior lecturer in biosciences at the University of Kent. “It is a poor indicator of fertility and World Health Organization guidelines recommend that you cannot investigate male reproductive health based on just that test.
“You need a full reproductive health test looking at fertility history, general health – because systemic illness could be a cause of poor semen quality – medical and urological history, underlying infections, and issues such as varicoceles – enlarged veins in the scrotum – which can all contribute to poor fertility for men. A physical exam is also advised.”
Results from detailed health checks give clinicians better options to address and manage male infertility, she adds.
“Treatment management should be assessed on these results rather than saying ‘off to IVF’ on the basis of the semen test,” says Dr Homa. “I believe there are a lot of people having IVF who don’t need it or who are handicapped because the man has an underlying infection, a varicocele that is damaging the sperm DNA or oxidative stress interfering with the functionality of the sperm including fertilisation.
“If you had a female patient who has problems with her hormones, you wouldn’t simply send her straight to IVF; you would investigate to make sure she doesn’t have other confounding issues such as fibroids in the uterus that impair embryo implantation which if removed may result in natural pregnancy.
“So why would you send a man off without a testicular scan that might reveal the underlying cause of his sperm quality and infertility? Detection of a varicocele, for example, may explain poor semen parameters and indicate damaged sperm DNA, and there is evidence to show that varicocele repair can improve sperm DNA quality and increase both natural and assisted conception pregnancy rates.”
Dr Homa also believes that more research is needed to gauge the impact of exposure to chemicals and medications, such as antidepressants, on male fertility, while educating young men on their role in conception needs to be improved.
“It is absolutely key that men look after their reproductive health if they are considering trying for a family,” she concludes. “Men need to understand that the whole point of the sperm is to deliver healthy genetic material into the egg and any anomalies passed on will have consequences in every single cell of that embryo – they are 50 per cent responsible for the health of that embryo.”