Male Infertility – Researching a Taboo Topic – Why Some Men “Shoot Blanks”
Daren and Joanne Herbert tried for six years to have a baby. When tests revealed Daren’s low sperm count was the issue, they were shocked. They eventually had their daughter, Ori, through IVF. (RANDY RISLING / TORONTO STAR)
After six years of trying to have a baby, Daren Herbert and his wife were stunned to discover he was the reason they were having difficulty.
He and Joanne were in their late 30s and both had suspected the issue was with her. But it turned out that his “catastrophically low levels of sperm” were the problem.
“(I was) afraid, shocked, surprised and feeling guilty because all that time we had assumed it was something to do with her,” recalls the Toronto actor. “I remember thinking, ‘Is it something I did through the course of my life that made my numbers drop so drastically? Or have they always been low?’ ”
A growing number of men are asking such questions as they grapple with fertility issues.
For Herbert, 41, and Joanne, 40, the journey to parenthood culminated happily in May with the birth of daughter Ori, after they underwent two cycles of In Vitro Fertilization (IVF). But across Canada about 16 per cent of couples struggle with infertility — a figure that has doubled since the 1980s.
Men are solely responsible for infertility in about 30 per cent of those cases, and contribute to half the cases overall, according to Health Canada. Factors affecting male fertility include genetics, a history of sexually transmitted infections, and environmental and lifestyle influences, such as exposure to pesticides, chemicals and smoking, excessive alcohol and stress.
It’s an issue that doesn’t get as much attention as female infertility — in part because women see doctors more regularly than men and are conscious of their biological clock. But a man’s age also affects sperm quality and count. Some do become fathers later in life — former prime minister Pierre Elliott Trudeau, artist Pablo Picasso, rocker Mick Jagger — but they’re the exception.
Acomprehensive study published this summer shows sperm counts of Western men dropped by more than 50 per cent in less than four decades. Sperm count is the best measure of male fertility. Researchers from Hebrew University of Jerusalem looked at data from 185 studies of almost 43,000 men done between 1973 and 2011. They found a 52. 4 per cent decline in sperm concentration and a 59.3 per cent decline in total sperm count in men from North America, Europe, Australia and New Zealand. There was no significant decline in counts in men from South America, Asia and Africa, where fewer studies have been done.
Male Infertility can be a very painful thing for a lot of people — and it was for us,” Herbert says. “But our pain was short-lived …. We were very lucky.”
That’s because couples can go through numerous IVF cycles and never have a baby.
The meta-analysis didn’t examine the cause for the decline, but the authors say the fact that it’s occurring in the West suggests chemicals used in commercial products play a role. They warn the decline has implications beyond fertility and reproduction, saying it may be a “canary in the coal mine” for male health across the lifespan.
“In the industrialized world we’re seeing a very definite and clear decline in sperm counts, in quality, even among fertile men, and as the world becomes more toxic, the effect will be greater,” says Dr. Art Leader of The Ottawa Fertility Centre and a board member of Conceivable Dreams, an Ontario-based infertility patient advocacy group.
“I think as well as The Handmaid’s Tale we’re going to have a sequel to it called The Manservant’s Tale.”
Although men can’t change the burden of global pollution there are things they can do to optimize fertility, says the professor of Obstetrics, Gynecology and Reproductive Medicine at the University of Ottawa.
He suggests minimizing alcohol, smoking and exposure to smoke, increasing exercise, maintaining a healthy weight, eating organic foods, taking an adequate dose of Vitamin D and not using anabolic steroids. And be mindful of endocrine disruptors, which are chemicals found in everyday products that interfere with the body’s naturally occurring hormones. Examples include bisphenol A (BPA), dioxins, phthalates and fire retardants.
Even medications used by men to stop hair loss — finasteride and minoxidil — have been shown to lower sperm counts. But once men stop taking these drugs, sperm counts bounce back.
Men should also be wary of reproductive hazards on the job, says Leader. For instance, bakers and chefs who work in hot places; mechanics and industrial workers who handle the metal degreaser Trichloroethylene (TCE), and farmers who work with herbicides and pesticides may be at risk.
If someone is really concerned, they can freeze their sperm before age 40, says Leader, noting: “Men have a best-before date of 40.”
For Herbert, learning in 2014 that he had a low sperm count was a difficult blow. The normal range is 15 million to 200 million sperm per millilitre of semen — he had about one million.
But infertility wasn’t something he felt comfortable talking about with his buddies.
“There is a taboo attached,” he says. “What’s the stigma? That you’re shooting blanks. It just doesn’t feel manly. This is the one thing that should be easy for us to do.
“We go through so much of our life trying not to get somebody pregnant … And then you get to this stage and it’s like, ‘What? I need help? It’s not working? I don’t have enough?’ ”
In hindsight, Herbert says, it would have been “a lot more helpful for me to talk about it.” But he didn’t, except with his wife, who happens to be a psychotherapist.
Jan Silverman, a fertility counsellor who also works at Create Fertility Centre in Toronto, says men don’t easily open up about infertility. But when given the chance they will.
“We get all kinds of guys coming out with sperm issues,” says Silverman, who runs an infertility support group. “Wives will say ‘Oh, he’ll never talk.’ And you get them in the room, with a couple of other guys there, and before you know it they are talking.”
Often what surfaces are feelings of shame, embarrassment and sexual inadequacy. And there’s guilt because even though they’re infertile, it’s their female partners who undergo the invasive and uncomfortable fertility treatments.“I’ll never forget having this huge police officer — a six-foot-five, big, burly guy — who found he had a sperm count of zero. He sat in my office weeping, asking ‘Me?’
“That was so poignant and telling because you never know. That’s the interesting thing about sperm. Just because you ejaculate you don’t know what’s in there. So for men, there is such a sense of shock.”
Even popular culture is tackling the topic. Recently on the HBO hit Ballers, the main character Spencer Strasmore, a retired football player portrayed by Dwayne ‘The Rock’ Johnson, is worried he may not have swimmers and seeks a referral to a fertility specialist. It’s still unclear how that storyline will unfold because moments before he goes into a collection room to ejaculate, he gets called away for work.
Dr. Keith Jarvi, director of the Murray Koffler Urologic Wellness Centre and Head of Urology at the Mount Sinai Hospital, says a sperm test should be the first thing a couple undergoes as part of fertility testing.
“It’s not any statement about your manhood,” says Jarvi, who heads the biggest centre in Canada for male infertility. “The frequency with having a lower sperm count is not uncommon.”
The test checks to see if there is sperm, how much of it there is, how it moves and if it appears healthy and normal. The test is covered by OHIP, relatively easy to do and may spare the female partner from undergoing treatments.
“Guys are often ignored,” says Jarvi. “But if you ignore the guy you might not find a fertility problem that could be fixed.”
Sometimes the fix is simple. Avoiding regular exposure to heat, such as hot baths and saunas, wearing looser underwear and keeping the genital area cool have all been shown to help.
“There’s a whole series of new techniques and new treatments that we can now offer men that we couldn’t offer them 15 years ago,” he says. “We’re now taking on more and more patients who we thought before had no hope.”
For the Herberts, fertility doctors suggested a type of IVF called Intracytoplasmic Sperm Injection, which is commonly used to treat severe male factor infertility. It’s a laboratory process involving eggs extracted from the female, and semen retrieved from the man. An embryologist takes a single healthy sperm and injects it into the egg to create an embryo that is then transferred to the uterus.
Herbert and his wife also made lifestyle changes. He started taking vitamins, improved his diet, stopped doing hot yoga, started acupuncture and eliminated soaps, shampoos, deodorants, toothpaste and household products with potentially harmful chemicals.
In total, they spent about $30,000 during that first IVF attempt.
“Once we said, ‘We’re going for this,’ then we were all in,” says Herbert.
But it wasn’t enough. In November 2015 they were devastated to learn that first cycle of IVF didn’t work. They tried again in 2016. By then the Ontario Fertility Program was up and running and they were eligible for provincial funding, which cut their costs by half. The procedure is covered, but not the drugs. Conceivable Dreams, where Herbert is a member, is trying to persuade insurance companies to add the drug cost to their standard plans.
About 8,200 patients have received government funded IVF treatments since it was introduced in December 2015, says the health ministry. There is a database tracking how many funded IVF cycles are the result of male infertility, but the figures are not yet available.
Doctors warned that IVF was a crap shoot, but the Herberts hit the jackpot on their second attempt.
“If it had been unsuccessful, I would’ve spent the rest of my life having to carry that: We spent our lives childless because of me. That’s pretty intense.”
But then Ori came along. Herbert now looks forward to a life filled with discovering the joys of fatherhood: Playing with her, teaching her to walk, speaking with her.
“She’s like a book that I’m anxious to read.”
Protecting your Sperm
- Clean your house: Use a vacuum with a HEPA filter, mop the floors and clean with a damp cloth to reduce fertility-impairing chemicals that may be in the dust, such as flame-retardants, polychlorinated biphenyls (PCBs) and phthalates. Particles may come from household products, construction materials in older homes and the outdoors.
- Avoid plastic containers and metal cans: Plastic containers may have phthalates and bisphenol A (BPA), which can leach into food or water. Opt for glass kitchenware and glass jars. Metal canned foods are often lined with BPA, so cut back and opt for fresh ingredients.
- Check labels on body care products: Many contain phthalates, a class of toxic chemicals that aren’t usually listed but can lurk under non-specific ingredient fragrance. Read the labels and avoid lead acetate, phthalates and any product with the generic word fragrance.
- Shop organic: Studies have found elevated rates of infertility among farm workers and agricultural communities exposed to high amounts of pesticides. Buy organic food as much as possible.
- Be aware of cellphone radiation: Some studies suggest cellphone radiation can affect sperm quality. Since levels decline with distance, keep your phone out of the front pocket and away from your genitals.
Source: Environmental Working Group