Men struggle to have babies too: the silent suffering partners on the infertility journey

In this two-part series, Carole Gilling-Smith, CEO and Medical Director of the Agora Clinic, explores some of the issues facing men trying to conceive

Society’s collective gaze tends to see fertility issues as female related when a couple struggles to conceive. However, the emotional and physical challenges of infertility affect men just as profoundly. In approximately one-third of infertility cases, the problem lies with the male partner, and in another third, we find it’s a combined issue or unexplained, making it clear that men are not merely bystanders in this journey; they are equal participants wrestling with the pain of unfulfilled parenthood.

What is male infertility?

To understand male infertility, we need to first unpick some of the basic biology behind sperm production and function. Sperm is produced from puberty onwards in the testicles and this process takes about 72 days. The sperm then mature in the epididymis (the cap above the testicle) before they are ejaculated during intercourse. For conception to occur, sperm must be able to fertilise an egg, which requires them to be produced in adequate quantity (which is measured as the sperm count), to be moving forward efficiently (measured as progressive motility) and to have a normal shape (measured as morphology.

The basic sperm test

The initial step in assessing male fertility is a semen analysis which measures the quantity and quality of a man’s sperm. The semen sample is typically collected through masturbation after three days of abstinence. At the Agora Clinic, we have private rooms for sperm collection but if you don’t live more than an hour away, you can bring a sample in from home. The sperm is then analysed in our andrology laboratory under the microscope for various parameters including sperm count, motility, and morphology.

Whilst a female produces on average a single egg each month, a typical ejaculate has millions of sperm. Counts can vary quite significantly from sample to sample, but sperm counts of less than 15 million per millilitre of semen per ejaculate are considered low. Normal motility requires at least 32% of sperm to be moving in a forward direction. When it comes to morphology it is surprising how much ‘rubbish’ sperm is found in a typical sample. Men can get away with up to 95% of their sperm being abnormally shaped! These are in fact functionless sperm and cannot penetrate the egg so they can’t make an abnormal baby. As a guide even sperm donors have 90-95% abnormal morphology rates but levels higher than 95% are considered abnormal. Poor motility or abnormal morphology can also impede a couple’s ability to conceive naturally or even with in vitro fertilisation (IVF).

Causes of male infertility

If you have a semen analysis or couple’s fertility MOT at the Agora, we always arrange a consultation with one of our expert fertility Consultants as a sperm test result alone is meaningless. The findings must be discussed in the context of your medical, personal and family history and often a repeat test or further blood tests or scans will be suggested, so that a proper diagnosis can be made.

Male infertility can be due to a variety of causes, ranging from genetic factors and lifestyle choices to medical conditions. Hormonal imbalances, infections, and ejaculation issues can all hinder male fertility as can a varicocele, a benign swelling of the veins that drain the testicle. Environmental factors are important too, such as exposure to certain chemicals or heat, as can lifestyle factors, including smoking, heavy alcohol use, obesity, and stress. Genetic issues such as Klinefelter’s syndrome or cystic fibrosis can also lead to a failure in sperm production or blockages that prevent sperm being ejaculated.

Treatment options

Treatments for male infertility depend on the underlying cause. For example, surgery can be an effective solution if a varicocele or blockage is discovered. Hormone treatments and medications may be effective in a few cases when sperm production is not happening correctly. In vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) are often best approaches when the sperm is low in count and quality. Lifestyle changes can also make a big difference as it takes 72 days to make sperm. There is now very good evidence that if you improve your diet, reduce stress, start an exercise regime, quit smoking, and abstain from regular and heavy alcohol intake you can significantly improve your sperm health over a period of three to six months. Additionally, our fertility specialists may recommend specific supplements that could potentially improve sperm count and quality, such as antioxidants, zinc, and folic acid.

The enhanced male fertility assessment and DNA Fragmentation

In recent years, more sophisticated tests have emerged which offer a deeper understanding of male fertility. One such test is the DNA fragmentation index (DFI), which measures the amount of damaged DNA in sperm cells. High levels of DNA fragmentation have been associated with reduced male fertility, increased risk of miscarriage and reduced chances of success with IVF. DNA damage in sperm cells can be caused by oxidative stress due to environmental factors, lifestyle choices, infection, underlying, often undiagnosed, medical illness or advanced age. At the Agora we offer an enhanced male fertility test which includes a DNA fragmentation test, oxidative stress test and infection screen followed by a medical consultation. This is particularly useful for couples who have experienced repeated IVF failures or who have unexplained infertility or recurrent miscarriage and it allows us to work with you on improving sperm health.

The emotional toll and seeking support

Despite advancements in diagnosis and treatment, the emotional toll of infertility on men is often overlooked. Men can feel isolated, emasculated, and helpless when faced with infertility. The societal expectation for men to remain stoic can compound these feelings, leading to silent suffering. It is crucial for men to seek support during this time. At the Agora, we offer counselling, either individually or as a couple, which we believe can provide a safe space to express and process these complex emotions. We also have a patient support group or can signpost you to support groups specifically for men to help you achieve a sense of community and understanding from others going through the same journey.

At the Agora, we are passionate about inclusive care for all on the fertility journey, which is why we encourage a culture of openness, so that our men feel acknowledged, listened to and involved and are treated as equal partners on this sometimes very challenging journey. For me, this article is as much about opening the conversation in the workplace as well as socially on the silent suffering of men struggling to have babies as it is to educate. If you are suffering alone, don’t be afraid to speak up and if you are not, be a friend and a colleague and just listen.

If you want to find out more about our male fertility tests or how to get support, please visit our website agoraclinic.co.uk or call 01273
229410. We offer male fertility assessments at our clinics in Brighton and Eastbourne.