In her consultations with patients, Genea fertility specialist Dr Kate Mcllwaine says many couples assume the issue is with the female reproductive system, “so it often comes as a surprise to patients when I diagnose male factor infertility.”
But a growing body of research about the male’s role in fertility is slowly turning the conversation away from just women. Only a few weeks ago, news that we could reach a zero sperm count in the West shocked the world, with New York-based environmental and reproductive epidemiologist Shanna Swan writing in her new book Count Down that following current projections, sperm counts are set to reach zero in 2045.
It’s an explosive claim, but one established from a 2017 systematic review which looked at 185 studies based on the semen samples of nearly 43,000 men between 1973 and 2011. Swan – a co-author – found that sperm quality and quantity has been steadily declining since the 1970s by about 1 to 2 per cent, which if continued will result in her claim of zero by 2045.
And while some researchers say this stark difference could be related to limited data (most of the 43,000 men analysed came from the west) it nonetheless raises an important question: what do we do about the plummeting sperm counts in the Western world?
“Historically, there has been way too much emphasis placed on female fertility and infertility — we know that it’s definitely a 50-50 issue,” says Monash IVF deputy director and senior lecturer in reproductive biology at the University of Melbourne, associate professor Mark Green.
While women’s ability to conceive plummets after age 35, male fertility decline is more subtle – but can be just as impactful. While men over the age of 40 can still sire children, Dr Green says their offspring tend to have a much greater chance of being on the autism spectrum or developing other neurological disorders.
“So you can have a female in her 20s and a male in his 40s, and while she is very fertile, the likelihood of their child having an issue is much higher than if the father was younger,” he says.
“There is a difference between conceiving and having a healthy pregnancy – even if a sperm can fertilise, it doesn’t mean the long-term health of the offspring won’t be affected.”
Aside from factors such as cultural shifts towards having smaller families, contraception and the rising cost of children, ‘everywhere chemicals’ found in plastics, cosmetics and pesticides that affect endocrines make it harder to conceive.
“Many people are unaware that products they use in daily life contain chemicals called endocrine disrupting chemicals (EDCs) that may reduce a couple’s ability to have a baby,” says Professor Green.
Some common examples of EDCs include bisphenol A (BPA) and phthalates, which are used in children’s products, personal care products and food containers, and flame retardants used in furniture and floor coverings.
“Men generally don’t talk as openly as women about this, and I think this contributes to how hard it can be when male factor infertility is at play.”
However, the worst chemicals – called PFAS – are found in Teflon products, as well as in the lining of pizza and popcorn boxes, Professor Green says.
“They’re called the ‘forever chemicals’ because they’re heat resistant and don’t break down easily,” he says. Studies show that about 95 per cent of people have EDCs in their bodies and that people who struggle to conceive often have higher levels of some EDCs.
Viewing infertility through the lens of being able to conceive places the blame more on the woman and psychologically minimises the role of the male, whose masculinity and sexual prowess is often conflated with the ability to impregnate a woman, says Professor of Psychiatry at The Alfred and Monash University Jayashru Kulkarni.
“A man can be very good as a lover, but be infertile – and the two things often get confused,” she says.
Professor Kulkarni points out that stories about men fathering children well into their old age – “we hear anecdotes about Picasso fathering children into his 70s” – make people believe that that is the primary role of the man in the fertility process.
David Allcock and his wife struggled with infertility for three years before starting IVF.
“Moreover, women and children are bracketed together and child rearing, as well as childbearing, is seen as a female role, so this is perhaps why the male role is not seen as critical,” she says.
When chef David Allcock from Orange, NSW found out his sperm were moving slower than usual, he didn’t fully comprehend what it meant.
“I had no idea really, no thoughts about it and did not consider the fact that I had a problem at all,” he says. “Definitely this is not something males think about; it’s usually left up to the woman.”
At the time, Allcock and his wife had been trying unsuccessfully for three years to have a baby, and even after tests showed his sperm motility (how fast the sperm swims) was reduced, the GP did not make a big deal of it.
“Even after another round of tests, our doctor said it was fine and to keep trying naturally,” Allcock, 37, says.
Eventually they realised time was running out, and the couple decided to try ICSI IVF.
“It all worked out the first time, from the same batch: we now have three children, aged five, three and eight months, as well as my wife’s first son.”
While Allcock says he’s always been comfortable with his masculinity, he says he copped a “bit of slack” in his regional town and had some uncomfortable conversations [about his own fertility].
Dr Kate Mcllwaine sees a similar sentiment among her patients. “Men generally don’t talk as openly as women about this, and I think this contributes to how hard it can be when male factor infertility is at play.
Allcock’s advice to other men out there with infertility issues is to seek help and advice as soon as possible: “it may surprise you how easily certain issues can be found and dealt with”.
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