Dr Ippokratis Sarris of King’s Fertility Clinic provides a how to guide for men on fertility and infertility.
Take a stroll down to your local pub on the weekend and perk up an ear to the groups of men conversing over their pints. Generally, it’s a conversation fuelled by a shared interest of balls. Rugby, football, cricket – no sport is off-limit. A subject that rarely, if ever, enters the conversation, is on the topic of a different set of balls. The kind that produce sperm.
Infertility affects an estimated 15% of couples globally, amounting to 48.5 million couples. Of all infertility cases, males make 20-30% of cases and contribute to 50% of infertility cases overall. Being infertile can result from complications of the reproductive system after the failure to achieve clinical pregnancy following 12 months or more of regular unprotected sexual intercourse. There is also a wide variety of other factors – such as illnesses, injuries, chronic health problems, and lifestyle choices, that play a contributing role.
A dark cloud of uncertainty and stigma surrounds male infertility, in a society that stereotypes a man to be sexually active and virile, the diagnosis of being infertile can have severe implications on the mental health of a man. Men and women have different emotional responses to grief, and men who are infertile might feel a pressure to conform to masculine norms by suppressing their emotions – whether it is to save face in the pub or by being the pillar of strength for their partner. Male infertility is a subject that lingers in the shadows, swallowed by male pride since traditionally, fertility is regarded as a ‘woman issue.’ This can also be attributed to the common misconception that male infertility is a result of impotence, although it is common knowledge that infertility has no impact on the physical aspect of potency.
Further to this, scientific knowledge of the emotional repercussions of infertility on men remains limited and has only recently become the focus of social science research. If academic publications have a limited perspective on the subject, where does that leave mainstream media? Media reports sensationalise male infertility in order to promote for men to focus on ‘the sperm decline’ or ‘stock up your sperm,’ neither of which provide an accurate picture of what couples should be doing in order to conceive. Men should be encouraged to have a healthy sex life and lifestyle, whilst acknowledging their own emotional vulnerability if they are struggling with infertility.
Whilst our society is becoming increasingly open-minded – male fertility remains a taboo subject, making it an underacknowledged problem from which approximately 1 in 20 men suffer from.
Is my sperm at risk?
Male infertility is commonly attributed to deficiencies in semen – whether that’s low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm. There are other factors – such as illnesses, injuries, chronic health problems, and lifestyle choices, that play a contributing role.
Semen quality can vary widely case by case for a multitude of reasons. Male fertility can be caused by a number of health issues and medical treatments, the most common one being varicocele, which causes the swelling of veins that heat up the testicle as much as four degrees, causing damage to the sperm. Luckily, varicocele is a reversible cause of male infertility and sperm numbers can be improved when using assisted reproductive techniques.
The same goes for infections, from the inflammation of the epididymis or testicles to sexually transmitted infections, there is still a possibility that sperm can be retrieved if the issue is caught in time. However, if left untreated it can lead to permanent testicular damage. By addressing the stigma surrounding sperm, men are more likely to perform the necessary tests required, beyond the standard semen analysis and pick up on prior health conditions which they may have not been aware of.
Sober for higher sperm count?
As doctors, we caution limiting alcohol and quitting smoking for those who are trying to conceive, which might seem a bit unfair if your drinking companion is a record pint sinker with a family of six at home. It’s not just a cautionary tale, alcohol does lower testosterone levels and can cause erectile dysfunction and decrease sperm production. It’s also a good reason to quit smoking since sperm count is lowered for the nicotine lovers – a cigarette a day will certainly keep the sperm away.
There are other lifestyle choices that couples need to keep in mind on their fertility journey. The possibility of children might be good enough reason to finally shed off those remaining few kilos and trim your waistline since obesity can directly impact fertility. On the flip side, if you’ve dabbled with anabolic steroid use for muscle gains, apart from a long list of other side effects, the use of the drug can cause testicles to shrink and sperm production to drastically decrease. The best approach is to reduce compromising lifestyle hazards and maintain a healthy diet with plenty of fruits and vegetables alongside a fitness regime, as well as partake in a vitamin supplement routine under the guidance of your doctor.
Let’s talk about sperm
Our society takes pride in child-bearing, placing emphasis on young couples and the miracle of new life. How children are conceived is usually a question that is only acknowledged behind closed doors or the office of a gynaecologist. We need to address the stigma associated with infertility and have patients open up and share their problems, not only for research purposes but to help others realise that they are not alone in their struggle. Solidarity will always break down the stigma.
At King’s Fertility Clinic, we have a unique proposition where we function as an academic institute that is also privately-funded by the Fetal Medicine Foundation (FMF) and is part of NHS. We are invested in the journey of all of our patients, from start to finish, albeit there are moments when the outcome is not always positive. Couples who have been told they are infertile are the ones who need significant emotional support and we do not want them to carry the burden alone, which is why we are with them every step of the way.
Next time the pub conversation turns to sports, perhaps ask your friends how they’re doing on the pitch. Everyone has blips when they go through a rough year, not just Chelsea F.C.
About the expert
Dr Ippokratis Sarris graduated from Trinity College, Cambridge in 1999 after which he completed his medical degree at Oxford’s Magdalen College. Moving to London, Ippokratis became a member of the Royal College of Obstetricians and Gynaecologists and joined the Oxford Maternal Perinatal Health Institute as a clinical research fellow. Through this, he was awarded his Doctorate.
Ippokratis completed his specialty training at several London teaching hospitals and subsequently moved to Newcastle to complete his subspecialty training in reproductive medicine and surgery, leading to his dual accreditation with the General Medical Council. Following this period, he returned to London to work as a fertility consultant.
Ippokratis has written two-dozen peer-reviewed academic papers, four book chapters and two Oxford University Press textbooks in the field of obstetrics and gynaecology. He has tutored and lectured in graduate and postgraduate Medicine and continues to mentor trainee doctors. An active member of numerous medical organisations, Ippokratis is on the Training Subcommittee at the British Fertility Society, having previously been on the Executive Committee. He was also co-founder and chairman of Maternity Training International.
Embracing the ethos of the Fetal Medicine Foundation, Ippokratis joined the organisation to set up and lead King’s Fertility. He is passionate about tailoring treatments to meet the unique and specific needs of patients: offering high-quality care and satisfying patient experience.