There was a time when infertility was seen as a women’s problem. Not anymore.

Older dads are more likely to pass on genetic mutations to their offspring than older mums, according to research.

And studies show that male infertility is behind half of all cases where couples fail to conceive after one year.

Sperm counts in men worldwide have declined by half over the past 50 years and are continuing to fall.

Here, in a piece for The Hippocratic Post, a range of experts reveal 23 things that could be diminishing your partner’s supply – and what can be done to prevent it.

Sperm, which are the swimming cells that carry a male’s DNA, are continually produced in the testicles at the rate of up to 100 million every day

The process, which is controlled by the endocrine system under the influence of the male sex hormone, testosterone, takes about 60 days.

It then takes a further 10 to 14 days for the sperm to pass through the epididymis, which is where they mature, before they can leave the body via ejaculation.

Fortunately, there are plenty of ways that men can optimise the quantity and quality of their sperm.

BIOLOGICAL CLOCK

Men have a biological clock just like women. Studies have shown that men’s fertility starts to decline after the age of 35 and female partners, regardless of their own age, have less chance of getting pregnant. 

One French study, published in published in the journal Fertility and Sterility in 2005, found that women younger than 30 years old was 25 per cent less likely to conceive a baby if her male partner was 40 years or older.

A woman aged 35 to 37 years was 50 per cent less likely to conceive if the male partner was over 40 years old.

Studies have shown that the genes contained in the sperm of older men have a greater chance of being abnormal.

A study at the University of California, Berkeley found that the sperm of older men were less mobile and less able to move in a straight line.

Allan Pacey, professor of andrology at the University of Sheffield, says: ‘We have known for some time that children of older fathers have a higher risk of being born with a range of genetically linked diseases such as Down’s syndrome, schizophrenia and autism spectrum disorders among others.

‘There is also evidence that as men get older their partner is at increased risk of infertility and miscarriage because of genetic changes which are evident in his sperm.’

WHAT TO DO ABOUT IT

You can’t turn back the clock and the age of first time fathers in the UK is rising steadily to 32 compared to 27 in 1980.

However, perhaps it is time for a rethink, according to Dr Pacey who points out that men over the age of 40 are advised against donating sperm.

‘Whilst not wanting to scare the children of older fathers, information like this is important to understand and should remind us that nature designed us to have our children at a young age and if at all possible men and women should not delay parenthood if they are in a position not to.’

TIGHT UNDERWEAR

Male models – and footballer David Beckham – may look great in tight designer briefs, but close-fitting underwear is going to hinder your chance of conceiving a child.

That’s the conclusion of a large-scale study of 2500 men published in the journal Human Reproduction in June 2012 by researchers at the University of Sheffield and the University of Manchester.

Dr Allan Pacey, one of the lead researchers, explains: ‘What we found is that the single biggest lifestyle factor affecting sperm count was tight underwear.’

The reason is probably related to underwear pulling the testicles closer to the body, reducing air circulation and causing the temperature of inside the testes to rise.

‘The scrotum sac hangs outside the body for a reason because testes work at an optimum temperature of around 35 degrees centigrade, or two degrees cooler than body temperature,’ says Dr Pacey.

Testes that are too hot produce less sperm because the seminferous epithelium, which lines the tubules where cell division takes place, is sensitive to elevated temperatures.

WHAT YOU CAN DO

‘Switch to boxer shorts and trousers which have room over the groin,’ says Dr Pacey.

‘Skinny jeans and tight cycling shorts probably have the same negative effect although we did not investigate this in our study.’

It will take three months to bring fertility levels back to normal.

‘This is how long the body takes to produce a sperm cell from the beginning to the end of the process,’ explains Dr Pacey.

UNDESCENDED TESTICLE

This is a common problem that occurs in 3-4 per cent of full term infants but it usually resolves itself before a child is a year old.

Occasionally, a male may reach adulthood with the problem still unresolved. 

Testicles that remain inside the body and have not come down into the scrotal sac will not be producing viable sperm.

They are considered abnormal and are also more prone to becoming cancerous.

WHAT TO DO ABOUT IT

If the testes does not descend on its own, surgeons may perform an operation called an orchiopexy to bring the testes down and stitch it in place within the scrotum.

‘Occasionally, this procedure can be carried out on adolescents or adult males and is usually successful,’ says Dr Pacey.

CANCER TREATMENT

Men who have undergone cancer treatment may find that their fertility has been affected,’ says Dr Mike Bowen, a consultant gynaecologist based in Oxford.

In particular, up to 70 per cent of men who have prostate cancer and have undergone a radical prostatectomy will not be able to maintain an erection after surgery, according to Cancer Research UK.

Radiation and chemotherapy treatment for cancer can also impair sperm production.

If radiation is focused on or near the pelvic area, abdomen, spine, and/or the whole body, it may reduce sperm count and motility in boys — these conditions may be permanent or may reverse after the treatment if sperm production recovers.

WHAT TO DO ABOUT IT

‘In many cases, specialists may advise patients to freeze sperm for future use,’ says Dr Bowen.

‘Men who have erectile dysfunction may be helped by the drug Viagra.’

Some chemotherapy drugs are more likely to lead to permanent infertility than others.

The high-risk drugs most likely to affect reproductive organs are Cytoxan, Ifosfamide, Procarbazine, Busulfan, and Melphalan.

Others, like vincristine and methotrexate, are typically less likely to harm fertility.

STAYING FIT

Staying fit and healthy and exercising regularly is important if you want to maximise your chances of conceiving a child.

However, men and women who exercise too much can impair their natural fertility.

‘There is evidence that some endurance trained men can affect their reproductive hormone profile, in particular reducing their testosterone levels,’ says Mr Bowen.

‘However, there is no direct evidence that this results in male infertility.’

Cycling is becoming more popular both as a recreation and a means of beating commuter traffic, but too much cycling can lead to impotence, according to Vinod Nargund, a consultant urological surgeon at St Bartholomew’s and Homerton Hospitals London.

This is because of prolonged pressure from the saddle on the perineum, which is the area of skin behind the scrotum. This is where nerves and blood vessels enter the penis.

Studies on volunteers have shown that cycling in a standing position does not alter penile blood supply after exercise and remain the same as before exercise.

Numbness of the genital region is reported by more than 60 per cent of the cyclists.

There is a higher incidence of numbness and erectile problems in men who cycle regularly on longer training distances.

Penile blood flow is affected due to the compression of vessels by sitting on the saddle.

WHAT YOU CAN DO

Try a softer saddle and stand up to pedal.

‘Studies on volunteers have shown that cycling in a standing position does not alter penile blood supply after exercise and remain the same as before exercise,’ says Mr Nargund.

‘It is important therefore to take rests intermittently during prolonged and vigorous bicycle riding and to restrict the training distance.

NOT HAVING ENOUGH SEX

ne of the leading causes of failing to conceive a child is actually lack of sexual relations.

And stress plays a major role in turning people off the idea. Stress reduces male fertility in two ways.

Firstly, stress hormones like cortisol seem to have an effect on the way that men ejaculate, according to research.

Sex Positions

High cortisol levels have a dampening effect on testosterone, which in turn lowers the quantity and quality of sperm. If stress is chronic, this can become a long-term problem.

‘Stress also has an important negative effect on libido and the desire to have sex in the first place,’ says Dr Jane Stewart. 

‘Men who are stressed may not be able to get an erection at all because of physiological effects of lower levels of testosterone circulating in the body and the psychological effects which are critical to creating desire in the first place.’

In fact, 15 per cent of men experience decreased libido because of stress, while 5 per cent of men experience impotence because of it.

WHAT YOU CAN DO

If stress is reduced, either by taking up meditation or improving work/life balance, the effect on fertility should be reversed almost immediately.

Failure to conceive can be an important cause of stress which is why it helps to be relaxed and not too focus on the goal of having a child.

LACK OF VITAMIN D

itamin D – the sunshine vitamin – is essential to sperm health. In 2006, it was found that human sperm had multiple Vitamin D receptors on its head and nucleus, suggesting that the cell needs this vitamin to function.

 

Getting enough UV rays is key to the health of male sperm, according to research presented to the Fertility Society of Australia conference in 2008.

Laura Thomson, a doctoral student from University of Sydney found that vitamin D deficiency – caused by too little sun exposure – played a a significant role in determining male fertility.

Thomson’s study involved screening 794 men who attended the same fertility clinic in Sydney in Australia.

Nearly a third, which is similar to the average, were found to suffer from too little Vitamin D which is synthesised in the skin during exposure to sunlight.

A group of 123 of the vitamin D deficient men in the Australian study were followed for 3 months as they took vitamin D containing multivitamin supplements, antioxidants and lost weight.

Follow-up tests showed improvements in sperm shape and a 75 per cent drop in sperm DNA fragmentation, when the DNA is damaged. In a quarter of these men, pregnancy was successful.

WHAT YOU CAN DO

Go easy on sunscreen when you are out and about not in the heat of the day, between 11am and 3pm.

Just rolling up your sleeves in your lunch break while outdoors should be enough to help your skin create enough Vitamin D from sunshine.

The effects on fertility should be felt within three months.

DRINKING TOO MUCH

Alcohol is a toxin that kills the cells that generate sperm. Too much alcohol can reduce sperm count and change the shape of sperm cells, making them less effective at fertilising an egg.

The effects won’t be noticeable unless you drink more than eight units in a day, according to studies.

Most alcoholics have a very low sex drive because excessive alcohol over a long period of time raises levels of female hormone oestrogen in the male body.

WHAT CAN YOU DO

Abstain from alcohol or significantly reduce your intake three months before you try to conceive a child.

Heavy drinking can damage DNA in all sperm cells held in the testes so it would take three months of reduced drinking to create sperm from scratch.

Impotence caused by alcoholism can take longer to reverse or may not be fully reversible.

SMOKING TOBACCO

‘In terms of how many sperm you produce in the testes, smoking does not seem to have an effect,’ says Dr Pacey.

‘However, smoking does damage DNA within the sperm cells, which could lead to infertility and miscarriage, which is the female body’s way of getting rid of a developing embryo with major genetic abnormalities.

A UK study, published in the medical journal Human Reproduction, recruited 2,249 men from 14 fertility clinics around the UK2 and asked them to fill out detailed questionnaires about their lifestyle.

Dr Andrew Povey, from the University of Manchester’s School of Community Based Medicine, said: ‘Despite lifestyle choices being important for other aspects of our health, our results suggest that many lifestyle choices probably have little influence on how many swimming sperm they ejaculate.

For example, whether the man was a current smoker or not was of little importance.

The proportion of men who had low numbers of swimming sperm was similar whether they had never been a smoker or a smoker who was currently smoking more than 20 cigarettes a day.’

WHAT CAN YOU DO

Current NICE guidelines remain that men who want to conceive should give up smoking.

However, if you want to have a child, give up smoking at least three months before trying to conceive with your partner. Avoid all recreational drugs.

BEING OBESE

Studies have found links between obesity and fertility problems in both men and women.

In one study, men with a higher body mass index (BMI) had a significantly higher risk of being infertile compared with men considered to be normal weight.

Fat_Man

In fact, the study found that men who are of normal weight and then put on just 20lbs could increase their chance of male infertility by 10 per cent.

‘Several mechanisms may account for the effect of obesity on make infertility, including changes in hormone levels caused by increased weight and increased scotal temperatures due to the fact that larger men tend to have hotter groins with fat acting as insulation,’ says Mr Bowen.

Men who develop ‘man boobs’ may be more at risk because the condition suggests heightened levels of the female hormone oestrogen.

There is no hard evidence that men who have beer bellies are more at risk than those who are bigger all over.

A separate study found that men who had a higher BMI were more likely to have poor quality ‘fragmented’ sperm where the DNA parcel has broken into pieces.

Fragmented sperm DNA is linked to reduced fertility as well as an increased risk of miscarriage.

Babies born are more likely to suffer from inherited conditions such as Down’s Syndrome.

WHAT CAN YOU DO

Healthy gradual weight loss should take months and possibly even years to achieve, depending on how much you need to drop to reach a healthy BMI.

‘However, neither reversibility of obesity-associated fertility with weight loss not effective therapeutic interventions have been studied in depth,’ says Mr Bowen.

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