Why Your Man Matters for Fertility
Fertility often is seen as a women’s issue because IVF, by far the most well-known treatment for infertility, is designed to get women pregnant.
Yet, let’s be clear: when it comes to fertility, men matter. Men are 50% of the baby making equation. In my practice, I see both men and women because your man’s health is just as important as yours—and male infertility can and should be addressed.
Research shows sperm counts have plummeted 50% since the 1970s. And there are specific things men can do to improve their sperm count, quality and reduce ED that should be part of any fertility program.
Data on declining sperm count and quality
Infertility is a heartbreaking and difficult journey for any couple. Yet, it is less well acknowledged that men are 50% of the infertility equation. Environmental contaminants, poor quality nutrition, lack of exercise, stress and aging have all contributed to male infertility.
While I find couples are often aware that both healthy eating and exercise are important, fewer are aware of environmental pollution and the impact on both female and male fertility. More data keeps coming out. On March 5, 2021, the New York TImes Book Review highlighted Shanna H. Swan’s Countdown: How Our Modern World Is Altering Male and Female Reproductive Development, Threatening Sperm Counts, and Imperiling the Future of the Human Race.
The book presents some staggering stats such as a quarter of all men have Erectile Dysfunction (ED) under the age of 40, and that testosterone levels have been declining by 1% each year since 1982—which is almost 30%. Declining sperm count and aspects of male infertility contribute to lack of success with pregnancy too, yet men are often overlooked in the fertility equation. Why?
Environmental toxicity affects sperm quality—and your future child
We know that environmental contaminants such as BPA, phthalates found in plastic packaging of foods, household chemicals, and even shampoo, are culprits. And the scary thing is that it doesn’t impact men only. Exposure to these chemicals can impact your future child’s fertility and their health during their lifetime.
As Bijal Trivadi says in her New York Times review of Countdown, “Parents’ exposure to these chemicals can affect the sexual development of their children. If a woman smokes when she is pregnant, her son’s sperm counts may drop by 40 percent—and if he is later exposed to endocrine disruptors, his sperm production may drop so low that he becomes infertile.
Countdown author Shanna Swan describes the collateral damage that can be caused by a combination of lifestyle factors such as stress or bad diet plus daily exposure to toxic chemicals. The effects can radiate down through several generations.
Also recently, the Guardian published an Op-Ed by the famed environmental activist Erin Brokovich, with a jaw-dropped title: Plummeting sperm counts, shrinking penises: toxic chemicals threaten humanity which also reviewed the book. She noted how phthalates are restricted in the European Union, but not on a comprehensive basis in the US.
The importance of health and healthy sperm to fertility
A woman's egg health is reflective of her total health. The very same thing is true for guys, and the importance of men’s health on fertility outcomes can’t be overstated.
Men’s sperm health is a picture of their total health. The study Lifestyle and fertility: the influence of stress and quality of life on male fertility reflects the crucial need to nourish men’s health with healthy nutrition, supplements, and exercise; help with mental health, stress and achieving good quality sleep; and reducing exposure to environmental toxins—evidence-based approaches to the treatment of male infertility.
As it is for women, age is not the automatic deciding factor of fertility for men. As we age, sperm quality declines, but men can still have good quality sperm at an older age—and it takes attention and commitment to health.
Sperm quality is directly related to your biological age—how old your body is in fact—not your chronological age, or your number of years. Is your guy a young 40 or an old 40? Anyone can be 40 with the body of a 50 year old or 40 with the body of a 35 year old. This makes a big difference in fertility since quality eggs and sperm are the ingredients to get pregnant, stay pregnant and have a healthier baby.
I have clients with husbands in their 30s who did not get tested initially. The entire workup was focused on the woman. One year into the fertility journey of not getting pregnant the clinic tested the husband and discovered that he had a low sperm count. Even if your partner or husband is not “old,” or “out of shape,” they can still have low sperm count, poor motility or misshapen sperm—all things that can factor into reducing your chances for conceiving.
Testing for male infertility
In order to optimize your fertility chances and lower risk, it makes sense to test for signs of healthy sperm before you begin or early on in your quest for a healthy pregnancy.
Semen Analysis
I suggest having your man tested now—whether now is thinking about getting pregnant in the future or having had difficulty trying. If you go to a fertility clinic, they can run a basic semen analysis. Men’s sperm testing looks at total sperm count, shape and movement (motility) of the sperm. It is an easy test for men to do and not invasive. This is a good first step, but this testing is not everything. It is recommended that men don’t ejaculate 2-5 days beforehand to get a good sample.
DNA fragmentation test:
The problem with the basic semen analysis is that in as many as 15% of cases, the semen analysis will be normal, but a man will still be found to have”male factor infertility.” The semen analysis tests volume, sperm count, and motility; this only provides information about sperm presence. The semen analysis does not show how effectively the sperm will fertilize the egg to create a viable pregnancy.
This is where the next generation of testing is important. To go a step further, we can actually look at the quality of the sperm through a relatively new test called the Sperm DNA fragmentation test.
Men can have a normal sperm count, motility or average shape, but the quality of the sperm are chromosomally abnormal. The DNA fragmentation test looks at the DNA, specifically the number of breaks present in the sperm’s DNA.
The Fragmentation Index is the proportion of normal-to-damaged sperm. This is a really neat test that we don’t have a similar version for women’s egg health right now.
Before doing IVF, I would definitely do a DNA fragmentation test even if your man’s basic semen analysis was normal. Your physician or any fertility healthcare provider can order a DNA fragmentation test. They are about $400.00 out-of-pocket (most insurance plans don’t cover them) and the test kit is delivered to your home. Your guy does the sample at home and it gets picked-up on the same day, preferably.
I highly recommend this test even though it isn’t covered by many insurance plans right now because it can save you heartache, unnecessary procedures, and delays in your fertility journey to get an answer on whether your man is a factor in getting pregnant.
Male sperm can contribute to miscarriages
Miscarriages are heartbreaking, as well as emotionally and physically draining. If they have happened more than twice, they are considered recurrent miscarriages.
Women tend to endure both the physical and emotional pain of a miscarriage along with a certain shame since it is usually a very private loss, not shared with friends, co-workers, and sometimes even family. That’s not ok, and thanks to many celebrities sharing their experience of pregnancy loss such as Megan Markle and Chrissy Teigen, more women are realizing that they are not alone and can seek support.
In fact, according to RESOLVE, 15-20% of all pregnancies end in a miscarriage.
Multiple miscarriage happen in 15-20% of pregnancies too. In the data on repeated pregnancy losses consecutively, the numbers dwindle to only 1% of women who are said to experience 3 or more losses—although I have some questions on that data since I also wonder if women report all miscarriages given the experiences my clients have had being spoken to negatively by clinical staff when revealing a miscarriage.
Since many miscarriages that are before 12 weeks are thought to be chromosomal in nature, there is more likelihood that chromosomally abnormal sperm can contribute to miscarriages just as poor quality egg health is also a contributor.
I’ve discussed egg quality on my blog and it is the centerpiece of my functional medicine fertility protocol. Yet, women should know that miscarriages are not just due to their health although they are the ones to experience the miscarriage. Especially if you’ve had a miscarriage, let’s look at how to improve your man’s fertility as a strategy for a rainbow baby the next time around.
What to do next: include your guy
Your guy should be part of your fertility plan. He should be part of your appointments, and taking care of his health is as important as taking care of yours to achieve a healthy pregnancy.
He is most welcome to join you for your fertility package plan, which focuses on functional medicine strategy for men and women. I’ll ask him questions and tailor support for his health specifically based on his testing and health status.
Whoever you choose for your provider to improve your fertility odds, make sure that provider includes your partner. After all, they are 50% of the equation and will be 50% of the solution.
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Annina is a PhD, Registered Dietitian, Licensed Dietitian Nutritionist and Board Certified in Functional Medicine specializing in nutrition and functional medicine for fertility, pregnancy and new mom and baby. She has 7 years of practice experience and has co-authored several books on infant, child nutrition and obesity prevention.