Male infertility Male infertility is soaring. So why do doctors keep blaming the woman when she can’t have a baby?

The Daily Mail 5 December 2012 Lois Rogers

To the outside world, Dennis Robinson has an enviable life. Happily married to an attractive woman with a comfortable home and a secure job, he is a father figure to his wife’s eight-year-old son.

There is, however, a yawning chasm in Dennis’s life. He cannot father a child of his own naturally.

He is part of a silent epidemic of male infertility, a problem growing at an extraordinary five per cent a year in Britain, and one which is now affecting many thousands of young, otherwise healthy men.

At least one in six couples now need medical help to have a baby — and for half of them the problem is the result of poor sperm quality. Infertility specialists fear this growing problem among men is bringing us closer to the day when most couples will need medical help to have a family.

This week, a major French study revealed sperm counts and quality have fallen sharply since the Nineties.

It is believed the trend is linked to diet, lifestyle and ‘gender-bending’ chemicals. The researchers, who used data from 126 fertility treatment centres, said their conclusions constitute a ‘serious public health warning’. But what is being done to alleviate the problem?

So far, it seems, very little.

A Femail investigation has shown the NHS barely addresses the problem of male infertility, choosing instead to focus on the woman if a couple seek treatment over their inability to conceive.

Our investigation raises many alarming questions: Why do male doctors continue to lay blame for infertility on women?

Do women themselves automatically assume infertility is their fault? Or could the driving factor be that invasive and complex fertility treatments for women are hugely lucrative for those carrying them out?

Dennis, 35, from Bishop’s Stortford, Herts, certainly feels he was the victim of this extraordinary discrimination.

His experience shows parts of the NHS operate from a standpoint that men are unquestionably fecund and virile and it is somehow inappropriate to humiliate them with intrusive tests.

When Dennis and his wife Kelly, 33, went to their GP after struggling for 18 months to conceive, the doctor referred them to a gynaecologist — by definition a specialist in women’s problems, despite the fact Kelly must have been fertile because she already had a son, Edward, from her previous marriage.

Kelly, an executive secretary, was subjected to half a dozen invasive examinations and tests which continued for more than a year and at one stage left her with a dangerous post-operative infection. Unsurprisingly, they all the showed she was fully fertile.

It was only then that medical attention was directed towards Dennis. Two straightforward and quick tests performed two months apart showed he had a very low sperm count.

The couple were at last referred to a male infertility specialist, only to be told the deepening recession meant funding restrictions applied to NHS treatment. Despite being ‘in the system’, they were suddenly no longer eligible because Kelly already had a child.

‘If they had checked me at the outset, they would have saved money on the tests on Kelly and we would have been treated before they decided to change the rules,’ says Dennis, an account manager in a shipping company. ‘We are very upset about it.’

Now at an age when most of his friends are ensconced with nappies, toddlers and swimming lessons, he has been left embittered by his experience at the hands of the NHS.

‘I can’t believe what has happened,’ he says. ‘I feel I’m being denied something I should be able to have because of a form of discrimination against men, and I feel angry that Kelly has been subjected to all this painful treatment for no good reason.’

Sam Abdalla, clinical director of London’s Lister Fertility Clinic, admits he is astonished at the ignorance about male infertility that seems to exist in many parts of the NHS.

‘All the guidelines make it clear you do the basic tests on both partners before you do anything else,’ he says. ‘I can only think doctors who don’t specialise in fertility just don’t know men are as likely to be infertile as women.’

Of an average 200 million to 500 million sperm released during male orgasm, only 50 to 100 will complete the journey to the egg without getting lost or dying from exhaustion. The journey can take up to six days.

Only a few dozen will have sufficient strength left to attempt to drill into the egg and only one will make it.

This natural selection — ensuring only the healthiest sperm succeed — has propagated the human species for thousands of generations.

It is now failing before our eyes, but the problem remains a taboo which many men — including doctors — find too embarrassing to discuss.

It seems they would rather subject women to pointless and intrusive tests than risk damaging fragile male egos.

Mark Griffiths’ story bears this out. Mark, 42, a fire protection specialist from Portsmouth, Hampshire, told Femail that he and partner Jeanette Parker, 38, wasted £15,000 on three unsuccessful attempts at IVF before  it occurred to anyone to check  his fertility.

‘It was only then they discovered a problem with a blocked duct meant I wasn’t producing enough sperm,’ he says.

‘I did have a sperm test at the very beginning, but it was done by a gynaecologist who obviously specialised in women’s reproductive systems, not men’s.

‘He commented on how small the sample was and made a joke about whether I had missed the pot, but he never considered at any point that this might be the reason for our problems.

‘We have not had a good experience with the infertility industry. It has taken four years out of our lives. We have had four attempts at getting pregnant. None has worked and the whole thing has cost around £18,000.

‘Now we’re a lot older, so the chances of it working are lower. We are going to have another try after Christmas, but if I’d had the right procedure at the beginning, Jeanette would have had a much better chance of getting pregnant.’

‘This happens all the time,’ says Annette Wilkinson, director of The Doctors Laboratory in London, one of a handful of centres offering a new test to assess levels of DNA damage.

This can mean even a man with a lot of sperm can still be infertile because it is too damaged to penetrate a female egg. The  so-called ‘sperm comet’ test uses a specialised light field which shows intact DNA in a sperm cell.

It gives a more accurate prediction of fertility than a straightforward sperm count, and can be performed with no involvement from the man other than providing a sample.

Fertility tests routinely performed on women, on the other hand, are far more painful, invasive and expensive. Apart from taking blood samples to check hormone levels, dye is injected into the ovaries to check eggs are being produced.

The womb, the tubes from the ovaries and the ovaries themselves are probed under general anaesthetic using keyhole surgery, and a different operation may be ordered to scrape tissue from the lining of the womb for analysis.

Further probes may also be inserted through the neck of the womb to check for abnormality. These operations can cost as much as £3,500 a time.

‘Often men aren’t tested at all until after the woman,’ says Annette Wilkinson. ‘A lot of GPs really don’t know very much about infertility and it doesn’t occur to them to check the man.  With some couples the  fact the infertility is due to a male problem may not even be mentioned.’

It does not have to be like this. Thomas Elton, from Sutton Coalfield, West Midlands, found himself facing a childless future at just 25.

He had met his future wife Beth when they were 14, and says he knew immediately she was the girl he would spend the rest of his life with. Thomas did a history degree, while Beth qualified as a midwife, with a specialist interest in couples with fertility problems.

They married in 2005, but were told a year later that Thomas would be unable to father children. Their dreams were shattered.

Thomas, 31, a project manager at Leicester University, had his sperm tested as soon as they struggled to conceive.

Because of her work, Beth knew only too well the problem of women being referred for repeated unnecessary tests by GPs when it was actually caused by a problem with the male partner, and she was not going to submit to such pointless treatment herself.

‘I was sitting at home by myself when I got the call,’ says Thomas. ‘They said I had an extremely low sperm count relative to an average man, and that the chances of me fathering a child were very low indeed.’

The couple’s pain was compounded by the fact Beth was by now working at the Midland Fertility Services, a specialist clinic in Aldridge, West Midlands, and maintaining a professional mask while dealing with the lengthening queue of men suffering the same problem as her husband.

The Eltons were told ICSI — Intra Cytoplasmic Sperm Injection — would be the only solution to Thomas’s infertility.

A semen sample is scanned under a high-power microscope by a technician searching for a single healthy sperm to be injected directly into the woman’s egg in the laboratory. In severely infertile men, the search for one viable sperm can take a hour or more.

The Midland Fertility Service said it would be unethical for Beth’s medical colleagues to treat them, so they went to another clinic and endured the misery of two failed rounds of ICSI costing £10,000, which were paid for by their generous parents.

‘I begged my own clinic to do another cycle. I just knew it would make a difference to be treated by people who cared,’ says Beth.

It did. Beth became pregnant and gave birth to twins Toby and Barney, who are now three. After the birth, Beth went on a major diet to lose 2st, and Thomas — who is slim anyway — shared the same meals.

He doesn’t know whether the change in food intake affected his fertility, but to the couple’s astonishment Beth then got pregnant naturally. Baby Phoebe was born last December.

So why is male infertility on the rise? Sheena Lewis, professor of reproductive medicine at Queen’s University, Belfast, is the inventor of the sperm comet test and has a long-standing interest in the area.

‘The number of men with fertility problems is growing rapidly,’ she says. ‘It is no longer a personal issue, it is a major public health issue.

‘Environmental factors must be the cause, and if we don’t find out what they are and do something, the problem will accelerate.’

Evidence showing that sperm concentrations had halved since the Forties first began to emerge 20 years ago.

Many scientists questioned the testing methods used in these early studies, but since then an avalanche of other research has shown sperm quality deteriorating year on year.

Incidence of cancer of the genital organs in young men has also inexplicably doubled since the Seventies.

Research published only last month shows more than one in 20 baby boys is now born with undescended testes, trebling the risk of testicular cancer which usually strikes in young adulthood and often results in infertility.

We now know chronic unfitness and obesity can also sabotage the reproductive capacity of men, and long-term harm from cigarettes can be passed from smoking father to non-smoking son.

It’s also known that by-products from some plastics that mimic the effects of female hormones are damaging to sperm, as are  by-products from car pollution.

‘There are lots of reasons to be worried about this,’ says Marco Gaudoin, medical director of the Glasgow Centre for Reproductive Medicine.

‘We now have something like 80,000 new chemicals introduced in the Western world in the past century. We have rivers where all the fish are female.

‘Even if you have a man with a normal sperm count by conventional measures, you might still find there are high levels of damage to the sperm DNA, and we don’t know what’s causing it.’

Although other doctors acknowledge the growing fears over environmental factors, many still maintain the biggest cause of the infertility epidemic is the cult of self-fulfilment.

On one hand we are now increasingly promiscuous, suffering epidemics of chlamydia and other sexually-transmitted diseases that affect fertility.

On the other hand, couples are leaving attempts to become parents later and later, allowing age and increased exposure to lifestyle risk factors to take their toll.

Meanwhile, it appears some doctors are capitalising on  fears of women to suck them  into the incredibly lucrative fertility industry.

‘I think we should be worried if women are having unnecessary tests because non-specialist doctors are not taking sufficient interest in male problems,’ says Gedis Grudzinskas, the editor of Reproductive Biomedicine Online.

‘The tests on women are painful, and there is a risk of infection which might cause more damage.’

Although it is not an issue which attracts the short-term interest of politicians or healthcare providers, this year the European Union launched Reprotrain, a four-year, ‘urgent priority’ international project involving six countries to identify ways of tackling the impending fertility crisis.

But even if the project comes up with answers, it is not an initiative that will help Dennis Robinson.

‘It never entered my head I would be unable to have a child of my own,’ he says.

‘I was never focused on it like I am now, it was just something I thought would happen when it happened. Now I want a child more than anything.’