The male infertility injustice: Why does the IVF industry still focus on women?
Male fertility in the West is in rapid decline.
Data from the Human Fertilisation and Embryology Authority, which regulates infertility treatment in the UK, shows the number of infertile men being treated has doubled in just four years.
The biggest ever study of male fertility in the developed world revealed a 59.3 per cent reduction in average sperm count between 1973 and 2011.
‘We have a huge public health problem that, until now, was under the radar. Health authorities should be concerned,’ says Dr Hagai Levine, an expert in environmental health at the Hebrew University in Jerusalem, who led the study of declining male fertility which was published in the journal Human Reproduction Update.
He says his findings should be treated as the ‘canary in the coalmine’, providing a warning for the future of male reproductive health.
Poor lifestyle is a recognised factor. As Dr Channa Jayasena, a specialist in diabetes and hormone activity based at Hammersmith Hospital in London, explains: ‘Rising obesity and diabetes are major factors in increasing rates of male infertility. This is because they damage overall fitness.
‘But, inexplicably, many affected men are apparently fit and healthy. Heavily processed foods, environmental pollution and lack of exercise may also be contributors to the problem.’
Other researchers have suggested female hormones in the water supply — from the contraceptive pill — could also be a contributor.
Last year the World Health Organisation warned that understanding of male infertility was ‘very low’ and the Medical Research Council (MRC) in the UK issued a call for research proposals.
Whatever the cause, it’s now acknowledged that in more than half of cases, the problems faced by infertile couples originate with the man.
And yet the infertility industry — which is led by gynaecologists focusing on female reproduction — continues largely to ignore them, even when it’s the male partner who is infertile.
One man Good Health spoke to told us he and his wife spent £20,000 on failed IVF, only to later be told by the clinic that the problem lay not with her but with his sperm quality.
‘There is a lack of recognition that male factor infertility is a problem — and because of this, a lot of IVF is unnecessary,’ Dr Ashok Agarwal, a leading infertility specialist from the Cleveland Clinic in Ohio, U.S. told Good Health.
Jonathan Ramsay, a urologist and male fertility expert at Imperial College London, concurs: ‘It is well known that men are just as likely as women to be the cause of a couple’s inability to conceive.
‘But infertility specialists are invariably gynaecologists who specialise in women’s reproductive health and don’t have a detailed understanding of how to pick up defects in sperm production. There are relatively few of us working in this area.’
Yet instead of a full health check and physical examination of their reproductive system, men are often simply asked to give a sperm sample which is then given only basic assessments to check for the number and movement (i.e. motility) of sperm — rather than, say, investigating why the sperm might be poor quality.
As the Mail reported yesterday, the failure to diagnose or treat infertile men leads to the ‘absurd’ situation where women routinely have IVF when there is nothing wrong with their own fertility, according to Sheena Lewis, a professor of reproductive medicine at Queen’s University in Belfast and chair of the British Andrology Society.
‘We are giving an invasive procedure to a person who doesn’t need it in order to treat another person,’ she said. ‘That doesn’t happen in any other branch of medicine.’
Professor Lewis is campaigning for the use of sperm DNA testing and has published numerous studies showing poor sperm will not work in assisted fertility treatment.
‘I think the IVF industry is out of control — it wrecks marriages, leaves people very unhappy and mostly doesn’t work,’ adds Dr Sheryl Homa, formerly one of the world’s pioneering embryologists. She is now the scientific director at the private Andrology Solutions clinic in London, the only infertility centre in Britain focusing on men.
‘IVF is much worse than cosmetic surgery,’ she adds. ‘If, like IVF, your facelift or breast augmentation carried only a maximum 30 per cent chance of working, you wouldn’t do it.’
The experts’ concerns are borne out by the experience of Dan James, 32, a professional cellist from Dartford in Kent, and his wife Gemma, 35, also a cellist. They tried for two years for a baby before seeking help in April 2015.
The couple, who’ve been together for ten years, were referred for NHS infertility treatment.
Although he was quickly told the results of his sperm samples (which he had to do at home) showed he had very poor motility, meaning he would not be able to naturally father a child, ‘all the focus was on Gemma’, says Dan.
‘We went back to the GP but we were told I should just take multivitamins. He said that before we would be referred for IVF, my wife would still have to undergo at least six months of investigations even though I was the one with the identified fertility problem and she’d already had initial tests that showed she was OK.
‘They were going to put dye into her fallopian tubes to check they weren’t blocked, insert a balloon to check the uterus was all right and make her take clomid, a drug which makes women produce huge numbers of eggs, which in itself is unnatural.
‘Doctors have a tick box mentality that they have to focus on women,’ he adds.
Yet when it comes to male fertility, a low-tech approach may actually be much more useful and vastly less stressful for couples. There is increasing interest in boosting sperm quality in subfertile men by giving them antioxidant dietary supplements.
The theory is that low antioxidant levels mean sperm DNA may be damaged, affecting swimming capability and the ability of the sperm to break through and fertilise an egg.
This summer, the European Society of Human Reproduction and Embryology conference in Barcelona gave unprecedented space to the discussion of successful results from studies by Dr Agarwal and others, investigating dietary supplements and other treatments for sperm problems.
Dr Agarwal, a world authority on identifying methods of repairing and boosting sperm quality, has already produced a number of studies indicating benefits from antioxidant supplements such as lycopene (see box, below).
Dr Albert Salas-Huetos, of the Universitat Rovira i Virgil in Reus, Spain, presented a study on the benefits of diet and eating nuts on sperm health.
This is what helped Dan and his wife Gemma finally conceive.
Frustrated by the failure of the NHS to help, they used their savings to see Dr Homa, who referred Dan for nutritional therapy with a ‘sperm-boosting’ diet — a Mediterranean regimen with lots of vegetables and fruit, and a personally tailored menu of supplements devised by Melanie Brown, a London nutritionist specialising in improving fertility. Melanie says three out of four of the subfertile men she treats go on to experience greatly improved sperm quality. ‘Demand for this treatment has rocketed,’ she says.
‘Men are much less willing to just accept the diagnosis that their sperm isn’t very good and they need to go for IVF or intracytoplasmic sperm injection [ICSI, where a single sperm is injected directly into the egg],’ she says.
‘It is a very intrusive dehumanising experience, and I think its use is masking the problem of defective sperm. Apart from anything else, we don’t know how many ICSI babies will themselves be infertile.’
Dan says: ‘After three months on the diet I had another sperm test which showed there was improved sperm quality — enough of a difference to mean I would be fertile.’
At this point, concerned that their age made conceiving naturally a risk, the couple opted for ICSI. ‘It worked straight away,’ says Dan, whose daughter, Phoebe, will be two in November. ‘We were delighted and have no doubt it was as a result of all the preparation to improve my fertility. We’ll now try naturally,’ he says.
Jim (not his real name), 39, a retail manager from West London, also credits the sperm-boosting diet and nutrients for his imminent fatherhood. He does not want to be identified because a leading IVF clinic is still supervising the 20-week pregnancy of his 38-year-old wife — even though she conceived naturally following treatment to improve his sperm quality.
‘I was more than a little annoyed to be told at the beginning that sperm quality was not a problem when it clearly was,’ he says.
‘The consultant who saw us after we had spent £20,000 on failed IVF said they needed to work on my sperm. I asked why his colleague had previously told us it wasn’t a problem. He didn’t answer.’
After six years of secret misery and failed fertility treatment, Will Walsh was also beginning to despair. ‘It was very difficult to talk to anyone about this,’ he says. ‘My friends and family didn’t know; I didn’t want the sympathy.
‘Your primary function is as a facilitator of reproduction, and if you can’t do that, you are seen as less of a man and someone who should be pitied.’
Will, 33, is a fit, slim, natural athlete. A freelance commercial interior designer, he lives in Kenton, Devon, with wife Dominique, 35.
Will explains that when they first tried for a baby, ‘nothing was happening. So we went to the GP and were referred for specialist help. But they wanted to investigate Dominique rather than me. She had a barrage of tests. We had them done privately just for speed. The results came back saying everything was fine.
‘Then we asked if we could have sperm tests done.
‘My male GP said it would be done under my wife’s name. He said that was normal — all the treatments are done under a female name with the man as an accessory, which says it all really.
Two sperm tests showed a low sperm count with poor motility, and the couple were offered IVF on the NHS. The first round failed.
‘At this point, almost two years after the first investigations and although I had undergone sperm tests which showed problems, I had not had a physical test done by anyone and the focus was still on my wife — even though she had no fertility problems.
‘During the consultation with the specialist after the failed IVF, there was still no discussion about whether there might be anything wrong with me. I was just a spare tool. It was all about my wife and what she should be doing.
‘After that we did our own research and discovered that DNA damage to sperm wouldn’t be picked up in a normal sperm test.’
Internet research led the couple to private treatment with Dr Ramsay. A physical examination immediately revealed a potential cause: a varicocele (a varicose vein in the testicle). This can overheat the sperm by reducing healthy circulation of a cooling blood supply.
A quick operation under local anaesthetic eliminated the defective blood vessel. Dr Ramsay then referred Will to nutritionist Melanie Brown for a tailored three‑month sperm-boosting diet and supplements.
Dr Ramsay says: ‘We are trying out lots of different dietary interventions with some very good results, but often male infertility can be caused by something as simple as a variocele.’
Since Will embarked on the diet and supplements, tests indicate everything is working fine, and he and his medical team are ‘completely confident’ it will soon lead to a naturally conceived baby.
TOMATOES COULD HOLD THE KEY
Leading researchers are investigating lycopene, the nutrient that makes tomatoes red, as a treatment for poor sperm quality.
Lycopene is poorly absorbed from tomatoes, but numerous studies have shown that supplements containing modified forms of this and other nutrients, such as L-carnitine, could improve sperm.
Professor Allan Pacey, a male fertility specialist at the University of Sheffield, has just completed a study looking at the effects on sperm production of a lactolycopene formulation called XY Pro. (Lactolycopene mimics the catalyst effect of olive oil in the Mediterranean diet, which allows lycopene to be absorbed. Lack of lycopene absorption in trials involving other supplements has until now inhibited efforts to measure its benefits as a health booster.) While Pacey’s results are yet to be published, he is hoping they will provide a ‘proof of concept’ for other studies.
Dr Ashok Agarwal, a world authority on improving sperm quality, has produced a number of studies on lycopene and other nutrients. ‘We have some promising results in terms of improved sperm, but more work is needed,’ he told Good Health.
He cautions against self-medicating. ‘I am worried people are being given antioxidants whether they need them or not. If the sperm is normal, supplements can do damage.’