• Malebox

Male fertility - The basics

Updated: May 4, 2020



We all know how a baby is made - Boy meets girl, sperm meets egg, fertilised egg becomes a baby. But, how much more do we actually know about male fertility specifically?


Fertility is an incredibly personal topic, however, this should not prevent it from being talked about. It doesn’t seem to stop Female fertility from being discussed far more openly than male fertility - this could be due to a number of reasons:


  • The fact that a female bears the physical brunt of pregnancy and any required fertility treatments

  • Women tend to be better at going to the doctors if they have a potential medical issue and therefore know about their fertility health more than men

  • Women are more open than men


Regardless of the reason, it has led to the general population having a poor understanding of male fertility and as a result there are some significant gaps in people's understanding.


Hopefully we can change this by setting the story straight on a few common misconceptions.



It’s not just a woman’s problem

Fertility struggles are common. It is an issue for around 15% of couples worldwide.


About one-third of fertility struggles are due to the man, another third are due to the women and the remaining third are caused by the combination of the couple or by problems that cannot be determined.


These proportions may sound obvious but for whatever reason fertility problems are wrongly seen, by too many people, as a female problem. It takes two to tango and the statistics show that it is both a male and a female problem. Come on guys - let’s start sharing the burden of fertility.



It’s not just sperm count?!

Male fertility is (wrongly) stereotypically thought of as just sperm count - When you think about it it is obvious that this isn’t the whole story but very few men actually do give it any thought, let alone talk about it.


In order for fertilisation to occur it actually requires a combination of a number of different factors to fall into place. The three most important from a male perspective are, sperm count, sperm motility (swim strength) and sperm morphology (shape).


Semen analysis of these three factors is the single most useful investigation for understanding a man’s fertility. If a man falls outside of the World Health Organisation (WHO) guidelines in one of these three areas then they are termed sub-fertile, however it is important to remember that it only requires one healthy sperm to fertilise an egg (so, for example, even if a man has a low sperm count, it is still possible to have a baby).



Fertility, it’s not as black and white as you may think…

It is rarely the case that someone is told that they are infertile. In the majority of cases where the man is having fertility struggles they will be subfertile. The table below shows the National Institute for Health and Care Excellence (NICE) thresholds for three most important factors for male subfertility:

We prefer to think of fertility as a scale and it is possible for a man to move up and down on that scale. Where a man is on that fertility scale can be due to a number of reasons. Some of these are understood (e.g. certain lifestyle factors) and others are not.


As a result a man’s fertility is always changing and WHO states it is helpful to take two to three samples over time in order to understand a man’s baseline fertility. Once understood, it is possible for men to make lifestyle changes that are proven to have positive impacts on fertility in order to slide further up the scale of fertility.



Men have a biological clock too?!


There are many cases of men having children later in life however, there is significant evidence that suggests this may not be the case for every man and many pregnancies involving an older man may have significant adverse effects.


This suggests that men have a biological clock of their own. Studies have shown that trying for children later in life can lead to increased pregnancy struggles, ranging from difficulties to conceive through to increased miscarriage rates through to increased rates of certain neurological disorders in the child.


We believe that having a child should be a conscious decision and one that is made at the right time in a couple’s lives. If a man is hoping for children in the future, we strongly feel there is a benefit in taking proactive steps to understanding and preserving their fertility.



By starting to open up the conversation around male fertility and busting some common misconceptions around the topic we hope men will start to think (and hopefully talk) about their fertility more, start to share the fertility burden with women and potentially even take small steps to take more control of their fertility health.




References:

https://www.hhs.gov/opa/reproductive-health/fact-sheets/male-infertility/index.html https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4691969/ https://www.who.int/reproductivehealth/publications/infertility/9789241547789/en/ https://www.nice.org.uk/guidance/qs73/chapter/quality-statement-4-semen-analysis https://www.who.int/reproductivehealth/publications/infertility/9789241547789/en/ https://www.researchgate.net/publication/283864069_Sperm_Biology_from_Production_to_Ejaculatio https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2605.1991.tb01071.x https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3253726/ https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/expert-answers/paternal-age/faq-20057873

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