tatler man male fertility

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Life s tyle

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We’ve all heard the
slang, we may have even
used it in conversation –

but when it comes
to male fertility issues,
it seems the less said,
the better. But is that

about to change?

special

rmepoart:le fertility

2223 IRISH TATLER MAN

The focus used to be on the woman but The reality is that sperm counts have
more and more, science is catching up to dropped by 50 per cent over the last decade
the fact that the male fertility factor is and men are showing increasing numbers of
much more important than we thought. sperm abnormalities.
And with that comes a need to better
inform men on possible choices. “Most men generally wouldn’t ring, but
their wives would ring if there’s a male issue.
Take for example, miscarriage. Males are not really getting the support,” says
Automatically all the investigations would have Helen Browne, Chair of the National Infertility
been done on the woman. Now science is Support and Information Group (NISIG).
coming around to the male side of things, that
if the sperm health is not good, the DNA is “In the past there were misconceptions, that
compromised, then that can cause a problem, people would automatically think it was a female
post-fertilisation. issue,” says Helen. “I think the internet has
lifted a lot of misconceptions and people are
far more informed of what’s going on.”

While prospective parents are more aware
of fertility issues, for many men, the supposed

Main image:

Technician injecting human sperm into a
human egg cell using a technique known
as intracytoplasmic sperm injection (ICSI).
This technique is used for in vitro
fertilisation (IVF). The injected sperm
fertilises the egg.

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Below:
A computer rendering of
In vitro fertilisation (IVF)
Facing Page:
A scientist lifting a bank
of frozen cells from a
liquid nitrogen tank

TERMINOLOGY

ICSI – the most successful form of treatment for men who are infertile

and used in almost 50 per cent of all IVF treatments. One sperm is
injected directly into the egg, then the embryo is transferred to the uterus

IVF – the process by which eggs are removed from ovaries and mixed

with sperm in a culture dish. Fertilisation takes place ‘in vitro’

INTRAUTERINE INSEMINATION – washed, prepared sperm

is placed into the uterus near to egg at time of ovulation. Often combined
with fertility drugs to increase chance of conception

link between virility and fertility cannot be easily and afterwards they hop into the jacuzzi WHAT AFFECTS
ignored. It’s not as far fetched as you would afterwards as a kind of relaxation – but it’s not FERTILITY?
have once believed: a couple is considered good, neither are hot baths.
infertile when they’ve failed to conceive after Caffeine – studies indicate problems with
12 months of contraceptive-free intercourse “Exercise is very good but too much
and the female is under 34-years-old. exercise is not good for a couple of reasons. It sperm health seem to increase the more
can be a stress on the body if you do intense coffee men drink daily. This could be because,
Male fertility is a massive topic and one of exercise, that is physical stress and it’s using as a diuretic, caffeine could deplete the body
which we can only scratch the surface in Irish up vital nutrients you might need for fertility. of vital fertility boosting nutrients such as zinc
Tatler Man. Here, we look at whether sperm
count can be improved and why there could be “Secondly, if you’re doing something like Weight – can reduce quality and quantity of
renewed hope for prospective parents. The running or more particularly, cycling, again the
important thing is to be open, honest and testes are being heated up if you’re wearing sperm count. Some researchers believe
upfront because in many cases, male fertility tight running or cycling shorts, the testes are obesity may affect fertility by lowering levels
issues can be overcome. being heated up the same as a hot bath so it’s of testosterone in men
a temperature issue and that high temperature
IT’S POSSIBLE TO MAKE damages the sperm.” Smoking – can affect the main semen
A DIFFERENCE
While the subject of male fertility and factors measured including motility, count
Is there any truth to hot baths or over infertility can have a psychological impact, and normality. Smoking also has a negative
exercising contributing to fertility issues? Heather says the most positive thing is that men effect on the head of the sperm making it
“There is actually, hot baths in particular as have a chance to make a difference. more difficult to fertilise an egg
they can heat the testes and they can make the
sperm too hot,” says Heather Leeson, “As women, we can’t change our egg quantity, Alcohol – a man can wipe out sperm count
Director of Glenville Nutrition Ireland we can only change our quality. With men, they
(www.glenvillenutrition.ie). can completely change their sperm; they’re for several months after a particularly heavy
making it all of the time. It takes about three drinking session
“The testes are dangling outside the male months to make a difference, sometimes a little
body which keeps them about two degrees bit longer, but you can make a huge difference. Stress – can raise the level of stress
cooler than the rest of the body. So one thing
that is important for guys is to avoid things “Lots of different things have an impact on hormones and this can interfere with the
like saunas and jacuzzis. A lot of guys are sperm quality: lifestyle aspects, stress hormones controlling sperm production
trying to get healthy and are going to the gym management is important because it affects
testosterone production which will affect sperm Age – very little is said about the change in
production, healthy diet, healthy exercise.
male fertility as they age. Research suggests
that in men over the age of 35, sperm count is
lower and sperm are less motile. DNA
fragmentation can be a cause of male
infertility with this increasing as the man ages

Undescended testicles – can lead to future

infertility issues

Varicocele – an enlarged vein in the scrotum,

which, if temperatures rise, can decrease
sperm quality and quantity

2425 IRISH TATLER MAN

There are some nutrients that are particularly who have been diagnosed with defective to the penis aren’t there.
important so from a clinical perspective we sperm production or who have had “In the majority of cases, the guys don’t
would be testing if someone was low in zinc, if unsuccessful conventional sperm retrieval
it was selenium they were lacking in.” procedures. realise it until they have a semen analysis.”
When the laboratory gets sperm samples to
Before you order a lifetime supply of vitamins, “Male subfertility and infertility is a problem
beware: “We’re seeing toxic levels of some and guys probably don’t really anticipate it’s analyse, thankfully a lot of the time there’s a lot
nutrients where guys have been on single going to be a problem until they’re told,” of sperm and movement, says Tim.
nutrients for too long and that’s causing a explains Dr Tim Dineen, Head of Laboratory
problem, particularly something like selenium, Services at Cork Fertility Centre. “There’s certainly a number of cases
so you need to be careful,” says Heather. each week where the sperm perimeters are
“Some guys will know because there are sub-optimal in a way, whether that be low count
“NHP Fertility Support for Men is a general some reasons for male infertility where they or low motility or even the likes of anti sperm
multivitamin that’s got more antioxidants that will know from their childhood there’s a antibodies where sperm are clumping together.
help protect sperm. That would be a nice one problem. Sometimes the testicles don’t drop
for a three-month period to try. That’s great if properly or are undescended and need to be “There are issues for that guy and that
you just want to be as good as you can be. If a brought down, or if someone is affected with couple. If he is subfertile, there is still sperm so
problem has been identified then probably CF will know, as the tubes linking the testicles it might take them longer to get pregnant but
more specialist support is useful.” they can still get there and maybe with relatively
non-invasive treatments.
Men should also be mindful of caffeine and
alcohol intake and watch their weight and diet.

“Alcohol is a toxin; it can really disrupt and
damage sperm. If a guy has been out on a
session then that can impact his sperm for a
period of time,” says Heather.

“Our genetic material is very delicate; the
sperm can be easily damaged even by a couple
of degrees of heat so having 20 pints is definitely
a bad idea.

“Guys are making sperm from raw material
they’re eating. So if they’re eating ‘rubbish’ then
you don’t have the nutrients you need to make
healthy sperm. Think of it like a 10km race, you’d
eat a bit better and this is exactly the same.”

RENEWED HOPE?

In June 2016, Cork Fertility Centre (www.cork
fertilitycentre.com) announced the first
reported pregnancy in Ireland as a result
of an advanced sperm retrieval technique.
Microsurgical Testicular Sperm Extraction
(Micro-TESE) may offer renewed hope to men

MY STORY: PAUL BRADLEY an extent. After seeing Kristel inject herself with a
few hundred injections, it was the least I could
In November 2013 Paul Bradley (now 31) and his then partner, now wife, do,” he says.
Kristel (now 30), attended a fertility clinic and began their fertility journey
The couple booked a holiday and relaxed,
“We started off with the Clomid [fertility drug] Understandably, Paul says it “took which took some pressure off them, and when
and ovarian stimulation for about six months,” over our lives a bit because they were
explains Paul. “I obviously had the sperm tests timed injections so we had to be they returned, Dr Kennedy rang and
and all came back grand, Kristel had blood tests home every night at certain times and asked what they had done, as Paul’s
and everything was perfect.” leave the house at certain times.” result had decreased to 19 per cent.
They agreed to try another round of
Six months later, the couple started on gonal f Unfortunately, despite egg IVF, this time the short, one-month
injections for 12 months and still nothing collection, Kristel was at risk of protocol.
happened. Ovarian Hyperstimulation Syndrome
(OHSS) so the couple agreed to a “We got set, we bought all the
“We done another sperm analysis because I’d frozen transfer. When it got to the drugs, invested the emotional time
had quite a few health issues with the gallbladder freezing process, none of the getting ready for it. Kristel fell sick for
being removed, ulcers and a few other things,” embryos made the criteria to freeze a couple of days and the clinic was
says Paul. so the cycle failed. ringing us to say we were due to come
in. She was sick the Monday and it came
It was February 2015 and as the couple was “We took a month of a break and to the Thursday. I had a good feeling
getting married that April, they decided to take a then were suggested a DNA that maybe we do a test.”
break. Post-wedding, the couple, who were told fragmentation test,” says Paul.
they were too young for IVF, underwent a further One test turned into another, and
two months of gonal f injections before changing “My DNA frag was 49 per cent and the the blood tests confirmed Kristel was
clinics to SIMS (www.sims.ie) for a second acceptable level is 15 per cent so that’s when we pregnant and her baby is now due within weeks.
opinion. found that it was actually probably me. “We spent the next three months second
guessing it, not really believing it,” says Paul.
“Dr John Kennedy flabbergasted us by saying, “Everything runs through the head as you “Then we had an early scan at six weeks with SIMS
the way we were trying then, the only chance was think about what you’re doing next.” and another scan at 12 weeks in the Rotunda.”
less than two per cent,” says Paul. The expectant father says that it’s important
The clinic made lifestyle recommendations men speak about male infertility.
They were scheduled for the IVF long protocol such as giving up caffeine and Paul began taking “Men need to ‘fess up a bit and take a bit of
in August to October 2015, after further tests ten supplements per day. responsibility. Men don’t want to talk about it or
came back sound. admit it.”
“I felt it was my fault so it was all or nothing to

specialreport

“There are the more extreme samples, “A lot of the times with male fertility or they come to a stage of fertility treatment and
typically once a week where there are no infertility, we’re not able to identify the reason thankfully, a lot of couples that come through
sperm in the ejaculate whatsoever,” says Tim. for the problem and because of that we’re not will end up with the right outcome at the end
able to correct the problem. But what we are of the day even after a few attempts, but
“It might be because obstructive able to do very successfully is overcome the unfortunately there will be some people who
azoospermia or non-obstructive azoospermia. problem. We can go in there, do the biopsy, won’t get there with their own gamine and then
If it’s due to obstruction, where basically there hopefully retrieve sperm that we can work with, they do need to look at maybe donor egg,
is sperm production but the sperm is not able we can freeze that sperm and then his partner donor sperm in order to make the transition
to get out, if you do a testicular biopsy for those comes through later on, we collect the eggs, into parenthood.” ITM
guys, in about 90 per cent of cases you will get we inject the eggs with the sperm and then
sperm. We’ve been doing biopsies for the likes fingers crossed end up with the right outcome.” ON THE AGENDA
of those guys for about a decade or more
[using the TESE treatment]. For a man being given the news that there is NISIG has been meeting with
no sperm or that their sperm is of poor quality, government officials for the last
“The non-obstructive ones are more it doesn’t necessarily mean the end of the road number of years as Assisted
difficult because it means there’s implications in having their own biological child. Human Reproduction (AHR)
in sperm production or spermatogenesis, services are not provided by public
basically there’s an actual issue with the “Unfortunately, there will be negative results health services.
factory of sperm production. For those guys, when we do biopsies and then the couple do
by doing a traditional type of biopsy, there’s a need to consider other options such as donor “We are very aware that AHR is on the
chance you don’t get sperm. So by going down sperm or adoption,” says Tim. government’s programme and we’re so
the route of Micro-TESE, it’s a more targeted aware that the government is looking into
route of biopsy. A high-powered microscope is “But by these procedures in place, the international models for funding,” says Helen
used in surgery to actually visualise the number of couple who need to access those of the NISIG. “We would hope that something
tubules. other options is a lot lower than what would like in the UK or in Scotland or in Northern
have been otherwise.” Ireland.”
“The healthiest of those tubules is removed
and given to us in the lab to work with them However, there is a limit of what can be Couples in Scotland and Wales are entitled
and hopefully get sperm that way. There would done in generating or creating sperm. to two NHS-funded cycles of IVF treatment if
be pockets of spermatogenesis and you have they meet certain medical criteria, irrespective
to hit those pockets in order to be successful “This certainly a step in the right direction of income. In Northern Ireland, one fresh and
and get the sperm.” for that category of guys where it’s certainly one frozen embryo transfer is funded to those
more tricky because the problem is to do with eligible for treatment.
Typically the centre would get one sample sperm production,” says Tim of Micro-TESE.
per week of ejaculate with no sperm. For these In ROI, individuals can apply for financial
men, and others with fertility issues, there “If that’s a negative result, realistically he support such as tax relief for medical expenses.
may be an option. does need to start thinking of other options.
“Where’s it going to go? I’m not sure to be “What we hope is that in the future that if
honest but it’s important for a couple when the government recognises it as a medical
condition that needs to be funded, that we
hope that the private health insurances would
take it on board,” says Helen.

2627 IRISH TATLER MAN