Too often, women carry the burden of fertility planning but a leading expert says men’s health can be just as critical to successfully conceiving.
Male fertility specialist Professor Rob McLachlan said male factors alone were responsible for about 30 per cent of cases in which couples experienced difficulty conceiving.
But what actually determines whether a man’s sperm is healthy enough to give conception the best possible chance, and what everyday factors could be working against them?
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What affects sperm health?
For conception to occur naturally, sperm have a difficult journey ahead of them. Millions begin the process, but only a tiny number will ultimately reach the egg.
McLachlan likened sperm to an army, where both numbers and performance matter.
“They have to know how to march and they need to know what to do when they get there,” he said.
“You’ve got to have tens of millions of sperm to start the journey so that you get enough to where the egg is.”
There are a number of reasons sperm may not function as expected.
Genetic factors can affect the way sperm develop, while infections, testicular trauma, some surgeries, chemotherapy and certain medications can also cause damage.
Mumps is one example. If the infection affects the testes during adolescence, it can have consequences for future fertility.
Lifestyle can also play a role with obesity, for example, associated with poorer sperm health, while poorly controlled diabetes can also affect reproductive health.
Smoking is one of the clearest things McLachlan wants men trying to conceive to avoid.
“You must not smoke … it damages the sperm directly,” he said.
There are also concerns around exposure to chemicals and other environmental factors, particularly for men who work in industries where they may regularly come into contact with pesticides, insecticides or fungicides.
McLachlan said basic occupational safety measures such as protective equipment and hand-washing could help reduce that exposure.
Keeping things cool
Temperature is another factor many men may not immediately think about when considering fertility.
The testes sit outside the body because sperm production works best at a temperature slightly below core body temperature.
McLachlan said excessive heat around the scrotum could interfere with that process.
“Testicles are a little bit like a coral reef — 1.5C difference and they get unhappy. It’s the same with testes,” he said.
That is why the scrotum acts as a kind of natural cooling system.
“They’re in the scrotum for a reason,” McLachlan said.
“They’re a couple of degrees cooler.”
Regularly exposing the testes to excessive heat, such as through very hot spas, is therefore something men trying to optimise their fertility may want to reconsider.
McLachlan also warned against prolonged direct heat from a laptop, suggesting placing a book between the laptop and the lap.
The three-month window
There is a reason men are often advised to think about their health before they actually start trying for a baby.
It takes roughly two months to produce a sperm, meaning the sperm involved in conception reflect the conditions in which they developed.
For that reason, McLachlan recommends men make healthy changes at least three months before trying.
But he believes the bigger picture should extend well beyond that short window.
“If you see yourself as a father, you should smarten up now,” he said.
For men who smoke, drink heavily, are carrying excess weight, or have conditions such as diabetes, waiting until they are actively trying for a baby may mean missing an opportunity to improve their overall health.
McLachlan sees preparing for fatherhood as a chance to think about the kind of health a man wants to have throughout his child’s life.
“You want to live to be a healthy, middle-aged man playing footy in the park with your son or your daughter,” he said.
“You need to be as healthy as you possibly can be in the months leading up to producing that sperm that will give you that child.”
Should men get their fertility tested before trying?
Routine fertility testing before a couple has even started trying is not necessarily required.
McLachlan said there were exceptions, including men with a history of testicular trauma or other reasons to suspect there could be a problem.
For everyone else, he believes it is reasonable to begin trying before seeking testing, while also rejecting the idea that couples must necessarily wait a full year before asking for help.
“If you’ve got concerns after a few months of trying without success, you should see your GP,” he said.
A semen analysis is a relatively straightforward first step and can provide doctors with important information about sperm count, movement and quality.
“If people are concerned enough to go to their doctor, I think a very minimum is a history, examination, and a semen test,” McLachlan said.
If the initial result is abnormal, it may need to be repeated and followed by additional blood tests or investigations.
Importantly, a poor sperm count does not necessarily mean a couple cannot have a child.
Modern IVF techniques can allow doctors to work with very small numbers of sperm in cases where natural conception is difficult.
Men do have a biological clock
The idea that male fertility is unaffected by age is a common misconception.
Men do not experience menopause, and healthy men can continue producing sperm into old age, but that does not mean sperm remain completely unchanged throughout a man’s life.
From around the mid-40s, some changes become more apparent, with increasing paternal age associated with small increases in the risk of certain genetic conditions and miscarriage.
The absolute risks remain low, but McLachlan said they demonstrate that age is not irrelevant for men.
“They’re not common. They go from being very, very rare to being very rare,” he said.
“Everything from miscarriage rates, they all go up somewhat as men get older.”
For couples considering when to have children, he believes fertility should therefore be a joint conversation rather than something placed primarily on the woman.
“Both partners need to be supportive of one another and recognise that age is a factor,” McLachlan said.
What about male fertility supplements?
With more men becoming aware of their role in fertility, the market for male fertility supplements has also grown.
Products such as Menevit are marketed towards men trying to conceive, with ingredients intended to support sperm health, motility and production.
But McLachlan said consumers should be realistic about what the evidence can currently prove.
“It’s controversial,” he said.
“If you’re asking me, is there unequivocal evidence that it improves fertility and live birth rates in humans, the answer is no.”
That does not necessarily mean supplements have no effect, but the evidence is mixed.
McLachlan said their appeal could also be psychological, particularly for men who want to feel they are actively doing something to improve their chances.
“It does give you a sense of empowerment. You’re doing something,” he said.
For men who choose to take them, McLachlan said he had no particular objection, but supplements should not replace the more fundamental work of looking after overall health.
The conversation needs to change
For McLachlan, the bigger issue is not simply getting more men tested or encouraging them to take supplements, it is changing the way couples think about fertility in the first place.
Rather than viewing conception as primarily a woman’s health issue, he wants both partners to recognise they have a role to play.
“It is a couple’s business,” he said.
“The man needn’t be bashful or awkward about coming forward.”
A conversation about fertility can also open the door to broader discussions about smoking, weight, diabetes, alcohol, exercise and long-term health.
For McLachlan, that broader health conversation may be one of the most valuable outcomes.
“I like the aspect of looking a little bit beyond just fertility and thinking about general health,” he said.
