The injustice of male infertility: why is the IVF industry still focusing almost entirely on women?

Family ties: Dan James, from Kent, pictured with wife Gemma and daughter, Phoebe

Male fertility in the west is in rapid decline.

Data from the Human Fertilization and Embryology Authority, which regulates the treatment of infertility in the United Kingdom, show that the number of infertile men receiving treatment has doubled in just four years.

The largest study conducted to date on male fertility in the developed world revealed a reduction of 59.3% in the average sperm count between 1973 and 2011.

Family ties: Dan James, from Kent, pictured with wife Gemma and daughter, Phoebe

Family ties: Dan James, from Kent, pictured with wife Gemma and daughter, Phoebe

"We have a major public health problem that, until now, was under the radar, health authorities should be concerned," says Dr. Hagai Levine, an environmental health expert at the Hebrew University of Jerusalem, who led the study on decrease in male fertility, which was published in the journal Human Reproduction Update.

He says his findings should be treated as the "canary in the coal mine", providing a warning for the future of male reproductive health.

Poor lifestyle is a recognized factor. As Dr. Channa Jayasena, a specialist in diabetes and hormonal activity at London's Hammersmith Hospital, explains: "The increase in obesity and diabetes are important factors in increasing rates of male infertility, because they damage general fitness.

"But inexplicably, many affected men appear to be healthy and fit, highly processed foods, environmental pollution and lack of exercise can also contribute to the problem."

Other researchers have suggested that female hormones in the water supply, from the contraceptive pill, could also contribute.

Last year, the World Health Organization warned that the understanding of male infertility was "very low" and the Medical Research Council (MRC) in the United Kingdom called for research proposals.

Whatever the cause, it is now recognized that in more than half of the cases, the problems faced by infertile couples originate in man.

Helping hand: The couple, who has been together for ten years, was referred for NHS infertility treatment after two years of trying independently for a baby

Helping hand: The couple, who has been together for ten years, was referred for NHS infertility treatment after two years of trying independently for a baby

Helping hand: The couple, who has been together for ten years, was referred for NHS infertility treatment after two years of trying independently for a baby

And yet, the infertility industry, which is run by gynecologists who focus on female reproduction, continues to ignore it to a large extent, even when it is the infertile male partner.

A man with whom Good Health spoke told us that he and his wife spent £ 20,000 on a failed IVF, and then be informed by the clinic that the problem was not in her, but in the quality of her sperm.

"There is a lack of recognition that male infertility is a problem, and because of this, a lot of IVF is unnecessary," Dr. Ashok Agarwal, a leading infertility specialist at the Cleveland Clinic in Ohio, told Good Health. USA UU

Jonathan Ramsay, a urologist and male fertility expert at Imperial College London, agrees: "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 gynecologists who specialize in women's reproductive health and do not have a detailed understanding of how to detect defects in sperm production." We are relatively few who work in this area. "

However, instead of a complete health examination and a physical examination of their reproductive system, men are simply asked to give a sperm sample which is then only evaluated to verify the number and movement (ie, motility) ) of the sperm, instead of saying, investigating why the sperm can be of poor quality.

As Mail reported yesterday, the lack of diagnosis or treatment of infertile men leads to the "absurd" situation where women usually have IVF when there is nothing wrong with their own fertility, according to Sheena Lewis, professor of reproductive medicine at the University of Queen in Belfast and president of the British Andrology Society.

"We are giving an invasive procedure to a person who does not need it to treat another person," he said. "That does not happen in any other branch of medicine."

Professor Lewis is campaigning for the use of sperm DNA tests and has published numerous studies that show that poor sperm will not work in assisted fertility treatment.

Fact: Last year, the World Health Organization warned that the understanding of male infertility was "very low" and the Medical Research Council in the United Kingdom called for research proposals

Fact: Last year, the World Health Organization warned that the understanding of male infertility was "very low" and the Medical Research Council in the United Kingdom called for research proposals

Fact: Last year, the World Health Organization warned that the understanding of male infertility was "very low" and the Medical Research Council in the United Kingdom called for research proposals

"I think the IVF industry is out of control: it ruins marriages, it leaves people very unhappy and most of them do not work," adds Dr. Sheryl Homa, formerly one of the world's pioneering embryologists. She is now the scientific director of the private clinic Andrology Solutions in London, the only center of infertility in Britain that focuses on men.

"IVF is much worse than cosmetic surgery," he adds. "If, like IVF, a facelift or breast augmentation would only have a 30% chance of functioning, it would not."

The concerns of the experts are confirmed by the experience of Dan James, 32, a professional Dartford cellist 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 have been together for ten years, were referred for NHS infertility treatment.

Although he was quickly told that the results of his sperm samples (which he had to do at home) showed that he had very low mobility, which means he could not have a child naturally, "the whole focus was on Gemma", says Dan. .

"We went back to the GP but they told us that I should take multivitamins." He said that before IVF was recommended, my wife would still have to undergo at least six months of research, even though I was the one with the fertility problem identified. and she had already had initial tests showing that she was fine.

There is a lack of recognition that male infertility is a problem, and because of this, a lot of IVF is unnecessary.

"They were going to put a dye in the fallopian tubes to verify that they were not blocked, insert a balloon to check that the uterus was okay and make her take clomid, a drug that causes women to produce huge amounts of eggs, which in itself is unnatural.

"The doctors have a mentality to check the box that they have to focus on women," he adds.

However, when it comes to male fertility, a low-tech approach can be much more useful and much less stressful for couples. There is a growing interest in increasing the quality of sperm in subfertile men by giving them antioxidant dietary supplements.

The theory is that low levels of antioxidants mean that sperm DNA can be damaged, which affects the ability of swimming and the ability of sperm to cross and fertilize an egg.

This summer, the conference of the European Society of Human Reproduction and Embryology in Barcelona provided an unprecedented space for discussion of the successful results of studies conducted by Dr. Agarwal and others, investigating dietary supplements and other treatments for sperm problems .

Dr. Agarwal, a world authority in identifying methods to repair and increase the quality of sperm, has already produced a series of studies that indicate the benefits of antioxidant supplements such as lycopene (see box below).

Reduction: the largest study in the history of male fertility in the developed world revealed a reduction of 59.3 percent in the average sperm count between 1973 and 2011

Reduction: the largest study in the history of male fertility in the developed world revealed a reduction of 59.3 percent in the average sperm count between 1973 and 2011

Reduction: the largest study in the history of male fertility in the developed world revealed a reduction of 59.3 percent in the average sperm count between 1973 and 2011

Dr. Albert Salas-Huetos, from the Universitat Rovira i Virgil in Reus, Spain, presented a study on the benefits of diet and the consumption of nuts in the health of sperm.

This is what helped Dan and his wife Gemma to finally conceive.

Frustrated by the NHS's inability to help, they used their savings to see Dr. Homa, who referred Dan to nutritional therapy with a "sperm stimulant" diet: a Mediterranean diet with lots of vegetables and fruits, and a personalized menu of supplements designed by Melanie Brown, a London nutritionist specializing in improving fertility. Melanie says that three of every four subfertile men she treats experience improved sperm quality. "The demand for this treatment has skyrocketed," he says.

"Men are much less willing to accept the diagnosis that their sperm are not very good and need an IVF or intracytoplasmic sperm injection" [ICSI, where a single sperm is injected directly into the egg], & # 39; she says.

"It's a very intrusive dehumanizing experience, and I think its use is masking the problem of defective sperm." In addition to everything else, we do not know how many ICSI babies will be infertile.

Dan says: "After three months on the diet, I had another sperm test that showed that there was a better quality of sperm, a difference enough to mean that it would be fertile."

At this point, worried that their age would naturally conceive a risk, the couple opted for ICSI. "It worked immediately," says Dan, whose daughter, Phoebe, will turn two in November. "We were delighted and we have no doubt that it was the result of all the preparation to improve my fertility, now we will try naturally," he says.

Jim (not his real name), 39, retail manager of West London, also credits the diet and nutrients that increase sperm for his impending fatherhood. He does not want to be identified because a leading IVF clinic continues to monitor the 20-week pregnancy of his 38-year-old wife, even though she conceived naturally after treatment to improve the quality of her sperm.

"It bothered me a bit that they told me at first that the quality of the sperm was not a problem when it clearly was," he says.

"The consultant who treated us after spending £ 20,000 on a failed IVF said they needed to work on my sperm." I asked why his colleague had previously told us it was not a problem.

After six years of secret misery and failed fertility treatment, Will Walsh was also beginning to despair. "It was very difficult to talk to someone about this," he says. "My friends and my family did not know, I did not want sympathy.

TOMATOES COULD SUSTAIN THE KEY

The main researchers are investigating lycopene, the nutrient that makes tomatoes red, as a treatment for low quality sperm.

Lycopene is poorly absorbed by 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 analyzing its effects on sperm production. Although the results have not yet been published, it is expected that they provide a "proof of concept" for other studies.

Dr. Ashok Agarwal, a world authority on improving sperm quality, has produced a series 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 warns against self-medication. "I worry that people get antioxidants, whether they need them or not, if the sperm is normal, the supplements can damage it."

"Your main function is to facilitate the reproduction, and if you can not do that, you are seen as a man less and someone who should feel sorry."

Will, 33, is a fit athlete, slender and natural. Independent commercial interior designer, lives in Kenton, Devon, with his wife Dominique, 35 years old.

Will explains that when they tried for the first time to have a baby, "nothing happened". So we went to the family doctor and they recommended us for specialized help. But they wanted to investigate Dominique instead of me. She had a flood of evidence. We made them in private only because of the speed. The results came back saying that everything was fine.

& # 39; Then we asked if we could do sperm tests.

"My family doctor said it would be done under my wife's name, she said that was normal: all the treatments are done with a female name with the man as an accessory, which really says everything.

Two sperm tests showed a low sperm count with low motility, and IVF was offered in the NHS. The first round failed.

"At this point, almost two years after the first investigations and although I had undergone sperm exams that showed problems, no one had done a physical test and the attention was still focused on my wife, even though I did not have any problems. fertility.

"During the consultation with the specialist after the failed IVF, there was still no discussion about whether there could be something wrong with me, I was just a spare tool, it was my wife and what I should be doing.

"After that, we did our own research and found that DNA damage to the sperm would not be detected in a normal sperm test."

Internet research led the couple to private treatment with Dr. Ramsay. A physical examination immediately revealed a possible cause: a varicocele (a varicose vein in the testicle). This can reheat the sperm by reducing the healthy circulation of a refreshing blood supply.

A quick operation under local anesthesia eliminated the defective blood vessel. Dr. Ramsay then referred Will to dietitian Melanie Brown for a three-month sperm-based diet and supplements.

Dr. Ramsay says: "We are testing many 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 diet and supplements, tests indicate that everything is working well, and he and his medical team are "completely sure" that he will soon lead a naturally conceived baby.

HOW TO IMPULSE THE HEALTH OF SPERMATOZOIDS

Stress is one of the worst things for a man's fertility, but it is not the only factor. Here are some other simple steps that men can take to help protect their fertility by taking care of the health of their sperm.

LOSE WEIGHT

Obesity is a factor in infertility, and more than 60 percent of the population is overweight or obese. In 2017, scientists from the Assisted Reproduction Center of the Krishna IVF Clinic in Visakhapatnam, India, studied 1,285 men and found that those who were obese had a lower sperm count and lower quality sperm.

KEEP IT UP

The testes hang out of the body for a good reason: the ideal temperature for sperm production is 34.5c (body temperature is 37c).

The colder testes produce sperm more effectively, says Allan Pacey, professor of Andrology at the University of Sheffield.

Wearing tight underwear or sitting in a car or hot room for hours can cause overheating and stop sperm production. That is why men who try to conceive are generally recommended to wear soft underpants and avoid prolonged periods of sitting.

GO TO BED AT 10PM

An early night may seem like obvious advice for a man who wants to become a father, but not for the reason you imagine.

A 2017 study at the Harbin Medical University in China found that men who hit the hay between 8 p.m. and 10 p.m. they had higher sperm counts than those who went to bed later, even if they slept the same.

It is believed that the last hours of bedtime increase the levels of anti-sperm antibodies, a protein produced by the immune system that can destroy sperm.

Professor Pacey adds: "To sleep too much, more than nine hours per night, seems to be as harmful as very little, six hours or less."

Studies found that men who sleep too much or too little tend to drink more and are more likely to smoke, which can damage sperm quality.

GIVE UP SMOKING

One in five men smokes regularly. In 2016, a study by the World Health Organization tracked 5,000 men across Europe and found that tobacco consumption not only reduced the amount of sperm produced, but also injured their motility, size and shape. Research has found that tobacco toxins penetrate sperm and begin to break DNA chains. These threads carry the necessary codes for a healthy sperm cell.

DO NOT DRINK BINGE

The relationship between male fertility and alcohol, even moderate consumption, is less clear than with smoking. "It is unlikely that a single session on a Friday night would be harmful, but regular binge eating affects the production and quality of sperm," says Professor Pacey.

GO FOR A RUN

Running for at least 25 minutes three times a week can improve sperm motility and increase numbers by 20 percent, according to a 2016 study in the journal Reproduction. It is believed that other forms of exercise that involve similar levels of effort have the same effect.

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