This afternoon, students will be storming through the Leaving Cert biology paper. Despite the rather lengthy copy on human reproduction, the notes in our house contain only a handful of points about male infertility. Female infertility disorders get a much more rigorous examination.
No doubt this reflects the focus of the research to date, which has largely concentrated on “women’s problems”. However, with more and more couples experiencing infertility, there’s a growing interest in getting the male body into shape for conception too.
It is estimated that male issues are involved in almost one-third of infertility cases. Going through infertility testing and treatment programmes is not easy. Couples need helpful strategies to see them through the physical, emotional and monetary demands that can sometimes rock their relationship to its core.
Hopefully the future will involve a more proactive approach to planning for pregnancy, particularly for men. Then the Leaving Cert syllabus can expand.
Semen quality
Semen quality is on the decline, and has been for decades. Problems include structural abnormalities and diminished sperm production and motility. Physiology, genetics, hormone imbalances, environmental toxins, diet and lifestyle have been identified as factors that have an impact on sperm quality.
Nowadays men are more likely to be invited to attend a preconception consultation on nutrition, along with the mum-to-be.
A man’s weight is one of the most important factors affecting his fertility. Being either underweight or overweight is linked with poor semen quality.
Studies show that men with a body mass index (BMI) over 35 have lower sperm counts and more DNA damage than men of normal weight. Overweight men tend to have lower testosterone and higher oestrogen levels, which have a negative impact on sperm production. Sleep apnoea, which is common in overweight men, is also linked to a fall in testosterone levels. Excess fat accumulation increases the build-up of toxic substances in fatty tissue and raises scrotal temperature.
Achieving a healthy BMI should be high on the priority list, as well as giving up smoking and avoiding second-hand smoke. Smoking can damage sperm, lowering count and motility. Studies also verify that pesticides, heavy metals and exogenous oestrogens, possibly found in water, decrease sperm production.
Two recent studies found that exposure to endocrine disrupters such as phthalates in plastic packaging and bisphenol A in tinned food may reduce fertility in men. More research is necessary but the advice is to limit exposure to these compounds in the meantime.
Alcohol consumption and stress are two weight-related lifestyle factors that influence fertility. Men who drink alcohol excessively may jeopardise implantation and conception as alcohol can be found in the semen comparatively quickly after drinking. Alcohol leads to free radical damage and so the advice is that both men and women should avoid or strictly limit alcohol while trying to conceive.
Stress management is important too, with work pressures and overscheduling an issue for many. Stress may also have an adverse effect on cholesterol levels.
A recent study in the Endocrine Society's Journal of Clinical Endocrinology and Metabolism found that if either one or both partners in a couple had high LDL, or bad cholesterol, it took them considerably longer to get pregnant. One of the researchers concluded that, in addition to raising the risk of cardiovascular disease, the findings suggest cholesterol may contribute to infertility. Not surprisingly, many men never have their cholesterol checked.
Preconception nutrition Many studies have linked certain micronutrients such as selenium, zinc, vitamins C and E and folic acid to sperm quality. These
nutrients are essential for better health and disease reduction. It appears that the beneficial nutrients recommended for conception are the same ones you need to keep healthy and alive to watch your children grow and start their own families.
The best way to get this diversity of nutrients is to eat well, focusing on seafood, lean animal and plant proteins such as nuts and seeds, wholegrains, antioxidant-rich fruits and vegetables, and essential polyunsaturated and monounsaturated fats. Supplementation may be necessary on the advice of your doctor or dietitian.
Right balance
Getting the balance right leaves little room for the not-so-fertility-friendly fats, such as saturated and trans fats. These are found in fried foods, processed meats and refined and processed foods such as biscuits, cakes and pastries.
An excess of these fats may decrease the membrane fluidity and flexibility necessary for healthy sperm mobility.
Diets poor in omega 3 and rich in omega 6 may also contribute to poor semen quality and sperm function. Walnuts are very rich in omega 3, as well as vitamin E, zinc, selenium and folate.
Our diets have transformed radically in the past 60 years. Last month researchers from the Harvard School of Public Health in Boston linked a high intake of sugar-sweetened beverages with lower sperm motility in healthy young men.
This builds on the evidence from the Rochester Young Men’s study which found that men who followed a “prudent” diet with high intakes of fish, chicken, whole-grains, fruits and vegetables had better semen quality and motility than those who followed the more typical “western” pattern of refined grains, pizza, high-energy drinks and high intakes of red and processed meats and sweets.
Dietitian Bridget Swinney, author of Eating Expectantly, suggests men change their diets when planning to start a family. She advocates an "antioxidant-rich diet [similar to a Mediterranean diet] before baby and beyond".
In an observational study in the journal Fertility and Sterility, researchers found that women undergoing fertility treatment who ate a diet similar to the traditional Mediterranean diet were 40 per cent more likely to become pregnant than those who had the least Mediterranean-like diets. The effects of this pattern of eating would be useful to study in males too.
So, it seems that the factors that affect fertility are many, but you are giving yourself the best start by achieving a healthy weight for your height, improving your diet, managing stress and limiting alcohol.
Risk factors: obesity, smoking, alcohol, stress, antioxidants
Obesity levels among men in Ireland have more than doubled to 23 per cent, compared with 20 years ago when just 8 per cent were obese, according to Dr Mary Flynn of FSAI.
Men are prone to carry excess weight in the abdominal area (also known as central obesity), commonly referred to as an apple shape. This excess weight in the stomach area is associated with an increased risk of metabolic syndrome, diabetes and an increased risk of heart disease. Obesity is also associated with an increased risk of hormonal disruption and infertility.
Some 23 per cent of Irish men smoke, according to a HSE smoking prevalence report in 2013.
One in every two smokers will die of a tobacco-related disease. See quit.ie. Alcohol consumption rate for Ireland is one of the highest in Europe at 11.9 litres per capita. Among alcohol drinkers, 29 per cent of men consumed greater than the maximum alcohol intake of units per week in the Irish Universities Nutrition Alliance (IUNA) study 2011.
One in four men will have a mental health problem at some point in their lives. It is estimated that depressive mental illness will be the leading cause of chronic disease in high-income countries by 2030.
In the IUNA study 2011, 21 per cent of men had inadequate intakes of vitamin A, which is found in foods such as melons, carrots, spinach and green leafy veg.
Some 22 per cent of Irish men take supplements.
Antioxidant-rich foods from Eating Expectantly, Fueling Your Fertility include: Fruits: blackberries, redcurrants, raspberries, strawberries, blueberries, oranges, pineapple, plums and pomegranates
Vegetables: spinach, chili peppers, black and green olives, mushrooms, asparagus, arugula, radicchio, beets, broccoli, artichokes and red peppers
Spices: clove, allspice, mint, sage, thyme, nutmeg, rosemary, saffron, tarragon, oregano, ginger, cinnamon, natural cocoa
Beverages: pomegranate, grape, prune, and cranberry juices. (Espresso, coffee, and green and black teas also contain antioxidants but should be consumed in moderation.)
Nuts, seeds, and grains: walnuts, pecans, sunflower seeds, chestnuts, peanuts, pistachios, buckwheat, millet and barley
