As people celebrate dads this month, about 10 million couples worldwide are projected to struggle to have a baby this year. Between 40-50% of those cases involve male infertility issues. But male reproductive health is not always a priority, which is why it's important for both partners to be tested, diagnosed, and treated for infertility issues.
"Getting people in to discuss male infertility is important," says Kelli Gross, MD, a urologist specializing in male infertility and men's health at University of Utah Health. "The issue has been ignored for a long time. Women often take the initiative and drive the whole process, but we are not getting the guys coming in at the same rate unless they have someone convincing them to seek care."
Infertility is defined as the inability to get pregnant after having regular unprotected sex for at least one year. Fertility issues can be diagnosed in both men and women, but it's often women who get examined and tested first.
"Culturally, we continue to hear that when couples suffer from infertility, it is the women who are talking about it and often blamed," Gross says. "People don't tend to think about testing men even though it is easier to test men than women, and women get a lot more of the testing."
If fear of testing is one of the reasons some men decline to participate in the search for answers to infertility issues, Gross says it should not be a concern.
"With men, the basic testing is often a semen analysis and a hormone blood test, while in the women it can be ultrasounds or x-rays that require fluid inserted into the cervix." Many causes of male infertility are treatable and involve simple interventions.
Men are becoming more aware of the infertility issue and coming in more and don't know what to expect, but it is rare that we need to do something invasive. There is hope for even the most difficult cases of male infertility.
–Kelli Gross, MD, University of Utah Health.
Gross emphasizes that not all her patients are resistant to testing and treatment. "There certainly is a subset of men who come in and say, 'It's a lot easier for me to fix — I want to do my part.' Often their partners are going through all these more invasive tests and procedures like in vitro fertilization and so they want to make sure they support the process."
Male infertility issues are not always easily diagnosed by those without experience. But possible causes include environmental and lifestyle factors.
"Heat to the testicle can be very bad for the sperm, and those effects can last for a while," Gross suggests. "Up to three months is what we normally tell people exposed to extreme heat. Then other environmental factors like potentially smoking. We don't have great data on all these issues, but we know the sperm can be sensitive to several environmental factors."
Exposure to toxic chemicals or pesticides can also affect reproductive health.
The quality and quantity of sperm can also be linked to health conditions like diabetes, obesity, genetic defects, and undescended testicles. Sperm count and sperm health can play an important but often modifiable role in addressing fertility issues.
"Sometimes we will see hormonal issues, and lots of times we don't find a specific cause," Gross says. "But the condition can still be modifiable. However, when we find very low sperm counts or no sperm at all, it can be more difficult to treat." In 15% of male infertility cases, the cause is a complete lack of sperm.
At U of U Health, scientists are investigating the connection between paternal reproductive health and a man and his children's overall wellness. Their research suggests that deficiencies in sperm count and sperm health can be early warning signs of a higher risk of other serious health conditions.
"Infertile men are more likely to get cancer, and that extends to their families," says Jim Hotaling, MD, one of the U of U scientists studying these connections. "The big question is, what's causing that?" Hotaling and Qi Chen, MD, PhD, continue to investigate the genetic and environmental factors that may underlie infertility and related cancer risks. Many of those are still unknown.
In the United States and worldwide, male reproductive health along with sperm counts have been on the decline since the mid-1900s. Meanwhile, cases of testicular cancer, hormone imbalances, and genital malformations are all on the rise and can seriously affect sperm count.
Just two years ago, the National Academies of Sciences, Engineering, and Medicine convened a workshop designed to explore in-vitro gametogenesis, or IVG. It involves custom-making human eggs and sperm in a laboratory from any cell in a person's body. U of U Health is involved in continuing research on this effort.
The goal is to clear the scientific hurdles that exist to the creation of functional human sperm in the lab. One approach involves combining biology with materials science and mechanical engineering to create model systems to replicate human testicular tissue. Success with this critical research could revolutionize fertility care for men who have already undergone failed sperm retrieval procedures, survived childhood cancer, or experienced severe unexplained fertility issues.
"Of course, men who can possibly benefit from this game-changing research now and in the future need to take the first step toward better understanding their infertility issues," Gross says. "It requires a willingness to be tested and treated."
She continues, "Men are becoming more aware of the infertility issue and coming in more and don't know what to expect, but it is rare that we need to do something invasive. There is hope for even the most difficult cases of male infertility."
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