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It was once an all too common story. A young couple spent a year or so trying to start a family. When it became apparent that the “old fashioned way” wasn’t working, they decided to seek help. And since they assumed that infertility was a “female problem,” the woman contacted her doctor. She was poked and prodded for months or even years before someone finally asked, “What about your husband, has he been tested?”
Fortunately, times have changed. The last two decades have brought extraordinary advances in the diagnosis and treatment of infertility. Couples that would have once been sent on their way with no hope of pregnancy are now becoming parents through assisted reproductive technologies (ART). But despite these advances, male infertility remains a mystery to many, clouded by myth and misinformation. Let’s try to clear up some of the myths that still surround male infertility.
Myth # 1: “Infertility is a women’s problem”
With 40% of all infertility attributable to male factors (with another 20% attributed to both male and female.), you would think this myth would be replaced by fact. You’d be wrong. Although infertility specialists regularly order basic semen analyses for today’s infertile couple, many lay people still assume that infertility is a female problem.
Myth # 2 “You need 20 million”
Most urologists consider 20 million sperm per ml of ejaculate -- give or take -- to be a “normal sperm” count. But men with lower sperm counts do father children on their own. And once ART procedures like In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI,) are introduced, far fewer than 20 million sperm are needed to fertilize an egg.
Myth #3: “You only need one”
The old line that “it only takes one sperm to complete the “800 mile Olympic swim” is not quite true. Yes, when a man has only a small number of sperm, an embryologist, using ICSI, can help those sperm to fertilize eggs. But it’s quite difficult to work with just one, or even two or three sperm. You don’t need 20 million, but you do need more than one.
Myth # 4: “All sperm are created equal”
A common misperception is that a sperm is a sperm is a sperm. Unfortunately, not all sperm can fertilize an egg. A semen analysis looks at the number of sperm, and it evaluates motility and morphology and some parameters of seminal fluid. Motility refers to how effectively the sperm swim. Do they move at a good pace and head in the right direction or are the little guys swimming around in circles, destination unknown? Morphology refers to the shape of the sperm. Are they well-formed or do they have malformed heads or tails? Urologists and scientists specializing in male infertility have found that sperm need to be well-formed in order to fertilize eggs.
Unfortunately, even healthy looking sperm aren’t always capable of achieving pregnancy and live birth. Important research in the field of male infertility has found that the DNA of some sperm has been damaged, preventing them from being able to fertilize an egg or create an embryo that will end up 9 months later as a normal, healthy baby.
At long last, couples plagued by what is known as “unexplained infertility” can request new testing that looks beyond count, motility, and morphology and assesses levels of DNA fragmentation and the functional ability of a sperm to father a child. Offered by Woburn, Mass.-based Repromedix, a leading infertility testing laboratory, the SDD and SDFA tests can identify those men whose sperm may look fine, but whose efforts--even with IVF and ICSI--are likely to lead to persistent infertility. Taken together, these tests provide the clearest indication of a sperm's ability to successfully achieve pregnancy and live birth.
There is good news here too. Some men whose SDD or SDFA tests results come back positive can reverse the damage through certain therapies, such as removing themselves from toxins or taking antioxidant vitamins, and go on to father healthy children.
Myth # 5: “Biology trumps all”
Of course, it’s important to dispel the biggest myth of all surrounding men and fertility—that biology is destiny and genetic fatherhood is the only way a man can truly be a parent. If a couple simply cannot conceive a biological child, fatherhood through adoption or sperm donation is every bit as rewarding, aggravating, and filled with love as “natural” fatherhood.
Good information is a powerful thing. Couples struggling with infertility need to separate myth from fact when it comes to male infertility so they can make reasoned, informed decisions about their future.