Traditionally, fertility tests and treatments are focused on the female partner. However, male partners do contribute about 50% to the problem. To improve the chances of getting pregnant, both male and female partners play an important role. In this article however, Dr Agilan Arjunan, Consultant Obstetrician & Gynaecologist, KL Fertility Centre explains how a man can improve his chances of becoming a father.
Firstly, a couple should aim to have sex 2-3 times a week during the female partner’s fertile period and sex every 1 or 2 days intervals during her fertile window. If one is unable to have sexual intercourse regularly, the chances of getting pregnant is significantly reduced.
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However, before that….
Get your general health in check.
• Consider food or supplements that can improve your fertility. For instance, anti-oxidants has been shown to improve sperm count, motility (movement) and morphology (shape of sperm). Antioxidants are substances that prevent cell damage in your body due to free radicals, which are formed in your body naturally. This includes sperm cells, where antioxidants will reduce sperms with DNA damage.
• Examples of anti-oxidants are zinc (oysters, shrimp,red meat), selenium (brazil nuts, tuna, cod, beef, chicken), Vitamin C (in many fruits and vegetables),Vitamin E (nuts,seeds, leafy greens) , Co-enzyme Q (salmon, tuna, beef).
• Food which are red in color ( ie strawberry, tomato, cherry ) also contain antioxidants.
Your BMI counts too
• Obesity (BMI > 30kg/m2) can reduce sperm production. Aim to have an ideal BMI of 19-24 kg/m2.
• To get started, aim to reduce 5% of your body weight.
If you’re smoking, stop!
• Smoking has been shown to reduce sperm quality. Quitting this habit will help to improve sperm quality. Look out to, for exposure to secondary smoke, for it can also reduce your sperm quality.
• Recreational drugs such as anabolic steroids and marijuana will also, needless to say, impair sperm function.
Mind your underwear
• There are some evidence to prove that wearing briefs may raise the temperature around the scrotum (skin covering the testicles) and may reduce sperm quality. Switching to boxer underwear may help. Also, avoid activities that raise scrotal temperature such as soaking in hot tubs and placing laptops on the lap.
Medications that may affect sperm quality and lead to infertility.
Testosterone:
Replacement testosterone (male hormone) can reduce your own testosterone levels in your body. This will negatively affect sperm production.
Anabolic steroids:
Mainly used to build muscle and reduce body fat is used by many non-competitive athletes . These types of drugs can reduce sperm production.
5 alpha reductase inhibitor:
Examples are finasteride and dutasteride. They are used to treat hair loss and prostate enlargement. This medications can reduce sperm count and volume of semen (fluid that contain sperm). However, the effect is reversible once the medication is stopped.
Selective Serotonin Reuptake Inhibitor (SSRI):
This medication is commonly used to treat depression and anxiety, but it may harm the motility (movement) of sperm.
Ketoconazole:
An antifungal medication that may not have any effect on sperm if used as skin cream or ointment. If used as oral pill however, it may decrease testosterone level and reduce sperm quality.
Other medications are also known to affect sperm quality, such as nifedipine and spironolactone (used as antihypertensive medication), cimetidine (for gastric ulcer), sulfasalazine (to treat rheumatoid arthritis) and colchicine (used for gout ).
Limit your soy intake!
Research has shown that consuming too much soy can reduce sperm count. If you think you are safe because you don’t eat tofu, think again, for soy is found in many other foods such as fake meat patties, energy bars and health drinks. The effect of soy on your fertility is stronger if you are obese.
Alcohol
Heavy alcohol intake may decrease testosterone production, increase rate of clearance of testosterone from body and increase the oestrogen (female hormone) levels in a male. So, if you’re a heavy drinker, consider cutting down if you want to see your fertility health improve. For couples undergoing IVF treatment, the risk of conception not leading to a live birth increases by 2 to 8 times if the male partner is a heavy drinker.
Even your dental health is important!
Who knew that dental hygiene is actually associated with sperm quality? A study done among men with reduced sperm quality found that after dental treatment, sperm quality improved compared to those who did not have dental treatment.
What about stress, then?
Stress has long been associated with infertility. To be more specific, stress may lead to male sexual dysfunction ( ie erectile dysfunction, inability to ejaculate etc). It does not necessarily reduce sperm production and quality though.
Male Fertility Test Simplified.
Fertility assessment can sometimes look very complicated with all those internal ultrasound (transvaginal) scans, blood tests, x-ray tests and sperm test (for a male partner).
For a man, the most important test is a semen analysis (sperm test). In about a third of all couples, the problem lies with the male partner and thus it is very important to do this test.
Since even a 70 year old man can still reproduce sperm, so this can’t be a major issue right? Well yes and no.
It is true that a man continues to produce sperm but the QUALITY of the sperm deteriorates as he ages. Low sperm quality equals to lower chances to conceive.
Sperm tests
In an andrology laboratory, there are four basic parameters that are of concern. These parameters are reported according to WHO standards (World Health Organisation).
Sperm concentration:
The lower range of normality is when at least 15 millions sperm for every millilitre (ml) of semen is found. Sperm concentration above this value is considered “normal”.
Vitality:
At least 58% of the sperm sample must be live sperm
Motility:
This parameter looks at the movement of the sperm. At least 40% of the sperms should be moving. The movements are further graded according to how fast it moves and direction of the sperm movements.
Morphology:
This refers to the physical shape of the sperm. It’s done under high powered microscope.
Just 4% (you read it correctly!) of the sperm should be normal-looking to be considered “normal”.
Azoospermia
Azoospermia is when a man’s semen contains no sperm whatsoever. It can be due to either production problem (i.e. sperm not produced by testis) or obstructive problem (i.e. sperm is produced but there is an obstruction in the sperm exit pathway). Generally, a physical examination is carried out to look for any signs of testosterone (male hormone) deficiency. Blood test for hormones (i.e. FSH,LH,testosterone) are also carried out.
- If it’s an obstructive problem, the sperm can be retrieved via a procedure called TESA/TESE, which is a minor surgical procedure where a small needle is inserted into the testis to retrieve testicular tissue which contain the sperm. The procedure is done under anaesthesia / sedation.
- If it’s a complete production problem however, there will be no sperm to retrieve. However, it is very rare for often enough, there are some sperm which can be retrieved.
Sometimes oral medications can be used to boost up sperm production, but this can be determined after the examination and blood test results.
When sperm is retrieved via TESE/TESA or by ejaculation, IVF/ICSI is the next appropriate step towards a successful pregnancy.
