The Fertility Spotlight Is (Finally) Shifting To Men

Throughout 2021, fertility was a high-priority topic at mbg, and we made a number of deliberate choices about how we discuss it on our site. 

With the guidance and advice of trusted fertility experts, we removed the word "infertility" and replaced it with a more accurate and sensitive "fertility challenge." We similarly traded the term "miscarriage" for "pregnancy loss" to capture a spectrum of outcomes and experiences. Our goal with both of these decisions was to better empathize, plus ease the guilt and blame that's all-too-often associated with the fertility journey, particularly for people with uteruses. 

While we certainly can't speak for everyone's experience, traditionally with heterosexual couples, the fertility focus has fallen on the female half of the equation. "All things children—making them, growing them, nurturing them—are still considered the domain of women primarily. Yes, even in 2021, and even in countries that are thought to be progressive," says scientist and fertility specialist Cleopatra Kamperveen, Ph.D.

As a result, women often lead the fertility journey, says reproductive endocrinologist and fertility specialist Dan Nayot, B.Sc., M.Sc., M.D., FRCSC, medical director at The Fertility Partners and chief medical advisor at Bird & Be. "This can be seen in many ways, such as the ones initiating the referrals to the clinic, deciding which physician would be the best fit, and staying organized in terms of setting up all investigations and follow-ups," he tells mbg, attributing this to both biological and complex social reasons. "Unfortunately men are sometimes viewed as 'less compliant' or 'less motivated' to attend information sessions, complete the required testing, or maintain any recommended lifestyle changes."

This can prove to be problematic for a number of reasons, not least of which is that there's a lot of data indicating sperm count and quality are declining in our modern age, as environmental and reproductive epidemiologist Shanna Swan, Ph.D., found in her own research. She was shocked to discover that in her meta-analysis of 42,935 men, from 1973 to 2011, the total sperm count in Western countries dropped by 59%1. 

What's more, as Kamperveen shares with mbg, another meta-analysis with 14,947 men, across 61 studies, suggests that this decline was happening as early as the 1930s2.​​ While average sperm counts currently remain within a healthy range, she says, "It is important to understand this dip and ensure this rate of decline does not continue."

This is why it's crucial to turn the spotlight on male fertility. "Challenges are equally likely to originate in the male as they are to originate in the female," Kamperveen shares. "So both members of any heterosexual couple who are experiencing fertility challenges automatically need to be taken into account. It doesn't actually make sense to start by looking just at the woman; yet, that's usually what happens."

A major part of the issue is lack of awareness and education around male fertility. "The problem is that men are very reluctant to address their sperm and reproductive function," Swan shared on the mindbodygreen podcast. "Most men I've talked to have no idea what their sperm count is, unless they've tried to get a woman pregnant. They assume that everything is good. I think that has to change now."

That's because, as Swan shares, markers of fertility have implications beyond conception—which is why she believes all men of reproductive age should test their sperm as early as possible. "They should be aware that having problems with their sperm could predict health problems more generally later in life...it's about how healthy they're going to be as they get older." In fact, according to a study of 43,277 men in the American Journal of Epidemiology, an increase in sperm concentration was associated with lower mortality. Swan thinks it should be a routine preventive test—just like checking blood pressure or cholesterol. "So that if there are problems, we can do something about it."

The good news is, within the last year, a number of companies have created at-home testing offerings—making these health metrics more accessible than ever. These new services eliminate the need to provide an on-site sample in a doctor's office, clinic, or specialty lab—a process which can be intimidating, and discourage men from seeking this important information.

This year, for instance, bioscience company Reproductive Solutions released ProteX, the first and only product designed specifically for semen collection at home. And retailer HoMedics saw a 580% rise in sales for Swimcount, a new home test that enables men to measure the progressive motility of their sperm.

Taking it a step further, this March, digital fertility clinic Legacy launched the first and only consumer-friendly sperm DNA fragmentation (SDF) available for at-home testing—which can be a valuable diagnostic tool—in addition to their other offerings. "Legacy helps men on their journey to fatherhood through mail-in sperm testing, analysis, and preservation at a time when sperm counts have declined over 50% and men are stepping up to be equal partners in the family planning process," Khaled Kteily, founder & CEO of Legacy shared in a news release. 

While sperm count and quality is certainly a crucial piece of the male fertility equation, Nayot also points out that it's important to look beyond this sample. "If the semen analysis is normal, then there's usually no further attempts to optimize overall health, where in fact there is still a lot of room for improvements ranging from lifestyle changes to nutrient supplementation."

Swan couldn't agree more, based on her research. To improve reproductive health, she encourages following a Mediterranean-style diet, eating plenty of fruits and vegetables, keeping alcohol to a minimum, ditching smoking, exercising (without overdoing it), avoiding endocrine-disrupting chemicals, and managing stress. 

In addition to these lifestyle best practices, Kamperveen encourages maintaining healthy blood sugar, cholesterol, and blood pressure levels. Plus, she advises aiming for seven-and-a-half to eight hours of sleep per night and meditating to help increase stress resilience. "The good news is that everything you do to contribute to your sperm health also contributes to your longevity," she says. 

If you are actively trying to conceive, Kamperveen explains that all of these lifestyle choices become even more crucial in the 120 days leading up to conception (what she refers to as the "Primester"). "It is during this window when we can literally change the quality and expression of the genes that we will pass down to our children (and grandchildren), through a process called epigenetics."

As for supplementation, research suggests that antioxidants such as zinc, selenium3, and CoQ10 may help limit sperm DNA fragmentation4. Plus some studies suggest vitamin D5, vitamin E6, vitamin C7, and folate8 can have an impact on sperm health, as well.  

What's more, if a man is facing fertility challenges, in addition to looking at overall health, Nayot encourages a scrotal ultrasound and hormonal panel blood test. "There are many sexual function considerations including libido, the ability to initiate and maintain an erection, and proper ejaculation," he says. 

"If the sperm count is really low, then usually IVF (or ICSI–intra-cytoplasmic sperm injection) should be able to overcome the main issue. Even if there is no sperm production, sometimes a surgery on the testicles can find a rare sperm that might just lead to a healthy pregnancy with ICSI. In short, there is a lot of hope, so it's best to look into your options."

As Swan and Kamperveen also note, it's important to take psychological factors into account, as well. "The psychological impact of sexual distress and male factor fertility can't be understated," says Nayot. "It's a hidden pain that doctors should ask about, and routinely offer counseling options." 

As for destigmatizing the topic, Nayot feels "all of fertility is trending in the right direction"—but we are only at the beginning of changing the male narrative, and making the conversation more inclusive as a whole. "Men still feel that their [fertility struggles] will be publicly judged as a marker of their masculinity, their sexual prowess, and their physical anatomy," he says. "The ongoing efforts of public campaigns to educate the masses, of public figures sharing their struggles, and safe forums for men to share and be supported will continue to make male [fertility challenges] less isolating."