Male potency has halved in the past 70 years. Now doctors are hoping a new home test will get men talking about sperm.
I had never thought about my sperm’s health before I decided to test it.
I didn’t know what motility meant (it’s sperm’s ability to move through the reproductive tract to reach an egg), or how many sperm I should have per millilitre of semen.Trying a home sperm test initially felt like a gimmick. But in the days before I took it I started to become nervous.
I am 30 years old and in December I am getting married. We want to have kids. We’ve even named the first two. Suddenly testing my sperm’s health made me feel like I was carrying the hope of our hypothetical family on the backs of my army of microscopic soldiers. Not only was my fertility being tested, my virility, my masculinity, was under examination. My ability to perform my primary function as a human was about to be exposed.
I collected a sample and left it to liquefy for half an hour. After stirring it 10 times as directed, 5ml was drawn into a syringe and injected into a machine that looks like a children’s science toy. I pushed the machine’s slider forward to activate the device and then waited another 30 manhood- defining minutes.
The machine offers three results represented by three shades of purple. The pale thistle indicates a low fertility status, fewer than 5 million motile sperm per millilitre. The mauve represents ‘‘normal’’ fertility, 5 million to 20 million healthy sperm, providing a good chance to get a fertile partner pregnant within 12 months. The deep purple band signals a motile sperm count of more than 20 million, a high count.
When I returned the slider to its original position, the sample drained into the indicator window where a purple hue appeared. My fiancee and I stared into the window in silence as the colour changed from pale to darker and darker. There was no doubting I was in the high bracket. I was fertile. I was an above average man on the most masculine test possible. I flexed my biceps in front of my chest like a bodybuilder and growled like a territorial Neanderthal. We high- fived. It was an incredibly validating moment for my testicles.
Historically men have branded fertility as almost exclusively a woman’s problem. In the past 15 years, awareness of male reproductive health problems has significantly increased. In about half of couples seen by fertility clinics, men contribute to the difficulty. But men are still shy beasts when it comes to talking about their sperm, and are often vulnerable about their infertility.
In the Western world, where good records have been kept for the past 70 years, sperm counts have roughly halved. In the past 30 years the World Health Organisation has dropped the lower limit of what is perceived as a normal sperm count three times. A ‘‘normal’’ sperm count is now anywhere between 15 million and 150 million sperm per millilitre. And the number of healthy sperm has declined by about a third. This has occurred at the same time as a rise in the incidence of testicular cancer, and undescended testicles in infant boys. The cumulative decline in male reproductive health is hard to attribute to specific environmental factors, but it is increasingly believed the damage occurs while the child is in utero. ‘‘It is thought that quite a lot of the influ-ence happens when the male is not yet born when the testicles are developing,’’says Dr Guy Gudex, medical director of Auckland fertility clinic Repromed. ‘‘Probably it is largely environmental things. But it is very difficult to say that it was pesticides, that it was diet.’’
It is also increasingly easy to link obesity to poor infertility in men. A study in South Australia showed 30 per cent of the men coming through fertility clinics were obese. And data shows a reduced chance of successful IVF if the male partner is obese. But infertility can affect anyone. ‘‘I still find it really amazing that fit young healthy men come in who appear really virile, but can have really low sperm with really low quality,’’ says Dr Debbie Blake, scientific director at Repromed. ‘‘For no reason, no incident, no injury, or no exposure to anything toxic. It doesn’t fit the profile.’’
Craig Berry and Andrea Donovan have the perfect little family. They have a cute house near the sea at Bucklands Beach, with a closely cropped front lawn. And inside are their two daughters – Millie 4, with curly blonde hair, and Harper 18 months, dressed in pink. The girls sit watching Frozen while their parents talk about how hard it was to conceive.
They had arrived back from London ready to start a family, and at 30 (Donovan) and 31 (Berry) they didn’t expect to encounter too many problems, despite suspicions she had polycystic ovaries. It was recommended they try to conceive naturally for six months before being tested. After no luck their doctor suggested Berry have his sperm examined, something he thought was a mere formality. ‘‘Back then I thought if there was going to be any issue it was going to be Andrea. And when they said I had to get tested I thought that was just a matter of course. When the test came back, that was a bolt from the blue,’’ he says.
The results showed he had only 2 million sperm per millilitre. And only 30 per cent motility. The couple were given a 1 per cent chance of conceiving naturally. Berry is a healthy, fit man. But suddenly he felt disabled, physically impaired. ‘‘You feel defective. You feel there is something wrong with you, but there doesn’t seem to be a rhyme or a reason for it. For me it was, ‘I am not going to be able to give Andrea what she wants.’ Not by myself, anyway. It is going to take a lot of help.’’
It took five years of testing, trying, acupuncture, supplements and four IVF cycles to conceive Millie. Then the stress of the pregnancy was crippling. When she was born, the sense of relief overwhelmed the couple. They call her their $100,000 baby (the costs include publicly funded IVF). ‘‘When Millie was born that was absolutely amazing. It was incredible. She was this perfect little baby. She was this beautiful little newborn,’’ says Donovan.
Two years later Harper was conceived on their first IVF attempt. Despite the fact he was successful and happy, married to an ambitious, beautiful woman, with a wonderful young family, I still couldn’t help feeling a slight pang of pity for Berry. I even sensed a small pathetic, primeval wave of superiority wash over me as I sat in their living room. I had more than 20 million sperm per millilitre, he had only 2 million.
There is an existential sense of male identity linked to a man’s sperm. Studies show that men are much more emotionally affected by a diagnosis of sperm problems, than if their partner has fertility issues. Women are likely to be upset by fertility issues no matter which side of the couple it comes from. Men seem to cope more easily if it is a female issue. ‘‘Some men are fine with it, some are devastated. They do instinctively link it with virility and with their manhood,’’ Gudex says.
Research shows men can suffer a number of deeply personal psychological wounds when they are diagnosed with infertility problems. They feel shame, a sense of personal failure, feelings of inadequacy and confusion around sexual self-image. They reported feeling specific losses around genetic continuity, concerned they can’t pass on their genealogy. One study found that 80 of 100 infertile men felt their manhood was injured by their perceived inability to provide for their partner.
The complex emotions associated with male fertility means that it is still a difficult problem to broach, and address for men. Many resist testing, and find the process awkward. There are hopes a new home-testing kit will reduce one barrier to men testing and talking about their sperm.SwimCount, the test I used in the privacy of my own home, is the first home test in New Zealand that is validated to measure sperm count and motility with accuracy. Available from Monday from Unichem and Life Pharmacy for $100, it reveals – with greater than 90 per cent accuracy – sperm’s potential to impregnate.
The product was developed by a Danish IVF clinic as a response to difficulties men had in providing semen samples, a growing number of men with low sperm counts, and the increasingly older age at which women are having children in Denmark. ‘‘We men, we don’t go to our GP unless we are very sick,’’ says Dr Steen Laursen, a fertility doctor in Denmark for 20 years and founder of SwimCount. ‘‘A lot of men, they are very shy and they don’t want to provide semen samples. I think people would really want to look at their semen count at home.’’ When Berry prepared a sample it was an ordeal. With a small window to get the semen to the lab within 60 minutes of production, and during working hours, Berry found himself trying to make a sample in his office just after everyone had left for the day. He was petrified someone would catch him. He would have welcomed the chance to receive an initial diagnosis in the comfort of his home. New Zealand is the first country outside Denmark to receive SwimCount. Reproductive specialists here believe it provides impetus for men to engage with their fertility.
‘‘I think it potentially is going to go a long way,’’ Gudex says. ‘‘It is going to generate quite a lot of discussion among men. It helps you to plan things. It might not mean trying straight away, but it might stop you from waiting until you are 35.’’ He wants to see New Zealand start educating its young people on reproductive health in the same way we talk about sexual health, careers and saving for retirement. As a gynaecologist, he sneakily raises the idea of fertility with his young female patients. He believes the same needs to start happening with men. He wants New Zealand to replicate Australia’s national fertility awareness programme, where the fertility consumer group Access is running a well-resourced and politically active campaign to raise the profile of fertility problems. ‘‘You sow the seeds and say you need to start thinking about it now. Even if they don’t think about it again for five years, at least you have mentioned it and sown the seed. It is more about don’t take things for granted,’’ he says.
‘‘I think men need to be particularly aware of the effects of lifestyle factors, being overweight, smoking, excess alcohol.’’ Declining sperm health must be married to the fact that women are having children much later as increasing career opportunities delay family planning. In the 1970s people were having children in their early 20s, now the average age of New Zealand mothers is 30, and fertility declines as women age. ‘‘That is the scary thing. A young egg can almost certainly make up, or compensate, for a sperm that is not performing well,’’ Gudex says.
As our population ages and people have fewer children (2.2 children per woman in 2010, down from 4.3 in 1961), fertility knowledge is essential. ‘‘Fertility is going to be really important. And it will be very important going forward. Any discussion that raises awareness is really good.’’ Although people talk about getting pregnant as easily as they talk about the weather, infertility is a deeply private subject. It’s time we men manned up and talked about our semen.