Silent agony of husbands haunted by MALE infertility
It’s the most disturbing of facts: sperm counts have fallen 60pc in 25 years . . . blighting the lives of more men than ever
WITH his wife Terri in floods of tears beside him, Richard Clothier felt torn. A few moments earlier they had been told the baby they so longed for was not going to happen. And the problem was down to him.
‘My whole world came crashing down,’ says Richard, 39 ‘I wanted to protect Terri but at the same time I felt terribly guilty that I had the problem. I was fit, a non- smoker and didn’t drink to excess. But tests showed my sperm count was low, the motility was poor and the morphology [shape] was poor.’
The scenario is one that is increasingly common. Last month, new research examining data on more than 43,000 men showed sperm counts in the Western world are declining at a terrifying rate.
Between 1973, when reliable records began, and 2011, Western men’s sperm concentration fell by an average of 1.4 per cent a year, an overall fall of 53 per cent in 38 years. In the span of one generation (25 years) the drop was 60 per cent.
While women are certainly choosing to have babies later in life — the average age of a firsttime mother in the UK is 29.6, a rise of almost four years in four decades — their physical fertilty rates have followed the same steady curve. Only 3 per cent of 20 to 24-year- old women will have trouble conceiving, rising to 15 per cent after the age of 35.
But men, who had always assumed they would remain fecund into middle age and beyond, are finding their fertility is falling off a cliff — often while they are comparatively young.
In the past, a third of fertility problems were said to be from the male side, a third from the female side and the rest ‘unexplained’. But experts now believe problems with sperm quality or count may account for some of the ‘unexplained’ cases.
While no specific reason has been found, it is suspected that pollution from the air and from contact with certain plastics, plus unhealthy lifestyles, is to blame. Chronic stress levels and use of antidepressants may also play a part.
SOME concerned scientists have dubbed it ‘spermageddon’ and say it could even lead to the end of the human race. ‘The data serves as a wake-up call,’ says Dr Hagai Levine, the epidemiologist behind the study that identified the decline. ‘If we do not make a drastic change to how we live and the chemicals we are exposed to, I am worried about the future.’
Another concern is that damaged sperm are having an effect already, which might help to explain the rise of conditions such as autism.
Then there is the impact, all too easy to overlook, on men’s mental health. While society has long accepted how devastating infertility is for women, men often suffer in silence, fearing to admit there is a problem. Many confess to having suicidal feelings.
This suffering is something Richard, a marketing manager from Dunstable in Bedfordshire, recognises. He and Terri, 35, a company administrator, started trying for a baby after they married in 2011. But after two years without success, their GP organised tests including semen analysis.
‘It hadn’t really occurred to me that the problem might be mine,’ says Richard. ‘The GP described my sperm as ‘a little bit lazy’ but assured us Terri would be pregnant by Christmas.’ Six months and a second opinion later, the couple were told it was far more serious. Richard’s sperm were hardly performing at all.
‘Terri took the news particularly badly,’ he says. ‘At 33, she felt time was marching on. We were advised to try fertility treatment but told that thanks to cuts, we’d only get one shot at it on the NHS.’
The news that he was infertile had a profound effect on Richard.
‘I couldn’t talk to anyone about it,’ he says. ‘I didn’t want to burden Terri and the vast majority of men I knew already had children. I visited a fertility clinic open day and even the men there seemed reluctant to discuss it.’
While women struggling to conceive have often described the agony they feel at hearing friends’ ‘happy news’, in the same situation Richard felt compelled to keep his pain inside.
‘Whenever a friend revealed they were expecting, I would put on a brave face and congratulate them but the stress was intense. There were mornings driving to work when tears would be streaming down my face.
‘We did tell a few people and some were tactful but others weren’t. I had to endure jokes about “firing blanks”. One man whose partner got pregnant said “I’m just relieved to know I’m fully functional”. Comments like that haunted me. When we did a pregnancy test on Mother’s Day and it came out negative, all I could think about was how I wasn’t ‘fully functional’.
Professor Sheena Lewis, of the British Andrology Society, says the effect on men’s self-confidence can be devastating: ‘It’s a hugely emasculating issue because men are inclined to think fertility is connected to virility — which it isn’t — and that they can’t be a good lover if they can’t be a father.
‘They don’t want to talk to their partner or to male friends, and feel they must be ‘strong’ for their partner when inside they’re hurting.
‘Men are hugely lacking in support. Even within the fertility industry they are marginalised. Every test and treatment is geared towards the woman, while the man is treated as “the sperm producer”.
‘What’s more, the current semen analysis doesn’t even check for DNA damage in the sperm, so in my opinion it’s unfit for purpose. Couples need to ask for a specific test to check. That needs to change.' Richard says Terri never made him feel he was to blame. `Although I felt guilty, I was lucky she never harboured any anger towards me,' he says. 'I've known other couples where that hasn't been the case.'
TERRI says: 'Although I grieved, I never blamed Richard. The problem could so easily have been with me. If anything, the experience made us closer — it's only recently that I've discovered he was suffering so much on his own.' Fortunately, in Richard and Terri's case, a second round of DIF — at a cost of more than £6,000 — proved a suc-cess. Their son James was born 16
weeks ago, after six years of trying. They underwent ICSI, a type of IVF used when there is a lack of good-quality sperm. Instead of the eggs and sperm being mixed in a dish to fertilise naturally, a single sperm is extracted and injected directly into the egg.
‘We’re happy, but I have a bit of survivor’s guilt because I know exactly how some men will feel reading this,’ says Richard. ‘Not everyone is as lucky.’
Nathan White is another man whose life has been deeply marked by the stress of infertility. The 33-year-old civil servant, who lives in Maidenhead, Berkshire, was told there was a problem with his sperm last year when he and wife Natalie, 31, went for tests.
‘We had been married for two years when we decided to try for a baby in 2012,’ says Nathan. ‘By 2014, nothing had happened and Natalie was very concerned, but I convinced myself it was down to our stress levels.
‘Then the GP found Natalie had polycystic ovaries, but further tests showed she should have no problem in conceiving. And that’s when they focused their attention on me.
‘No bloke wants to go through all those tests but you do it because you have to. I didn’t know how I would react when the results came back. What if they said “sorry mate, nothing works, you’re useless”?
‘As it turned out, I was the problem. I had low mobility and low motility [meaning the sperm had problems moving independently and through the seminal fluid]. I felt pretty useless and emasculated.
‘ I’d already been feeling depressed and there were moments when I thought about killing myself. Natalie wanted a baby so much and I thought if I took myself out of the equation, maybe she could find someone to start a family with.
‘It was difficult to talk to anyone. Men aren’t very good with these things. When my brother asked how things were going with trying for a baby, I said: “Looks like I’m firing blanks, mate.” and he replied: “Oh, that sucks,” and that was it.’
The pressure affected his relationship with Natalie. ‘ My mood was so low, I never knew how I was likely to react,’ he says. ‘ Sometimes I’d be snappy and irritable.’
Natalie agrees: ‘ We struggled as a couple for a little while. I did get angry that he didn’t seem interested in making changes to improve the situation. I wanted him to take care of his diet and lose weight. I took him along to exercise classes with me and he’d just sit there at the back. At one point, I was so fed up with him I went on holiday alone to get away.’
What the couple didn’t realise was there was a physical reason for Nathan’s infertility and odd behaviour. Two months later, tests showed he had a prolactinoma — a benign brain tumour in the pituitary gland — which was affecting his hormone levels.
Such tumours, thought to cause about 11 per cent of male infertility cases, often go undiagnosed. One small study on rats suggested exposure to the chemical BPA, found in plastics, may contribute to the growth of prolactinoma but much further investigation is needed.
‘I started on medication and Natalie and I were told to keep trying,’ says Nathan. ‘ Within six months she was pregnant. Our daughter evelyn was born in January 2017.’
Between 20 and 25 per cent of all sperm problems could be due to an underlying medical condition, and men taking medication for other conditions should check it isn’t damaging to sperm.
‘There are underlying conditions which affect hormone levels and there are sometimes testicular factors such as tumours, infection or undescended testes,’ says Professor Geeta Nargund, medical director of Create Fertility. ‘ But lifestyle and environmental factors are also to blame — we know that smoking can affect sperm, as can being overweight and taking anabolic steroids.
‘And it’s not only women who have a biological clock. After the age of 40, a man’s sperm quality and count decline. It takes longer to conceive and there is evidence that autism, ADHD and mental health disorders are more common in children whose fathers are older.’ Often, fertility treatment can offer help to these men. ‘Around 1 per cent of men have azoospermia — they have no sperm in the semen,’ says Professor Nargund. ‘In some cases we can obtain sperm from the testes and use ICSI treatment but if there are no sperm at all, we look at donor sperm. ‘For other men, ICSI can help with severe sperm problems. But it’s important to remember only 30 per cent of fertility treatment is successful. We need to educate boys and men to protect their natural fertility. Many don’t go on to become fathers.’
This was the case for Clive Brewer, a 57- year- old businessman from Twickenham who found he was infertile in his early 40s.
Far from plunging into self-pity and blame, though, he says he was blasé and philosophical about it — ‘but my partner, who already had a four-yearold daughter, was disappointed.
‘We discussed IVF treatment but nothing ever came of it. We were together for another seven years before separating.
‘It’s only since I met my new partner and grew up a bit that the thought of never having children has played on my mind. I love being a stepfather to my stepsons but I’d be lying if I said there wasn’t a pang of regret.’