With so much attention being placed on female reproductive health, it’s easy to forget about the other essential half of conception relying on the male and their sperm. Almost 50% of couples struggling to conceive find it is due to male infertility. This statistic proves there is a far greater need for more attention to be placed on male reproductive health (1). Stereotypically, women are prescribed more responsibility regarding conception, but sharing the journey and being accountable for one another’s reproductive health is vital. So let’s get down to the nitty-gritty details of these often sidelined swimmers.
Sperm Production 101
On average, a male will produce between 200 - 300 million sperm every single day. However, the actual production process is lengthy and takes between two to three months (2). Located in the testicles, sperm cells grow to develop mobility and create the properties needed to bind to an egg during fertilisation. Once a sperm cell is fully developed, it moves from the testicles to the ejaculatory ducts where it mixes with fluid produced by different glands (seminal vesicles, prostate and bulbourethral glands). This fluid, known as semen, nourishes the sperm and is rich in vitamins, as well as other healthy proteins. It leaves the body through the urethra and out of the penis. The average amount of semen released per ejaculation is between two and five millilitres. This is the equivalent of roughly one teaspoon, and in each millilitre is roughly 15 - 200 million sperm (3).
Role of sperm for pregnancy
Each sperm is carefully crafted to carry genetic information. The head of the sperm contains 23 chromosomes, which, when combined with the 23 chromosomes in an egg, develops into a zygote which then becomes a fetus. The tail of the sperm and the fluid around it help with mobility. Post ejaculation, the seminal fluid aids sperm to move from the vaginal canal through the cervix and into the fallopian tube, where the woman’s egg is waiting. It only takes one sperm to fertilise an egg; however out of the millions produced, roughly 1000 will successfully reach the fallopian tube, and only 200 get to the egg (3). Post ejaculation, sperm can survive within a woman’s body for roughly 5 days due to the protective effects of cervical mucus (4).
Assessing sperm health
When assessing the health of a man’s sperm, there are usually two criteria looked at; quantity and quality. The term ‘sperm count’ tends to refer to the number of sperm found in the semen upon ejaculation. The higher the sperm count, the more likely it is that one of them will reach the egg. A low sperm count is considered when there are fewer than 15 million sperm per milliliter (5). You can determine your sperm count through a semen analysis, which can be done with an at-home test or by visiting a doctor.
The quality of the sperm is reviewed mostly on its motility and shape. Sperm motility describes the sperm cells’ ability to move through the fallopian tube post ejaculation. The higher percentage of moving sperm, the greater chance they have of reaching the egg. A healthy-shaped sperm is usually determined by a smooth, oval-shaped head covered by a well-defined cap known as the acrosome. The acrosome helps the sperm to get through the protective coat of the egg and allows the plasma membranes of the sperm and egg to fuse (6).
Sperm's DNA is also an important factor to consider and pay attention to. This is because mutations or deletions in the DNA structure of the chromosomes have been seen to affect the motility of sperm. Research shows that men with higher DNA fragmentations lead to a lower chance of fertilising an egg. While couples whose pregnancy resulted in miscarriage showed a trend of poorer sperm DNA (7). Advancing age has been associated with DNA damage due to the increased risk of genetic diseases (8).
Causes for male infertility and how to improve sperm health
Interestingly, 85% of infertile males can produce sperm. However, that sperm is not healthy enough or does not move well enough to fertilize an egg (9). There are a number of factors that can contribute to decreased sperm health and fertility issues. These include lifestyle choices, genetic abnormalities, and hormone levels. For men to produce sperm, their bodies rely on the production of follicle-stimulating hormone (FSH) alongside the steady release of testosterone. If men do not produce enough testosterone, it can impact their sperm production. Similarly, if they have too much testosterone or are on testosterone treatment, it can decrease the production of FSH, meaning less stimulation of sperm production. The same goes for anyone using anabolic steroids for a significant amount of time (10).
Lifestyle factors are hugely important to be aware of. Making changes to help improve sperm health should be implemented for at least two to three months during the sperm production period. Smoking, drinking, and recreational drugs (in particular marijuana and hash smoking) are known to negatively affect sperm quality and quantity (11). So cut down or quit the above if trying to conceive. Looking after your body by eating well and exercising steadily are also ways to better your sperm health. The extremities of being underweight or overweight can also be closely linked to changes in testosterone production. And similarly, a lack of exercise or excessive exercise (which increases stress hormones) can reduce your testosterone levels. So, the best solution is to try to find a healthy middle ground.
Understanding why sperm is produced in the testicles can also help to consciously improve sperm health. The testes are located in the scrotum (commonly known as the balls) which hang outside of the body. This is because sperm production needs to happen at a cooler temperature, roughly 2 to 8°C lower than inside the body (12). Therefore, wearing tight-fitting underwear and trousers, as well as having your laptop on your groin is a bad idea if trying to conceive (13). Instead, opt for wearing loose-fitting clothes and avoid anything that may increase the temperature around the crotch.
For some men, sexual intercourse problems, such as premature ejaculation or erectile dysfunction, contribute to difficulties during conception. Approaching these challenges with patience and exploring options such as counseling or medication can be of great help. Blockages can also occur within the male reproductive system, meaning that although sperm is being produced, it is unable to reach the semen and exit the body. Similarly to investigating any genetic factors such as autoimmune conditions (where the body attacks its own production of sperm), it’s wise to visit your doctor after a few months of trying to conceive for a detailed fertility test.
Including Men In The Fertility Conversation
There’s a lot to be said for the way many men will be advised to only investigate their sperm health after a year of trying to conceive. Whereas for women, the encouragement to assess fertility even before considering motherhood creates an imbalance of responsibility. One couple we spoke to confirmed the gendered bias that exists within the medical room, noting how it provokes unjust blame placed on women. They told us how “When my husband went to have his fertility checked, the Doctor commented on how many women encourage their partners to be tested without any real cause for concern. He told my husband to wait a few months until it was confirmed that my fertility was ok before he had any tests. I, on the other hand, was doing every kind of examination suggested, in addition to checking my temperature every morning and going to endless doctor appointments.” They explained their frustration at the lack of sincerity concerning male fertility and, though thankfully this couple's fertility proved to be ok, they pointed out that “imagine something was wrong with my husband's sperm. We would have waited so long before the doctor decided it was time to check”.
Through this experience, the imbalanced stress and pressure put on women regarding fertility is highlighted. As our interviewee explained, “This makes me feel that the presupposed notion is that there’s always something wrong on the woman’s side. Because while I was doing everything to get pregnant as quickly as possible - a simple, painless, and noninvasive exam to provide answers about my partner’s fertility seemed so difficult to get. I get so mad imagining how this must make other women feel, believing it’s their fault they can’t conceive. Only to later realise it was their partner’s sperm that caused any delay.” This reality reflects the lack of encouragement men receive to be accountable for their fertility and the process of conceiving with their partners.
How inne can help
Whether you are trying to get pregnant or not, using a product like inne allows you to share information about your menstrual health with a partner. It provides both of you the opportunity to better understand how the woman’s hormones are functioning, meaning your partner will feel more involved in the process and decision-making. If you are trying to conceive, inne is there to help increase your chances of pregnancy by timing your all important attempts of conception correctly. Giving you agency over your bodies and levelling the playing field of reproductive responsibility.
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Rupert P. AmannThe Cycle of the Seminiferous Epithelium in Humans: A Need to Revisit?, 02 January 2013, American Society of Andrology, https://doi.org/10.2164/jandrol.107.004655
Trevor G. Cooper, Elizabeth Noonan, Sigrid von Eckardstein, Jacques Auger, H.W. Gordon Baker, Hermann M. Behre, Trine B. Haugen, Thinus Kruger, Christina Wang, Michael T. Mbizvo, Kirsten M. Vogelsong, World Health Organization reference values for human semen characteristics, Human Reproduction Update, Volume 16, Issue 3, May-June 2010, Pages 231–245, https://doi.org/10.1093/humupd/dmp048
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