How much progress have we actually made?
Male infertility is a really, really important issue — that simply doesn’t get enough recognition
It’s now the most common reason for couples in the UK to have IVF, according to the latest HFEA data.
And we really, really should be paying more attention.
Last year, an apocalyptic study by the Hebrew University of Jerusalem found that sperm counts in the West have more than halved over the past four decades, and are continuing to decline — but we don’t really understand why, or what to do about it.
Despite so many cutting edge advances in assisted reproductive technology, the way we approach male infertility isn’t really that dissimilar to 150 years ago.
Women are routinely undergoing IVF — even if there’s nothing wrong with their own fertility — because their infertile partners are being ignored by the medical profession.
Leading fertility expert Prof Sheena Lewis — chairwoman of the British Andrology Society — says the lack of focus on male infertility within the health system is an “urgent” problem:
Men are not being looked after properly, not diagnosed, and not cared for.
The woman actually acts as the therapy for the man’s problem. We are giving an invasive procedure to a person who doesn’t need it, in order to treat another person. That doesn’t happen in any other branch of medicine.
A couple with a male factor infertility diagnosis will be referred to a fertility clinic, where they will be treated by a gynaecologist. It’s the male partner who has the medical issue — but yet they’re sent to a specialist in women’s reproductive health.
Dr Jonathan Ramsay, a consultant urologist specialising in male fertility sees many couples who’ve undergone multiple rounds of failed IVF, where the underlying pathology was never identified and treated — rendering the treatment utterly futile.
Which sounds rather like the 1945 case mentioned above, where no one had bothered to look at the man’s sperm until 2 years of harrowing treatment down the line.
Dr Ramsay says:
What gynaecologists don’t do is look at the bloke and say, let’s do some old fashioned doctoring with you. Let’s do a few more tests. A physical examination could reveal a varicocele, for example: a varicose vein in the testicle that can overheat the sperm, yet be eliminated by a quick operation under local anaesthetic.
Or it could be that he’s obese and drinking too much. If that guy loses weight, stops drinking and just does sensible exercise, he may well get over the threshold where she gets pregnant. We need to treat the man and the sperm, ignoring half of the picture is just not sensible.
We saw above that varicoceles had been identified as a cause of male factor infertility in a medical text from 1687 — and yet in 2018 a couple may be referred for ICSI without anyone even bothering to examine the man to see if this might be a treatable issue?
How much unnecessary time, money and heartache might be saved if men were actually acknowledged as more than the sperm donor?
They deserve better. Their partners deserve better. We might have moved on from peeing on lettuce leaves in 2018, but in many ways we haven’t really moved on at all.