There is a registry known as the Australian and New Zealand Assisted Reproduction Database (ANZARD). Recently, their 2020 data was released suggesting that one in three cases of infertility were directly as a consequence of problems with the male.
Male infertility is related to having a low sperm count, sperm dysmotility (this is where the sperm are poor swimmers for some reason) or abnormally shaped sperm that typically have some chromosomal abnormalities.
There are many causes for these abnormalities of sperm including relatively uncommon genetic abnormalities, a prior infection such as mumps, testicular trauma or abnormal sperm production such as seen after chemotherapy for cancer. There are also obvious causes of a male’s inability to conceive such as those who have already undergone a vasectomy, failure of ejaculation, poorly timed intercourse and, of course, varying degrees of erectile dysfunction.
There are also hormonal issues such as marked reduction in testosterone or pituitary gland failure along with many chronic illnesses such as obesity, diabetes and drug use, including cigarettes, alcohol or illegal drugs. For example, smoking one joint per week in a male significantly reduces the chance of his partner getting pregnant.
I have seen occasional patients who were commenced early in their life (e.g. twenties) on statin drugs to lower cholesterol, who could not conceive until the statins were ceased.
We have seen the rates of infertility in males increase over the past few decades, possibly because of increasing environmental exposures such as the ubiquitous chemicals found in a variety of household goods, especially plastics, increasing air pollution and potentially an increase in electromagnetic radiation exposure from all of the appliances that we use on a daily basis, although the evidence for the latter is rather tenuous and sketchy.
For men who would like advice as to how to improve their chances of conceiving, there are many interventions that may be of some benefit.
1) For many years I have been discussing the five keys to good health and there is no doubt that men who practice these 5 keys will have a much greater chance of having healthy sperm.
2) Achieving ideal body weight, which is clearly related to the five keys of being healthy specifically improves a couples’ chance of conceiving.
3) There are a variety of supplements on the market which typically contain high quality multivitamins which may be of some benefit but the evidence base around this is not particularly strong. Regardless, these supplements are harmless and may enhance your chance of conceiving.
4) Any male with a history of sexually transmitted diseases may have experienced some damage to their reproductive organs with scarring in the vas deferens & epididymis. These tubes transfer sperm from the testicles into the prostate. Chronic prostatic infections may also be a factor in these cases.
5) Finally and probably most controversially is the modern trend to delay conceiving. If you think of it logically, our bodies were designed physiologically to live for 30 to 40 years, wandering around a jungle with a spear, dying from some infection or having a sabretooth tiger rip off your head.
Young girls would go through puberty in their early teens and conceive within a year or two and their grandmothers in their late 20s would help them look after the child in a very simple “top of the food chain” existence.
These days, it is more the norm than the exception to have a child over the age of 35 and regardless of the social acceptance of this concept, women conceiving beyond this age are at much higher risk for maternal complications and in children conceived to parents over the age of 35 (males & females), there are much higher rates of congenital abnormalities, schizophrenia, autism and ADHD.
The discussion around the world population crisis and pollution is for another time but without wishing to sound trite, if you are serious about having children, my strong medical advice is to “go hard and go early” rather than delaying until well over the age of 35. It is much more difficult to conceive beyond age 35 and if you do there are many more complications and often the need for assisted reproduction in this age group.