In couples with fertility problems, it is thought that approximately one third could be attributed to the male partner, one third to the female partner and one third to a combination of both partners.

For men, the most common problem is not just how many sperm there are, but the quality of the sperm. In other words, are they strong, normal and fit enough to reach and penetrate a ripe egg? Both sperm quality and quantity can be affected by lifestyle factors, such as poor diet, stress, smoking and alcohol. Your partner should also avoid hot baths, tight underpants, exposure to traffic fumes and long hours sitting and driving because studies have shown that all these factors can have a negative effect on sperm quality and quantity. It is interesting to consider the following:

Sperm counts have dropped by 50% over the last ten years.

Men are showing increasing numbers of sperm abnormalities

1 in 4 women miscarry – although it is the woman who miscarries it is important that her partner is also investigated because a miscarriage will also occur if the sperm in not as good as it could be. The most common cause of miscarriage or repeated implantation failure is chromosomal abnormality of that pregnancy (not an inherited genetic problem) and the miscarriage is simply the body’s way of rejecting a foetus that is not viable (nature’s survival of the fittest) and that can be caused by problems with the sperm.

It typically takes at least three months for sperm cells to mature, ready to be ejaculated and that’s why it is vital for your partner to put healthy diet and lifestyle changes into place at least three months before trying to conceive. In order to successfully impregnate a woman, a man must first produce sperm that is capable of reaching the egg and then fertilising it. For this to happen sperm must be produced in sufficient quantities and of good enough quality and if a man’s sperm is abnormal or unhealthy in any way this can affect a couple’s fertility.

One thing that has become evident to me over the years is that more and more men are coming to me with fertility problems and this simply confirms what research is already indicating; that sperm counts are falling. Some experts believe that there is a strong link between declining sperm counts and environmental toxins like xenoestrogens. Some toxins cause free radical damage and can be responsible for larger numbers of abnormal sperm and even DNA damage within the sperm.  (Free radicals are controlled by anti-oxidants, so that’s why I always urge men with abnormal sperm readings to take an antioxidant supplement as can give them the chance of producing more normal sperm.)

One of the most important nutrients for male fertility is zinc.  This mineral is needed for the production of sperm and the male hormones; several prominent research studies have found that the male sex glands and sperm contain high concentrations of zinc. Modern diets tend to be low in zinc and stress, pollution, smoking and alcohol all deplete the body’s levels further. Zinc rich foods include fish, sardines, eggs, whole grains, brown rice and nuts. Vitamin C has been shown to reduce the tendency of sperm to clump together (agglutination),  a common factor in infertility. Citrus fruits, strawberries and peppers are great sources of vitamin C and should be included in the five portions of fruits and vegetables a day.

Research has shown that men with infertility problems consume less omega 3 fatty acids than fertile men. One fatty acid component in particular, alpha linolenic acid, has been shown to have a significant effect on sperm quality and researchers advise men attending fertility clinics to supplement with omega 3 in the belief it will increase low levels of fertility by making the sperm more resistant to potential damage resulting from the chilling and freezing processes involved in assisted reproduction techniques. Good food sources of omega 3 are fish oils, nuts and seeds.

Caffeine has an affect on male fertility.  Studies indicate that problems with sperm health seem to increase the more cups of coffee men drink a day. This may be because caffeine has a diuretic effect and this can deplete the body of vital fertility boosting nutrients such as zinc and calcium.

If your partner has weight to lose encourage him to lose it too. Being overweight can affect male fertility and reduce the quality and quantity of his sperm count. Both overweight and obese men have reduced fertility and obese men have decreased sperm quality.  Obviously when both the man and woman are overweight this can give a combined effect on fertility but interestingly in one Danish study there were problems even if only the male partner was underweight.  Another article suggests that being obese can raise a man’s infertility by more than a third. A study of more than 25,000 couples found that men classed as clinically obese were 36 per cent more likely to be infertile than men of normal weight. Those who were classed as overweight were 20 per cent more likely to be infertile. The finding held true even when the researchers took into account other factors that affect fertility, such as age and smoking habits. The researchers believe that obesity may affect fertility by lowering levels of testosterone in men.

For many years it has been thought that age only mattered with women when it came to fertility but we now that it is a different story and the age of man does count too. 

Although everybody talks about women’s fertility and the changes with age, very little is said about the change in male fertility as they get older.  Men do have a biological clock and it starts ticking around the age of 35.  Research has shown that with men over the age of 35 the count is lower and the sperm are less motile and that the risk of miscarriage is increased in women whose partners are over the age of 35.

The other finding is that over the age of 35, a man’s body is less capable of seeking out and destroying damaged sperm resulting in sperm with more DNA damage.  This means that either there is less chance of getting pregnant or could lead to a miscarriage or birth defects. 

We know that a high level of DNA fragmentation in sperm can be a cause of male infertility, with this increasing as the man gets older.  But DNA fragmentation cannot be detected using a normal semen analysis.  Having a high level of fragmentation could well be a crucial factor in unexplained infertility, low fertilization rates in IVF, poor embryo quality, implantation failure after IVF and recurrent miscarriage.  It is also important for men over the age of 35-40 to be tested for DNA fragmentation of sperm even if they have had children before because research has shown that couples are much more likely to achieve a successful pregnancy either naturally or through assisted conception if DNA fragmentation is less than 30%. 

So is it possible to reduce a high level of DNA fragmentation? 

DNA fragmentation can be caused by exposure to toxins, such as smoking, or chemicals from either the environment or from the diet, so this means that by making changes in diet and lifestyle it is possible to reduce a high level of DNA fragmentation.

It takes almost three months for sperm to be produced so if a toxin hits the sperm during that period of development then DNA damage can happen.  It is particularly important then for men to eliminate smoking, alcohol, hot baths, saunas and additives, preservatives and artificial sweeteners in foods when trying to conceive anyway but more important when aiming to reduce a high DNA fragmentation level.  Their diet should be as healthy as possible with good levels of fruit and vegetables and to buy organic food for two reasons.  It is more likely that the food will contain higher levels of valuable minerals like zinc and selenium but more crucially with respect to DNA fragmentation, this will reduce exposure to pesticides and herbicides, possible toxins to the sperm, which are sprayed on the crops.

Another important factor in DNA fragmentation is body weight.  We know that when BMI (Body Mass Index) is over 25 (classed as overweight) fragmentation rises and becomes even more of a problem when the BMI is over 30 (classed as obese).

As well as changes in diet and lifestyle, another way to help lower sperm fragmentation is to increase antioxidant intake.  Antioxidants are powerful substances that are known to protect against DNA damage by protecting the body against toxins and pollutants.  Selenium, zinc, vitamins A, C and E are all antioxidants are generally contained in brightly coloured fruit and vegetables (e.g. carrots, pumpkins, broccoli, berries, beetroot, and tomatoes) and also in oily fish, nuts and seeds.  But I would suggest that if your partner has been told he has a high DNA sperm fragmentation that these nutrients are also taken in supplement form in order to help reduce the fragmentation level as quickly as possible.  One study in 2005 looked at men with more than 15% DNA fragmentation.  They were given 1000 mg vitamin C and 1000 mg vitamin E for two months after having one failed ICSI attempt.  76% of the men had a decrease in the percentage of DNA fragmentation and a second ICSI was performed.  There was a staggering difference in the number of pregnancies (48.2% compared to 6.9%) on this second ICSI treatment and implantation rates went from 2.2% to 19.6

So although chronological age is important for male fertility it is not the only factor effecting sperm quality.  Men produce sperm all their lives so it is possible to improve the quality and quantity of sperm by making healthy lifestyle and nutritional changes. 

Apart from effecting erectile function, smoking can also have a negative effect directly on sperm affecting all the main semen factors measured including count, motility and normality.  Researchers have found that men who smoke have lower levels of vitamin C in their semen but was even more interesting was men with normal semen analysis (non-smokers and smokers) all had significantly higher levels of vitamin C than men with low sperm counts and/or low motility and/or abnormal sperm. 

Smoking also has a negative effect on the head of the sperm making it harder to fertilise an egg.  Researchers from theUniversityofBuffaloin theUSstudied men who had smoked at least four cigarettes a day for more than two years and compared them with non-smokers.  They used the zona pellucida, the shell surrounding the egg, and placed half of the shell with smoker’s sperm and the other half with non-smoker’s sperm.  They then looked to see how many of the sperm were attached tightly after several hours.  They found that the sperm of two thirds of the smokers failed the test. Those who did fail were 75% less fertile than non-smokers.  It is thought that nicotine overloads the receptors on sperm and this affects their ability to bind to the egg.

Smoking affects all the factors relating to sperm including sperm count, motility and morphology (whether the sperm are a normal shape or not) and this is thought to be due to high level of cadmium which is heavy toxic metal from tobacco.

But smoking can bring other problems when trying to conceive because it can lead to impotence.  Cigarette smoking causes damage to the blood vessels that supply the penis which alters blood flow and affects circulation.  The title of one medical study was aptly called ‘A cigarette after sex, or instead of it.’ 

Alcohol can affect the head of sperm making them more abnormal and of course the head of the sperm is critical for fertilization of the egg.

 A man can wipe out his sperm count for several months after a drinking session. This is because alcohol reduces the level of vital sperm making hormones and because of this it makes sense for a man to stop drinking for at least three months before trying to get his partner pregnant.

Stress can affect male fertility too by raising the level of stress hormones and this can interfere with the hormones controlling sperm production.  Research has shown that men under stress at work or home are more likely to have poor sperm quality. One study of 157 men conducted by the University of California in showed that a very depressing experience, like the loss of a loved one can temporary reduce a man’s sperm count. Other research shows that stress or unhappiness can lower sperm count and make the sperm that are left move badly and even cause sperm cell abnormalities. Stress has also been shown to have an impact on the quality of sperm of men in couples undergoing the roller-coaster of stress that often goes hand in hand with IVF.

Article appeared in Grazia September 2010