A belated Happy Father’s Day to all fathers around the world!
This day celebrates the dedication and effort that you have silently put in even before you embraced fatherhood.
Couples who have endured through the challenges of infertility, especially the male partner, would truly understand the statement above.
Yes, the effort towards parenthood actually starts even before pregnancy.
Nearly half of all fertility treatments, especially in-vitro fertilisation (IVF), are due to male infertility.
Many seemingly healthy men get confused and wonder what went wrong when they discover this problem.
The male fertility rate has been declining over the past 50 years, and the trend does not seem to be showing any signs of improvement.
There are multiple lifestyle factors that can affect a man’s fertility.
Here are the relevant issues men should watch out for.
Obesity
Obese men are more likely to have lower sperm count and quality.
In extreme cases, they can suffer from azoospermia (no sperm cells in the ejaculate).
In fact, obesity in the male partner lowers the chances of conceiving via IVF as a couple.
So, the solution is weight reduction.
However, take note that even after significant weight loss, there may still be mixed results when measuring one’s semen quality.
Of course, in most men who lose significant weight, there will be an improvement in semen quality, but this does not necessarily happen for all obese men.
From my clinical experience, I do see improvement in male fertility when the man achieves significant weight loss, especially those with azoospermia.
Any slightest improvement in male fertility will go a long way towards helping the couple succeed in their fertility journey.
Diet
Have you heard of the saying, “You are what you eat”?
It is quite true when it comes to male fertility.
Processed meat, full-fat dairy products, alcohol, coffee and sugar-sweetened beverages are all associated with poor sperm quality.
It is recommended to eat more vegetables, fruits, fish, poultry, cereals and low-fat dairy products to improve sperm quality.
Vitamins
Many of you might be taking vitamin C supplements.
Vitamin intake has been promoted so widely that they have become a regular supplement to our daily diet.
But do vitamins improve male fertility?
Vitamins, or more precisely, antioxidants, have been suggested as a method to improve sperm quality because it reduces damage to sperm cells from oxidative stress.
Yes, your sperms are susceptible to stress too.
This oxidative stress is self-induced in the majority of men as a direct consequence of smoking, excessive alcohol intake and exposure to pollution.
Psychological stress can also induce oxidative stress through the formation of more reactive oxygen species (ROS).
There are many anti-oxidant supplements available on the market, such as zinc, coenzyme Q10, carnitine, vitamin E and so on.
A 2019 evidence-based medical review article suggested that antioxidant use in male sub-fertility may improve clinical pregnancy and live birth rate.
Overall, the level of evidence is still low to substantially support the usage of antioxidants.
However, in daily clinical practice, antioxidant supplements are widely recommended for both women and men.
Smoking and vaping
It has been known for many years that smoking negatively affects one’s chances of conceiving, even though the exact mechanism of how this happens is not well understood.
Smoking has been shown to disrupt DNA (deoxyribonucleic acid) integrity in sperm and affects testosterone levels in men.
A sperm that may look normal externally, but has defective DNA, may not be able to fertilise an egg, or worse, contributes to the formation of an abnormal embryo that leads to increased risk of a miscarriage.
So, it’s important to note that miscarriage is not a female-only issue; male fertility also plays a role in causing a miscarriage.
Available evidence suggests that there is a significant benefit in stopping smoking if you are trying to conceive a child.
Every additional year following the male partner’s cessation of smoking reduces the risk of fertility treatment failure by 4%.
And what about vaping?
Generally, vaping is viewed as less harmful than smoking.
However, animal studies show that vaping also has a detrimental effect on sperm production, and can lead to oxidative stress.
Therefore, the advice to stop smoking should also be taken to refer to the habit of vaping.
Alcohol
Alcohol consumption has been associated with reduced semen volume.
Its effect on sperm parameters is dose-dependent, meaning the more you drink, the more likely it is for your sperm to be abnormal.
Sperm count, sperm movement and the percentage of normally- shaped sperms are all reduced in men with heavy and chronic alcohol consumption.
However, there is no evidence that occasional alcohol intake has similar negative effects.
Caffeine
You might be wondering why caffeine made it into this list.
While sperm quality appears to be unaffected in most studies related to caffeine intake, caffeine-containing soft drinks appear to have negative effects on semen volume, sperm count and sperm concentration.
This is as caffeine intake may be associated with DNA damage in sperm.
So, unsurprisingly, some studies show that the male partner’s caffeine consumption is associated with a longer time to achieve pregnancy.
Stress
This is a word linked with most of the couples facing temporary obstacles in conceiving.
Psychological stress can lower sperm concentration and sperm movement, as well as increase the percentage of abnormal sperm.
This is due to the suppression of testosterone by raised levels of stress hormones known as corticosteroids.
Some may rely on medications to control their stress level.
However, antidepressant medication also has a negative effect on sexual function and semen quality.
Alternatively, men can try non-pharmacological methods such as behavioural therapy, psychotherapy, and fertility counselling and support, to help manage their stress.
Sleep
Disturbances in sleep is prevalent and is becoming more common now in the era of social media.
Personally, I feel that we sometimes “live” more on social media platforms than in reality.
Sleep disturbance is closely associated with psychological stress and has a profound effect on sperm quality.
Inadequate sleep and irregular sleep patterns throw off a normal testosterone secretion pattern, which directly affects sperm production.
An abnormal testosterone secretion pattern also affects men’s libido and leads to sexual dysfunction.
Testosterone secretion follows a diurnal pattern, with a rise in testosterone coinciding with the REM (rapid eye movement) stage of sleep.
You reach REM-stage sleep approximately 90 minutes after you fall asleep.
During your sleep, you cycle between REM and non-REM stages.
The initial REM sleep stage lasts about 10 minutes and subsequent REM sleep stages are longer.
Thus, a shorter and disturbed sleep pattern affects your REM sleep stage and negatively affects testosterone production.
Some advice to all men: no matter how busy your schedule can be, please do take some time to have a good night’s sleep.
For those thinking of having a child, do consider the above eight factors in your quest to improve your overall fertility.
Changes do not happen in a day; they take time.
Remember, change is hard in the beginning, messy in the middle, and gorgeous in the end.
I wish you all the best on your journey to fatherhood; may you have a little bundle of joy to hold in your hands next Father’s Day.
Dr Agilan Arjunan is an obstetrician and gynaecologist, and fertility specialist. For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
Credit to: https://www.thestar.com.my/lifestyle/health/2022/06/29/8-lifestyle-factors-that-decrease-a-man039s-fertility